Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial

Yılmaz, Hakan; Kazbek, Baturay Kansu; Köksoy, Ülkü Ceren; Gül, Ahmet Murat; Ekmekçi, Perihan; Sinem Çağlar, Gamze; Tüzüner, Filiz

doi:10.1016/j.bjane.2021.04.028

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Brazilian Journal of Anesthesiology

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ORIGINAL INVESTIGATION • para Braz. J. Anesthesiol. 72 (01) • Jan-Feb 2022 • https://doi.org/10.1016/j.bjane.2021.04.028 copy

Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purpose:

To compare hemodynamic effects of two different modes of ventilation (volumecontrolled and pressure-controlled volume guaranteed) in patients undergoing laparoscopic gynecology surgeries with exaggerated Trendelenburg position.

Methods:

Thirty patients undergoing laparoscopic gynecology operations were ventilated using either volume-controlled (Group VC) or pressure-controlled volume guaranteed mode (Group PCVG) (n = 15 for both groups). Hemodynamic variables were measured using Pressure Recording Analytical Method by radial artery cannulation in addition to peak and mean airway pressures and expired tidal volume.

Results:

The only remarkable finding was a more stable cardiac index in Group PCVG, where other hemodynamic parameters were similar. Expired tidal volume increased in Group VC while peak airway pressure was lower in Group PCVG.

Conclusion:

PCV-VG causes less hemodynamic perturbations as measured by Pressure Recording Analytical Method (PRAM) and allows better intraoperative hemodynamic control in exaggerated Trendelenburg position in laparoscopic surgery.

KEYWORDS
Laparoscopic surgery; Mechanical ventilation; Hemodynamic monitoring

	Group PCVG (n = 15)	Group VC (n = 15)	p
Age (yr)	32.7 ± 6.5	29.7 ± 5.9	0.190
Weight (kg)	78 ± 15.6	78.3 ± 10.4	0.956
Height (m)	161.2 ± 8.1	162.6 ± 7.6	0.628
BMI (kg.m^-2)	26.6 ± 5.1	24.6 ± 2.7	0.204
Duration of anesthesia (min)	88.3 ± 14.6	88 ± 13.9	0.949
Duration of surgery (min)	76 ± 15.7	74.7 ± 14.1	0.808
Duration of pneumoperitoneum (min)	64.3 ± 15	64 ± 12.4	0.948

