Find in Library

Background. Anesthetic support for transabdominal and extraabdominal endovideosurgical hernioplasty should take into account the peculiarities of endovideosurgical intervention technologies: the use of carboxyperitoneum, specific positions of the body on the operating table, often a longer duration of surgery. Being a soluble acid, CO2 causes hypercapnia, hypercarbia, and acidosis, which an anesthesiologist must compensate with hyperventilation. Thus, the development of a strategy to reduce hypercapnia during transabdominal and extraabdominal endovideosurgical hernioplasty is relevant. The purpose was to study the possibility of correcting hypercapnia during transabdominal and extraabdominal endovideosurgical hernioplasty. Materials and methods. One hundred and thirty-nine men who underwent endovideosurgical intervention for anterior abdominal wall and inguinal hernias were examined. The age of the patients was 34–76 years, they had II–IV functional class of severity according to the American Society of Anesthesiologists. Group I (n = 72) included patients who underwent transabdominal preperitoneal plasty, group II (n = 67) — totally extraperitoneal repair. The duration of the surgery was 2–2.5 hours. General anesthesia using the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl was performed under low-flow artificial lung ventilation. Intraperitoneal and extraperitoneal pressure, CI, DO2, VO2, O2ER, TV, PaCO2, PetCO2, pH were monitored. Results. It was found that as the intra-abdominal and extraperitoneal pressure increased during the operation, the concentration of CO2 in both the arterial blood and the exhaled mixture increased. Of the negative effects of hypercapnia, special attention should be paid to respiratory and, as a result, mixed acidosis. A perioperative management program for eliminating hypercapnia and its consequences has been developed. For this, a safe increase in respiratory volume and respiratory rate, an increase in positive end-expiratory pressure, changes in the inhalation/exhalation ratio from 2 : 1 to 1 : 1 were used. Despite all measures, it was not possible to fully compensate the ongoing processes. Conclusions. TV, PaCO2, etCO2 increased during surgery in both groups. However, PetСО2, PaCO2 in group I increased only 1.5 hours after the intervention started, this was not critical and was easily corrected during the operation. In group II, an increase in PetСО2 and PaCO2, requiring careful correction, occurred already 30 minutes after creating extraperitoneal pressure. A perioperative management program for eliminating hypercapnia and its consequences has been developed.