Pneumothorax During Laparoscopic Fundoplication: Diagnosis and Treatment with Positive End-Expiratory Pressure

• Published in: Anesthesia and analgesia Vol. 81; no. 5; pp. 993 - 1000
• Main Authors: Joris, Jean L., Chiche, Jean-Daniel, Lamy, Maurice L.
• Format: Journal Article Web Resource
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.11.1995; Lippincott; Lippincott Williams & Wilkins
• Subjects: Adult; Anesthesia & intensive care; Anesthésie & soins intensifs; Biological and medical sciences; Carbon Dioxide; Female; Fundoplication - adverse effects; Human health sciences; Humans; Laparoscopy - adverse effects; Male; Medical sciences; Pneumothorax - etiology; Pneumothorax - therapy; Pneumothorax/etiology/therapy; Positive-Pressure Respiration - methods; Sciences de la santé humaine; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Pneumothorax; Effusion; Pathophysiology; Respiratory disease; Laparoscopy; Artificial ventilation; Positive end expiratory pressure; Plication; Treatment; Gastric fundus; Digestive diseases; Pleural disease; Complication; Diagnosis; Gastric disease
• ISSN: 0003-2999; 1526-7598; 1526-7598
• DOI: 10.1097/00000539-199511000-00017

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, endtidal 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 changesdecrease 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.(Anesth Analg 1995;81:993-1000)