Cardio-respiratory effects of balancing Positive End Expiratory Pressure with intraabdominal pressures during laparoscopic cholecystectomy

INTERVENTION: Positive End Expiratory Pressures of 5 and 10 cm H20 were applied using the ventilator in the Datex Omheda Anaesthesia Machine. 75 patients were randomly allocated to Group 0PEEP (n=25, PEEP 0), Group 5PEEP (n=25, PEEP 5) and Group 10PEEP (n=25, PEEP 10) according to level of PEEP in whom pneumoperitoneum was created with Intra Abdominal Pressures of 14, 8 and 14 mm Hg respectively. Before creation of pneumoperitoneum 0, 5 and 10 cm H2O of PEEP was applied in 0PEEP, 5PEEP and 10PEEP groups respectively. The pneumoperitoneum was created by CO2 insufflation performed by the surgeon. IAP was set to be maintained at 14 mmHg by an automatic insufflator in 0PEEP and 10PEEP groups and 8 mm Hg in 5PEEP group. The PEEPs were applied upto 30 min of capnoperitonium. CONDITION: Cardio‐respiratory effects (Heart rate, Mean arterial pressure, Cardiac output, Haemoglobin oxygen saturation, End tidal carbon dioxide concentration, Mean and peak airway pressure, Arterial blood gas analysis) PRIMARY OUTCOME: Mean end tidal carbon dioxide concentration. ; End‐tidal carbon dioxide (ETCO2) were recorded using multiparameter monitor (Datex omheda side stream carbon dioxide analyser). Data were analyzed using Graphpad Instat 3.0, Graphpad software, San Diego, CA. Inter‐group differences between the variables recorded were analyzed by repeated measures analysis of variance(ANOVA Test) followed by Bonferroni post hoc test of significance. SECONDARY OUTCOME: Arterial PH as assessed using Arterial blood gas analysis Partial Pressure of arterial carbon dioxide as assessed using Arterial blood gas analysis Partial Pressure of arterial oxygenation as assessed using Arterial blood gas analysis INCLUSION CRITERIA: All ASA I and II patients between the age group of 15‐60 years scheduled to undergo elective laparoscopic cholecystectomy were recruited in the study after obtaining informed consent