Hypoxemia during diagnostic laparoscopy: a prospective study

doi:10.1016/S0016-5107(96)70128-1

Gastrointestinal Endoscopy

Volume 44, Issue 2, August 1996, Pages 124-128

https://doi.org/10.1016/S0016-5107(96)70128-1 Get rights and content

Abstract

Background: Laparoscopic liver biopsy can be safely performed using local anesthesia and intravenous sedation, but the frequency of hypoxemia is unknown. Methods: We prospectively studied 68 patients undergoing diagnostic laparoscopy and liver biopsy managed by a standard protocol. Results: The mean duration of laparoscopy was 27 ± 5.53 minutes; the mean dose of diamorphine administered was 6.9 ± 2.7 mg; diazepam, 7.05 ± 3.52 mg. The baseline arterial oxygen saturation was 95.6% ± 2.5% and trough was 85% ± 5.1%. A fall of greater than 4% saturation from the baseline occurred in 64 out of 68 patients (94%). The mean decrease in saturation was 10.1% ± 5.4%. An arterial oxygen saturation of less than 85% was seen in 32 patients (47%). There was no correlation between the fall in oxygen saturation and the dose of diamorphine or diazepam, the duration of procedure, body mass index, hemoglobin, or volume of pneumoperitoneum induced. One-way analysis of the variance failed to show a significant relationship between the degree of oxygen saturation and Child's class, etiology of liver disease, or smoking habit. Conclusions: In this study, we demonstrated that significant desaturation is common in diagnostic laparoscopy with liver biopsy and is likely due to a combination of different pharmacologic and physiologic effects. We recommend continuous monitoring of both arterial oxygen saturation and supplemental oxygen for all patients throughout laparoscopy. (Gastrointest Endosc 1996;44:124-8.)

Section snippets

Study population

Sixty-eight consecutive patients undergoing diagnostic laparoscopy and liver biopsy were studied. Indications for laparoscopy included abnormal liver biochemistry, abnormal radiologic investigations, and assessment of chronic liver disease. Patients with severe cardiorespiratory or cerebrovascular disease were excluded from selection for the procedure.

Laparoscopy

After an overnight fast, all subjects underwent laparoscopy in the recumbant position, breathing room air. Premedication consisted of intravenous

RESULTS

The mean age of the 68 patients (46 men, 22 women) was 50.8 ± 15.4 years. The mean duration of laparoscopy was 27.11 ± 5.53 minutes (from infiltration of local anesthetic to suturing). The mean dose of diamorphine administered was 6.9 ± 2.7 mg; and diazepam, 7.05 ± 3.5 mg (Table 1).

The mean baseline SaO₂ was 95.6% ± 2.5% and the mean trough was 85.5% ± 5.1%. A fall of greater than 4% saturation from the baseline occurred in 64 out of 68 patients (94%); the mean decrease in saturation was

DISCUSSION

Laparoscopic liver biopsy performed with local anaesthesia using intravenous sedation is safe and comfortable for patients and is associated with low morbidity and mortality. There is, however, no uniform consensus regarding the appropriate degree of monitoring of patients required. Knowledge of risk factors for arterial desaturation would help identify groups requiring monitoring and supplemental oxygen during the procedure.

