Article (Scientific journals)
Pneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure.
Joris, Jean; Chiche, Jean-Daniel; Lamy, Maurice
1995In Anesthesia and Analgesia, 81 (5), p. 993-1000
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Keywords :
Adult; Carbon Dioxide; Female; Fundoplication/adverse effects; Humans; Laparoscopy/adverse effects; Male; Pneumothorax/etiology/therapy; Positive-Pressure Respiration/methods
Abstract :
[en] Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such an event will result in specific pathophysiologic changes, since CO2, under pressure in the abdominal cavity, will pass into the pleural space. The aim of this study was to document the pathophysiologic changes induced by pneumothorax, and to evaluate the benefit of positive end-expiratory pressure (PEEP) to treat pneumothorax. Forty-six ASA physical status I and II patients scheduled for laparoscopic fundoplication were monitored extensively; heart rate, mean arterial pressure, end-tidal CO2 (PETCO2), oxygen saturation of hemoglobin (Spo2), minute ventilation, tidal volume, dynamic total lung thorax compliance, and airway pressures were recorded. In 25 patients, oxygen uptake, CO2 elimination and arterial blood gases were also measured. Pneumothorax was diagnosed in seven patients. It resulted in the following pathophysiologic changes: decrease in total lung thorax compliance, increase in airway pressures, and increase in CO2 absorption. Consequently, PACO2 and PETCO2 also increased. Spo2, however, remained normal. The use of PEEP largely corrected these respiratory changes. None of these pneumothoraces required drainage. These data suggest that pneumothorax is common during laparoscopic fundoplication. Early diagnosis is possible by simultaneous monitoring of PETCO2, total lung thorax compliance, and airway pressures. Finally, treatment with PEEP provides an alternative to chest tube placement when pneumothorax is secondary to passage of peritoneal CO2 into the interpleural space.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Joris, Jean ;  Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Chiche, Jean-Daniel
Lamy, Maurice ;  Centre Hospitalier Universitaire de Liège - CHU > Anesthésie et réanimation
Language :
English
Title :
Pneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure.
Publication date :
1995
Journal title :
Anesthesia and Analgesia
ISSN :
0003-2999
eISSN :
1526-7598
Publisher :
Lippincott Williams & Wilkins, Baltimore, United States - Maryland
Volume :
81
Issue :
5
Pages :
993-1000
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 27 October 2009

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