Cardiorespiratory changes during gynaecological laparoscopy by abdominal wall elevation: comparison with carbon dioxide pneumoperitoneum

We have studied the cardiorespiratory changes produced by abdominal wall elevation (AWE) or carbon dioxide pneumoperitoneum (PN) in 20 women undergoing gynaecological laparoscopy. Arterial pressure, heart rate, lung/chest complicance and blood-gas tensions were measured 10 min after induction of general anaesthesia (T0), 10 min after abdominal distension in the supine position (T1) and 10 min after the Trendelenburg position was assumed (T2). Visual analogue scores for pain were recorded 1 and 6 h after the end of surgery. We found that lung/chest compliance was reduced significantly in group PN at T1 and T2 compared with both T0 and group AWE. Diastolic arterial pressure increased significantly in group PN at T1 and T2 compared with both T0 and group AWE, while it remained unchanged in group AWE. Arterial PCO2 increased significantly only in group PN after pneumoperitoneum, while oxygenation was almost unchanged in both groups. AWE patients had greater abdominal pain 1 h after surgery. Six hours after surgery pain was similar in the two groups. These data indicate that abdominal wall elevation reduced pulmonary compliance less than a pneumoperitoneum in patients undergoing gynaecological laparoscopy.