Effect of Hyperventilation Prior to CO2 Insufflation in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract Background: Carbon dioxide (CO 2 ) insufflation during laparoscopic surgery may result in hemodynamic and ventilatory side effects, due to hypercarbia and elevated intra-abdominal pressure. Several techniques have been developed and evaluated to reduce these adverse effects. Aim: The aim of the study was to compare hemodynamic changes after controlled hyperventilation prior to CO 2 insufflation during laparoscopic cholecystectomy. Methods: Thirty patients scheduled for laparoscopic cholecystectomy were randomly divided into two groups. Group 1 patients were ventilated with a tidal volume (TV) of 8 mL/kg, 15 min before CO 2 insufflation. The respiratory rate (RR) was adjusted to maintain an end-tidal CO 2 (EtCO 2 ) of 31–35 mmHg. In Group 2 patients, the lungs were ventilated with a TV of 8 mL/kg 15 min before CO 2 insufflation. The RR was adjusted to maintain an EtCO 2 of 36–40 mmHg. Hemodynamic parameters were compared between the two groups. Results: It was observed that the mean value of mean arterial pressure (MAP) was higher in group 2 (94.80 ± 6.372, 89.87 ± 4.779) in comparison to group 1 (87.07 ± 4.818, 86.27 ± 4.217) at 5 min and 10 min after insufflation. The differences were statistically significant ( P = 0.001 and P = 0.037, respectively). There was a statistically significant difference in the mean heart rate at 5 min after insufflation in group 1 (73.80 ± 6.483) and group 2 (82.00 ± 8.375) ( P = 0.006). Conclusion: Hyperventilation before CO 2 insufflation is a simple and effective measure for decreasing the effect of pneumoperitoneum. It can be used in limited-resource settings.