Perioperative respiratory acidosis: outcome of long laparoscopic surgery

Abstract

Background: Long laparoscopic surgery can be challenging. The use of carbon dioxide (CO2) to create and maintain a pneumoperitoneum during laparoscopic surgery may lead to hypercapnia and respiratory acidosis. Every possible cause of intraoperative hypercapnia should be considered to successfully lower CO2 in patient’s bloodstream. Case report: A 54-year-old man with gastric cancer was hospitalized for laparoscopic gastrectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Before surgery the patient was evaluated for general anaesthesia: ASA class 3, mallampati class 2, concomitant diseases such as bronchial asthma and prostatic hyperplasia. To ensure invasive monitoring, analgesia, and administration of fluids during the surgery, certain procedures were completed: epidural, central venous, arterial catheterization, and esophageal temperature probe insertion. Combined epidural-general anaesthesia was applied. The surgery lasted for 11 hours, out of which 8 hours was spent on laparoscopy. During it, core temperature increase was present. Respiratory acidosis was identified after receival of arterial blood gas results (pH 7.24, pCO256.9 mmHg). To lower CO2, the patient was ventilated with adequate tidal volume and respiratory rate. In addition to this, CO2 absorbent and ventilator’s circuit were changed. After anaesthesia, the patient was conscious, responsive, breathing spontaneously with supplemental oxygen, hemodynamically stable. He was transferred to intensive care unit for monitoring. The patient recovered from respiratory acidosis one hour after the surgery. Conclusions: Respiratory acidosis is a common acid-base imbalance, and it should be monitored during long and difficult surgeries such as laparoscopic gastrectomy with HIPEC when there is a high risk of increased CO2 absorption.