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Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position
Author(s) -
Takahata O.,
Kunisawa T.,
Nagashima M.,
Mamiya K.,
Sakurai K.,
Fujita S.,
Fujimoto K.,
Iwasaki H.
Publication year - 2007
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01311.x
Subject(s) - medicine , insufflation , pneumoperitoneum , lithotomy position , anesthesia , trendelenburg , trendelenburg position , laparoscopy , tidal volume , peak inspiratory pressure , respiratory minute volume , surgery , respiratory system , alternative medicine , pathology
Background: Physiological changes in respiratory mechanics caused by aging may lead to a deterioration in pulmonary gas exchange, an increase in the alveolar–arterial oxygen gradient [(A–a) D o 2 ] and a difference between the arterial carbon dioxide (CO 2 ) tension ( P a co 2 ) and expired end‐tidal CO 2 tension ( P ET co 2 ) [ P (a–ET) co 2 ] during laparoscopy in the Trendelenburg lithotomy position (TLP). Methods: The subjects were 51 gynecologic patients. Pressure‐controlled ventilation was used to maintain P ET co 2 , measured by the side stream method, within the range 4–4.67 kPa. During laparoscopy with CO 2 insufflation in TLP, the tidal volume was increased to keep P ET co 2 within ± 20% of the pre‐insufflation value. The subjects were divided into three groups by age: young group (< 45 years); middle‐aged group (45–64 years); and elderly group (≥ 65 years). Results: Before pneumoperitoneum (PPN), significant differences were found between the young and elderly groups in the arterial oxygen tension ( P a o 2 ), (A–a) D o 2 , P a co 2 and P (a–ET) co 2 . In all groups, the peak inspiratory pressure and P a co 2 increased progressively during PPN in TLP. P (a–ET) co 2 increased gradually after starting CO 2 insufflation in TLP only in the elderly group. Conclusions: An increase in P (a–ET) co 2 was seen during PPN in TLP in the elderly group. With CO 2 insufflation in TLP, the setting of mechanical ventilation based on the value of P ET co 2 (measured by the side stream method) should be determined with caution in elderly patients.