Diaphragm function is not impaired by pneumoperitoneum after laparoscopy
D. Benhamou, G. Simonneau, T. Poynard, M. Goldman, J. C. Chaput and P. Duroux
Department of Anesthesiology, Universite Paris-Sud, Hopital Antoine-Beclere, Clamart, France.
Open cholecystectomy is known to induce a major restrictive respiratory
syndrome. These respiratory disturbances, although of reduced magnitude,
still persist after laparoscopic cholecystectomy. To determine the role of
pneumoperitoneum per se in the respiratory dysfunction observed after this
procedure, seven patients were studied before and 2 hours after
laparoscopy. This diagnostic procedure avoids the upper midline incision
and the surgical injury of cholecystectomy. Ventilatory performance and
diaphragm function were assessed as follows: (1) during quiet tidal
breathing by obtaining measurements of esophageal, gastric, and
transdiaphragmatic pressures; determining the ratio of gastric pressures to
esophageal pressures; and abdomen-rib cage partitioning of tidal volume
obtained from two differential linear transformers and (2) during maximal
respiratory efforts by obtaining measurements of vital capacity and maximal
transdiaphragmatic pressure during Muller's maneuver and a sniff test.
Although a large residual pneumoperitoneum (assessed as the maximal height
of the suprahepatic space: Hmax = 30.3 +/- 7.8 mm) was observed after
laparoscopy, we did not find any change suggestive of diaphragm
dysfunction. We thus conclude that postoperative residual pneumoperitoneum
per se is unable to explain the diaphragm dysfunction observed after open
or laparoscopic cholecystectomy.
