Oxygenation, Ventilation and Hemodynamic Changes during Diagnostic Pelvic Laparoscopy in Siriraj Hospital

Abstract

During laparoscopic procedure, an alteration in hemodynamic and pulmonary mechanic was noted. An appropriate anesthetic technique is still under debate in term of safety and low cost benefit ratio. Thirty five female patients undergoing diagnostic pelvic laparoscopy in Siriraj Hospital for gynaecologic reasons were investigated. Laparoscopy was done under local anaesthetic technique and supplemented with systemic sedation and analgesia. Hemodynamic (MAP, PR, ECG), oxygenation and ventilation (Spo, EtCO, ABG) changes at baseline control, post sedation, post CO, insufflation, post CO, exsufflation and postoperative periods were compared. Hemodynamic changes were not significant difference. Pulse oxygen saturation (Spo) and arterial 0, tension decreased significantly at post sedation period. Six patients had 0, saturation less than 95 per cent and three less than 92 per cent. An increase in end tidal CO, (EtCO,) was observed at post sedation and postoperative periods. Three patients had EtCo, more than 50 mmHg. Although diagnostic pelvic laparoscopy is classified as a minor procedure, oxygen ation and ventilation changes could be anticipated due to the effect of posture and pneumoperitoneum with CO, gas. Local anaesthetic technique with conscious sedation has an advantage over general anaesthesia because of low cost and simplicity of the technique. Nevertheless on the safe side, simple 0, supplement, hemodynamic and respiratory monitoring are recommended to avoid a decrease in oxygenation and a prompt response to any abnormalities. (Thai J Obstet Gynaecol 1995;7:135-141)