Laparoscopic cholecystectomy and permissive hypercapnic ventilation anesthesia: prospective, randomized study

Abstract

Background. Hipercapnic ventilation during general anesthesia was a disputed topic for researchers during last ten years. However there were observed potential beneficial effects of induced mild hypercapnia during the anesthesia on intraoperative and postoperative outcome: lower necessity in opioids, reducing the rate of wound infections,, accelerated wound healing. AIM. Estimation of the effects of intraoperative induced mild hypercapnia (ETCO2=45-50 mmHg), on postoperative recovery after laparoscopic colecistectomy. Materials and methods. Prospective randomized study (normocapnic lot, n=42; hypercapnic lot, n=58), written informed consent. Positive agreement of Ethics Committee. Anesthesia: induction – propofol, fentanyl, maintenance – sevofluran, relaxants – tracrium. Statistics: t-Student, Fisher exact test, Mantel-Cox test and ANOVA. Results. Similar lots in terms of age, BMI, ASA, surgery and hospitalization period. Hypercapnic lot vs. normocapnic lot: length of awakening from anesthesia – median, 15 vs. 20 min (χ2=12,6; p<0,0001); postoperative ileus period – median, 28 vs. 30 hours (χ2=10,8; p=0,001); PONV risk, in favor of hypercapnic lot – OR=0,50 (95CI=0,24-1,05), p=0.0695. Neurocognitive tests (DCT, DSST, Wechsler, Stroop), similar resuls for both lots and for the pre and postoperative periods. Study limits: reduced sample, short period of surgery, mild hypercapnia. Conclusions: The results of our research show a reduced period of awake after anesthesia, also a reduced period of ileus, and a minimized PONV risk, after laparoscopic cholecystectomy with induced mild hipercapnia with no hemodinamic and neurocognitive side effects.