Variable	Group	Ti	T0	T1	T3	T5	T10	T30	Tdef	Tdef5	p
HR (bpm)	PCVG	75 ± 9	79 ± 9	82 ± 8	75 ± 10	78 ± 8	77 ± 10	76 ± 8	80 ± 10	83 ± 9	0.093
HR (bpm)	VC	86 ± 14	80 ± 15	79 ± 13	78 ± 15	83 ± 10	86 ± 13	85 ± 14	82 ± 9	81 ± 10	0.093
MAP (mmHg)	PCVG	77 ± 13	78 ± 8	77 ± 11	78 ± 11	76 ± 11	77 ± 11	78 ± 11	76 ± 10	76 ± 11	0.916
MAP (mmHg)	VC	77 ± 16	78 ± 14	76 ± 14	74 ± 12	74 ± 11	77 ± 13	78 ± 11	75 ± 13	77 ± 18	0.916
SVRI dyne.s.m^-2.cm^-5	PCVG	2687 ± 288	2484 ± 244	2548 ± 364	2530 ± 246^a a p < 0.05 between groups at the same time points.	2454 ± 184^a a p < 0.05 between groups at the same time points.	2566 ± 172	2464 ± 245^b b p < 0.05 compared with anesthesia induction (Ti).	2499 ± 246	2506 ± 257	0.317
SVRI dyne.s.m^-2.cm^-5	VC	2669 ± 418	2675 ± 417	2799 ± 541	2852 ± 453	2770 ± 474	2784 ± 597	2668 ± 316	2558 ± 349	2542 ± 527	0.317
SVI mL.m^-2	PCVG	35 ± 9	34.2 ± 7.5^a a p < 0.05 between groups at the same time points.	38.2 ± 7.8	37.6 ± 5.9	34.1 ± 7.7	37.3 ± 9.7	38.9 ± 7.9	39.3 ± 7.7^a a p < 0.05 between groups at the same time points.	37.5 ± 8.6	0.438
SVI mL.m^-2	VC	30.7 ± 10	24.6 ± 5.8^b b p < 0.05 compared with anesthesia induction (Ti).	31.3 ± 7.1^c c p < 0.05 compared with peritoneal insufflation (T0).	32.4 ± 9.2^c c p < 0.05 compared with peritoneal insufflation (T0).	32.8 ± 8.8^c c p < 0.05 compared with peritoneal insufflation (T0).	33.7 ± 8.9^c c p < 0.05 compared with peritoneal insufflation (T0).	34.7 ± 9.1^c c p < 0.05 compared with peritoneal insufflation (T0).	30.1 ± 8.5^c c p < 0.05 compared with peritoneal insufflation (T0).	32.2 ± 8.3^c c p < 0.05 compared with peritoneal insufflation (T0).	0.438
CI L.min^-1.m^-2	PCVG	2.56 ± 0.32	2.61 ± 0.22	2.77 ± 0.30	2.75 ± 0.28	2.79 ± 0.31	2.65 ± 0.26	2.69 ± 0.29	2.60 ± 0.28	2.65 ± 0.21	0.025
CI L.min^-1.m^-2	VC	2.73 ± 0.48	2.86 ± 0.51	2.58 ± 0.45	2.55 ± 0.54	2.62 ± 0.46	2.92 ± 0.69	2.88 ± 0.49	2.64 ± 0.43	2.80 ± 0.57	0.025
SVV (%)	PCVG	24 ± 21	23 ± 23	23 ± 17	17 ± 8	18 ± 9	19 ± 12	21 ± 18	19 ± 10	19 ± 15	0.144
SVV (%)	VC	23 ± 9	21 ± 9^b b p < 0.05 compared with anesthesia induction (Ti).	18 ± 8^b b p < 0.05 compared with anesthesia induction (Ti).	20 ± 8	23 ± 19	32 ± 25	22 ± 11	20 ± 6	18 ± 7^b b p < 0.05 compared with anesthesia induction (Ti).	0.144
dP/dt mmHg.s^-1	PCVG	0.57 ± 0.24	0.55 ± 0.37	0.49 ± 0.34	0.62 ± 0.28	0.62 ± 0.27	0.72 ± 0.25^c c p < 0.05 compared with peritoneal insufflation (T0).	0.60 ± 0.35	0.60 ± 0.32	0.68 ± 0.33	0.347
dP/dt mmHg.s^-1	VC	0.51 ± 0.28	0.35 ± 0.27	0.57 ± 0.35	0.58 ± 0.28^c c p < 0.05 compared with peritoneal insufflation (T0).	0.48 ± 0.34	0.61 ± 0.29^c c p < 0.05 compared with peritoneal insufflation (T0).	0.54 ± 0.29	0.73 ± 0.26b, c	0.62 ± 0.26^c c p < 0.05 compared with peritoneal insufflation (T0).	0.347
CCE	PCVG	0.154 ± 0.79	0.171 ± 0.83	0.169 ± 0.72	0.169 ± 0.71	0.072 ± 0.66	0.084 ± 0.69	0.164 ± 0.81	0.265 ± 0.43	0.305 ± 0.48	0.554
CCE	VC	0.039 ± 0.56	-0.131 ± 0.59	0.010 ± 0.52	-0.117 ± 0.66	-0.104 ± 0.47	0.140 ± 0.46	-0.081 ± 0.38	0.238 ± 0.49	-0.041 ± 0.55	0.554

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail: bkkazbek@gmail.com (B.K. Kazbek).