Effect of Different Levels of Positive End-Expiratory Pressure (PEEP) on Respiratory Status during Gynecologic Laparoscopy

Simin Atashkhoei; Negin Yavari; Mahsa Zarrintan; Eisa Bilejani; Sina Zarrintan

doi:10.5812/aapm.100075

Effect of Different Levels of Positive End-Expiratory Pressure (PEEP) on Respiratory Status during Gynecologic Laparoscopy

Anesth Pain Med. 2020 Apr 18;10(2):e100075. doi: 10.5812/aapm.100075. eCollection 2020 Apr.

Authors

Simin Atashkhoei¹, Negin Yavari², Mahsa Zarrintan¹, Eisa Bilejani¹, Sina Zarrintan³

Affiliations

¹ Department of Anesthesia, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
² Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Division of Vascular and Endovascular Surgery, Department of General & Vascular Surgery, Shohada-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: During gynecologic laparoscopy, pneumoperitoneum, and the position of the patient's head can lead to pathophysiologic changes in cardiovascular and respiratory systems, complicating the management of anesthesia in these patients. One of the strategies for improving the respiratory status of patients undergoing laparoscopy is the use of Positive End-Expiratory Pressure (PEEP).

Objectives: This study aimed to evaluate the effect of different levels of PEEP on the respiratory status of patients undergoing gynecologic laparoscopy.

Methods: In this clinical trial, 60 patients with ASA I were randomly assigned to three groups to control anesthesia: ZEEP (PEEP 0 cmH₂O; 20 cases), PEEP₅ (PEEP 5 cmH₂O; 20 cases), and PEEP₁₀ (PEEP 10 cmH₂O; 20 cases). Respiratory and hemodynamic variables of patients were compared before general anesthetic induction and immediately after CO₂ insufflation at intervals of 5, 10, 20, 30, and 60 min and the end of the operation in the three study groups.

Results: The PEEP application improved pH, PaCO₂, and PaO₂ levels at the end of pneumoperitoneum compared to baseline when compared with the non-use of PEEP (ZEEP group). Also, the frequency of dysrhythmia in the use of PEEP in controlled ventilation was significantly lower in patients with PEEP₁₀ (P < 0.05). The application of PEEP₅ resulted in similar effects to PEEP₁₀ in the levels of respiratory variables.

Conclusions: The PEEP application is associated with improved arterial blood gas in patients with gynecologic laparoscopy. The use of PEEP₁₀ has a greater effect on the improvement of respiratory parameters and complications of pneumoperitoneum.

Keywords: Laparoscopy; Pneumoperitoneum; Positive End-Expiratory Pressure; Respiratory Status.