TO ASSESS EFFECTS OF PNEUMOPERITONEUM ON VENTILATORY MECHANICS AND HEMODYNAMICS DURING LAPAROSCOPIC CHOLECYSTECTOMY IN OBESE AND NON-OBESE PATIENTS

Aim: The aim of the study was to assess effects of pneumoperitoneum on ventilatory mechanics and hemodynamic during laparoscopic cholecystectomy in obese and non-obese patients

Method: A total of 100 patients were divided into two groups of 50 each. Obese (O) group consisted of 50 patients with BMI>30 kg/m2 and non-obese (NO) group consisted of 50 patients with BMI<30 kg/m2. Anaesthesia protocol was kept uniform in both the groups. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (EtCO2), perfusion index (PI), peak (PPEAK), plateau (PPLAT) and driving (PDRIVING) pressures, static (CST) and dynamic (CDYN) lung compliances were measured at baseline and at sequential time intervals following induction of anaesthesia, insufflation, desufflation and before extubation.

Results: On induction of anaesthesia, a decrease in HR was observed in non-obese patients whereas an increase was observed in obese patients though statistically non-significant (p>0.05). A higher SBP, DBP and MAP was observed following insufflation, after desufflation and before extubation in the obese patients but was non-significant . The PI value was high in obese patients though non-significant. Also, EtCO2 values remained minimally elevated in obese patients but were statistically insignificant. PPEAK, PPLAT as well as PDRIVING remained high in obese individuals following insufflation, after desufflation, and before extubation and were significant (p<0.05). CST and CDYN remained low in obese patients following insufflation, after desufflation, and before extubation and were statistically significant (p<0.05).

Conclusion: Obese patients undergoing LC have slightly higher hemodynamic variations than non-obese patients, but non-significant (p>0.05). The respiratory parameters PPEAK, PPLAT and PDRIVING remained elevated whereas CST and CDYN remained low following insufflation, after desufflation, and before extubation in obese patients as compared to non-obese patients and were statistically significant (p<0.05).