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International Journal of Recent Trends in Science and Technology, ISSN 2277-2812 E-ISSN: 2249-8109
Volume 15, Issue 2, June 2015 pp 298-304
Efficacy of PCV as compared to VCV in obese patients undergoing laproscopic cholecystectomy
Jyoti Khanna1, Priya2, Ashwani Kumar3, Smriti Gulati4
1Associate Professor, 2PG, 3Lecturer, 4HOD, Department of Anaesthesiology, Government Medical College, Jammu, Jammu & Kashmir, INDIA.
Introduction: Laparoscopic surgery requires the creation of pneumoperitoneum. Pneumoperitoneum decreases thoracopulmonary compliance by 30% to 50% in healthy and obese patients. An elevated intra-abdominal pressure and abdominal expansion shifts the diaphragm upwards. Thus, as the intra-thoracic pressure increases, the abdominal part of the chest wall becomes stiff and expansion of the lung is restricted. This is followed by a significant decrease in pulmonary dynamic compliance and changes in the ventilation and perfusion from increased airway reassure. However, high airway pressures and decreased compliance can be associated with pulmonary barotrauma. Obesity is a well-established risk factor for cholelithiasis for which laparoscopic cholecystectomy is routinely performed. Aims and objectives: To study the efficacy of PCV as compared to VCV in obese patients undergoing laproscopic cholecystectomy. Materials and method: Present study was undertaken to compare the volume controlled mode of ventilation with the pressure controlled mode for providing better oxygenation in obese patients undergoing laparoscopic cholecystectomy. 60 patients as ASA Grade I/II, between the ages of 18-55 years belonging to either sex and posted for laparoscopic cholecystectomy under general anesthesia were divided into two groups of 30 each. Patients in Group V were ventilated with volume controlled mode of ventilation whereas patients in Group P were ventilated with pressure controlled mode of ventilation. In both the groups, patients were intubated with a PVC cuffed endotracheal tube of appropriate size after achieving adequate relaxation with inj. suxamethonium 1.5 mg/kg. They were ventilated with 60% nitrous oxide, 40% oxygen and isoflurane 09.-1%. Muscle relaxation was maintained with Inj. Vecronium Bromide 0.08 mg/kg followed by additional top up doses of 0.02 mg/kg. at the end of surgery, neuromuscular blockade was reversed with Inj. Neostigmine 0.05 mg/kg and Inj. Glycoprrolate 0.01 mg/kl. The patients were extubated after fulfilling the criteria of adequate reversal. Results: Both the groups were comparable in respect to age (yrs), weight (Kg), Height (m), BMI (Kg/m2), sex (F:M) and ASA I/II grading. Both the groups were comparable in respect to duration of surgery (min), duration of anaeshtesia (min), duration of CO2 insufflation (min) and intra-abdominal pressure (mmHg).The difference between ventilation parameters i.e. Respiratory rate (per Min), Tidal Volume (mL), Minute Ventilation (L) and Peak airway pressure (cm H2O) was statistically insignificant 10 and 20 minutes after insufflations of Pneumoperitoneum but it was statistically significant at 30 minutes after Pneumoperitoneum with respiratory rate (per min), Tidal volume (mL), minute ventilation (L), peak airway pressure (mmHg) being significantly less in PCV group (Group P)as compared to VCV group (Group V). The oxygen saturation (SpO2)was comparable in both the groups, preoperatively as well as at 10 minutes after Pneumoperitoneum but it was higher in PCV group (Group P) as compared to VCV group (Group V) at 30 minutes after Pneumoperitoneum i.e. at 30 munities after Pneumoperitoneum the difference in both the groups was statistically significant.Both the groups were statistically comparable to each other in respect to pH, PaO2, (mmHg), PaCO2 (mmHg), )PAO2-PaO2 (mmHg), PaCO2-EtCO2 (mmHg) preoperatively and 10 minutes after the establishment of Pneumoperitoneum but there was statistically significant difference in both the groups in respect to PaO2, (mmHg), PaCO2 (mmHg), )PAO2-PaO2 (mmHg), PaCO2-EtCO2 (mmHg) at 30 minutes after the establishment of Pneumoperitoneum. Conclusion: Thus in the end we conclude that pressure controlled ventilation as a batter option for ventilating obese patients undergoing laparoscopic cholecystectomy.