Karnataka Anaesthesia Journal

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Comparison of Respiratory Mechanics - Volume Controlled Ventilation Versus Pressure Controlled Ventilation using Proseal Laryngeal Mask Airway during Laparoscopic Cholecystectomy: A Cross-over Study


Affiliations
1 Senior Resident Anaesthesiology, Sakra World Hospital, Bengaluru - 560103, Karnataka, India
2 Professor and Head, Department of Anaesthesiology, Bangalore Medical College and Research Insitute, Bengaluru - 560002, Karnataka, India
3 Professor, Department of Anaesthesiology, Bangalore Medical College and Research Insitute, Bengaluru - 560002, Karnataka, India
 

Background and aim: Pressure Controlled Ventilation (PCV) is claimed to be superior to Volume Controlled Ventilation (VCV) but with insufficient evidence. The aim was to compare the respiratory mechanics in VCV and PCV with Proseal Laryngeal Mask Airway (PLMA) in patients undergoing laparoscopic cholecystectomy. Methods and Materials: Study was conducted involving 50 ASA I and II patients aged 20-50 years undergoing laparoscopic cholecystectomy in this open label study. Patients were randomly allocated into group V and group P. Induction and maintenance of anaesthesia was uniform in both groups. All patients received Volume Controlled Ventilation till pneumoperitoneum, following which patients in group V received volume controlled ventilation for 20 minutes and switched over to PCV and vice versa for group P (PCV). Ventilator parameters for PCV and VCV were uniformly set initially irrespective of group allocation and adjusted later to maintain PaCO2 35 – 45 mm of Hg and SpO2 > 95%. Baseline hemodynamic parameters and respiratory parameters like peak and mean airway pressures, compliance were recorded during each mode of ventilation for 20 minutes. Data analyzed using IBM SPSS software version 20, Student T-test applied, P value < 0.05 considered significant. Results: Demographic data was comparable between two study groups. Peak airway Pressures (Ppeak) were 24.2 ± 2.38 cm of H20 during VCV and 22.46 ± 2.07 cm of H20 during PCV respectively (P value 0.019). Compliance was found to be 20.58 ± 5.1 cm of H20 during VCV and 21.56 ± 5.1 cm of H20 during PCV respectively (P-value 0.016). Airway resistance and expired tidal volumes were comparable. None of patients had desaturation or hypercarbia. Conclusion: Pressure controlled ventilation is better than volume controlled ventilation in terms of lower airway pressures and increased dynamic compliance.

Keywords

Laparoscopy, Pressure Control Ventilation, Proseal LMA, Volume Control Ventilation
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  • Comparison of Respiratory Mechanics - Volume Controlled Ventilation Versus Pressure Controlled Ventilation using Proseal Laryngeal Mask Airway during Laparoscopic Cholecystectomy: A Cross-over Study

Abstract Views: 265  |  PDF Views: 113

Authors

Amardeep Kulkarni
Senior Resident Anaesthesiology, Sakra World Hospital, Bengaluru - 560103, Karnataka, India
R. S. Raghavendra Rao
Professor and Head, Department of Anaesthesiology, Bangalore Medical College and Research Insitute, Bengaluru - 560002, Karnataka, India
S. S. Nethra
Professor, Department of Anaesthesiology, Bangalore Medical College and Research Insitute, Bengaluru - 560002, Karnataka, India
D. Devikarani
Professor, Department of Anaesthesiology, Bangalore Medical College and Research Insitute, Bengaluru - 560002, Karnataka, India

Abstract


Background and aim: Pressure Controlled Ventilation (PCV) is claimed to be superior to Volume Controlled Ventilation (VCV) but with insufficient evidence. The aim was to compare the respiratory mechanics in VCV and PCV with Proseal Laryngeal Mask Airway (PLMA) in patients undergoing laparoscopic cholecystectomy. Methods and Materials: Study was conducted involving 50 ASA I and II patients aged 20-50 years undergoing laparoscopic cholecystectomy in this open label study. Patients were randomly allocated into group V and group P. Induction and maintenance of anaesthesia was uniform in both groups. All patients received Volume Controlled Ventilation till pneumoperitoneum, following which patients in group V received volume controlled ventilation for 20 minutes and switched over to PCV and vice versa for group P (PCV). Ventilator parameters for PCV and VCV were uniformly set initially irrespective of group allocation and adjusted later to maintain PaCO2 35 – 45 mm of Hg and SpO2 > 95%. Baseline hemodynamic parameters and respiratory parameters like peak and mean airway pressures, compliance were recorded during each mode of ventilation for 20 minutes. Data analyzed using IBM SPSS software version 20, Student T-test applied, P value < 0.05 considered significant. Results: Demographic data was comparable between two study groups. Peak airway Pressures (Ppeak) were 24.2 ± 2.38 cm of H20 during VCV and 22.46 ± 2.07 cm of H20 during PCV respectively (P value 0.019). Compliance was found to be 20.58 ± 5.1 cm of H20 during VCV and 21.56 ± 5.1 cm of H20 during PCV respectively (P-value 0.016). Airway resistance and expired tidal volumes were comparable. None of patients had desaturation or hypercarbia. Conclusion: Pressure controlled ventilation is better than volume controlled ventilation in terms of lower airway pressures and increased dynamic compliance.

Keywords


Laparoscopy, Pressure Control Ventilation, Proseal LMA, Volume Control Ventilation