This study demonstrates that a reduction in arterial oxygen saturation

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This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores.
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SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.
Anesthetic complications in urologic surgery
2009, Complications of Urologic Surgery: Expert Consult
Anesthesia for laparoscopy: A review
2006, Journal of Clinical Anesthesia
Laparoscopy is the process of inspecting the abdominal cavity through an endoscope. Carbon dioxide is most universally used to insufflate the abdominal cavity to facilitate the view. However, several pathophysiological changes occur after carbon dioxide pneumoperitoneum and extremes of patient positioning. A thorough understanding of these pathophysiological changes is fundamental for optimal anesthetic care. Because expertise and equipment have improved, laparoscopy has become one of the most common surgical procedures performed on an outpatient basis and to sicker patients, rendering anesthesia for laparoscopy technically difficult and challenging. Careful choice of the anesthetic technique must be tailored to the type of surgery. General anesthesia using balanced anesthesia technique including several intravenous and inhalational agents with the use of muscle relaxants showed a rapid recovery and cardiovascular stability. Peripheral nerve blocks and neuraxial anesthesia were both considered as safe alternative to general anesthesia for outpatient pelvic laparoscopy without associated respiratory depression. Local anesthesia infiltration has shown to be effective and safe in microlaparoscopy for limited and precise gynecologic procedures. However, intravenous sedation is sometimes required. This article considers the pathophysiological changes during laparoscopy using carbon dioxide for intra-abdominal insufflation, outlines various anesthetic techniques of general and regional anesthesia, and discusses recovery and postoperative complications after laparoscopic abdominal surgery.
Pathogenesis of CO<inf>2</inf> pneumoperitoneum-induced metabolic hypoxemia in a rabbit model
2002, Journal of the American Association of Gynecologic Laparoscopists
To investigate the effects of carbon dioxide (CO₂) pneumoperitoneum-induced changes in blood gases, acid-base balance, and oxygen homeostasis in rabbits.
Prospective, randomized, controlled study (Canadian Task Force classification I).
University training and teaching center.
Twenty-six adult female New Zealand white rabbits.
Anesthesia and pneumoperitoneum.
In anesthetized rabbits arterial blood gases, acid-base balance, oxygenation values, and lactate concentrations were assayed during 2 hours. Spontaneous breathing, superficial and optimal ventilation without pneumoperitoneum, and with pneumoperitoneum at low (6 mm Hg) and higher (10 mm Hg) insufflation pressures were compared. The CO₂ pneumoperitoneum profoundly affected blood gases, acid-base balance, and oxygen homeostasis. Carboxemia with increasing end-tidal CO₂ and partial pressure of CO₂ (p< 0.001), acidosis with decreasing pH (p< 0.001), and base deficiency with decreasing actual base excess (p< 0.001), standard base excess and standard bicarbonate and acid excess with increasing hydrogen bicarbonate (p<0.05 and <0.01) were found. Desaturation (p <0.01) with decreasing oxyhemoglobin p <0.05) and hemoglobin oxygen affinity (p <0.01) were also found. Carboxemia with acidosis was more pronounced with higher (p <0.01) than with lower (p >0.05) intraperitoneal pressures, and also with spontaneous breathing (p <0.05) and superficial ventilation (p< 0.001) than with optimal ventilation, resulting in metabolic hypoxemia.
In superficially ventilated and spontaneously breathing rabbits, CO₂ pneumoperitoneum profoundly affected blood gases, acid-base balance, and oxygen homeostasis, resulting in metabolic hypoxemia. With optimal ventilation and low intraperitoneal pressure carboxemia, respiratory acidosis, and changes in oxygen metabolism were minimal.
Comparison of anesthetic methods for microlaparoscopy in women with unexplained infertility
1999, Journal of the American Association of Gynecologic Laparoscopists
Abstract
Study Objective. To evaluate the effectiveness of ketamine compared with fentanyl as analgesia or sedation for microlaparoscopy.
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Setting. University-affiliated hospital.
Patients. Forty-one infertile women.
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Measurements and Main Results. Abnormal findings such as endometriosis and periadnexal adhesions were identified in 24 patients. Ablation, coagulation, and adhesiolysis were easily performed in 14 (82.4%) of 17 women receiving ketamine, but difficulties were encountered in operating on 16 patients receiving fentanyl. Ketamine was administered to 10 patients (47.6%) in the fentanyl group because anxiety and pain were not sufficiently controlled by fentanyl. There were no significant differences in visual analog scale scores and recovery time between groups. On questionnaire, 19 (95%) of 20 patients receiving ketamine indicated they would choose the same anesthesia again if offered, compared with only 4 (19%) of 21 receiving fentanyl (p<0.001).
Conclusion. Microlaparoscopy in infertile women was performed more effectively under sedation with ketaminethan with fentanyl.Supported by a grant from the Japanese Foundation for Research and Promotion of Endoscopy.
Anesthesia for gynecologic laparoscophy
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^☆: From the Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.

^☆☆: Reprint requests: Dr. Geoffrey H. Haydon, Medicine, Royal Infirmary of Edinburgh, 1, Lauriston Place, Edinburgh, U.K.

^★: 37/1/70039

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Hypoxemia during diagnostic laparoscopy: a prospective study☆,☆☆,★

Abstract

Section snippets

Study population

Laparoscopy

RESULTS

DISCUSSION

Br J Anaesth

Gastrointest Endosc

Diagnostic laparoscopy 1992: time for a new look

Endoscopy

Observer error and sampling variability tested in evaluation of hepatitis and cirrhosis by liver biopsy

Am J Dig Dis

Sampling variability of percutaneous liver biopsy

Arch Intern Med

A comparison of accuracy of peritoneoscopy and liver biopsy in the diagnosis of cirrhosis

Gut

Korrelation des laparoskopischen und histologischen befundes bei chronischer hepatitis und zirrhose

Dtsch Med Wochenschr

Reproducibility of liver biopsy diagnosis in relation to the size of specimen

Scand J Gastroenterol

Complications of laparoscopy

Endoscopy

Color atlas of diagnostic laparoscopy

Zwischenfalle und komplikationem der laparoskopie und gezielten leperpulektion

Dtsch Med Wochenschr

Complications of peritoneoscopy: a survey of 1455 examinations

Gastrointest Endosc

Endoscopic complications

JAMA