Effect of different positive end-expiratory pressure levels in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Abstract

Objective: To investigate the effect of different levels of positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Methods: This retrospective study included patients who underwent laparoscopic cholecystectomy under general anesthesia in the Xuzhou Hospital of Traditional Chinese Medicine from January, 2023 to March, 2024. Based on the PEEP levels, patients were grouped into 0cm group (0cmH₂O), 5cm group (5cmH₂O), 8cm group (8cmH₂O), and 10cm group (10cmH₂O). Mean arterial pressure (MAP), mean airway pressure (P_mean), peak airway pressure (P_peak), and blood gas status levels (oxygenation index[OI], arterial partial pressure of oxygen [PaO₂], and arterial partial pressure of carbon dioxide [PaCO₂]) of all four groups were measured at five minutes after the intubation (T1), five minutes after pneumoperitoneum (T2), and 30 minutes after pneumoperitoneum (T3).

Results: A total of 84 patients (37 males and 47 females) were included in this study. The number of patients in the 0cm group, 5cm group, 8cm group, and 10cm group were 24, 24, 21, and 15, respectively, and there were no significant differences in the baseline data among the four groups. There were significant differences in P_mean, P_peak, and MAP between the four groups at T2 and T3. The increase in PEEP was accompanied by a gradual increase in P_mean and P_peak (P<0.05). There were significant differences in OI, PaCO₂, and PaO₂ among the four groups at T2 and T3. With the increase in PEEP, OI and PaO₂ values continued to increase while PaCO₂ continued to decrease (P<0.05).

Conclusions: During laparoscopic cholecystectomy under general anesthesia, PEEP = 5cmH₂O can inhibit a significant decrease in MAP while ensuring the patient's blood gas and respiratory mechanics status, which can ensure hemodynamic stability.