Systemic Physiological Changes Induced by CO₂ Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract

Objective: Carbon dioxide pneumoperitoneum is crucial for laparoscopic surgery but has adverse cardiorespiratory effects due to raised intra-abdominal pressure, diaphragmatic displacement, and systemic CO₂ resorption. We aimed to investigate intraoperative variations in respiratory and cardiovascular parameters induced by CO₂ pneumoperitoneum and to determine the factors contributing to this effect, including BMI and anaesthetic techniques.

Methods: A total of 150 adult ASA I–II patients undergoing laparoscopic cholecystectomy were monitored prospectively in this clinical study. Respiratory (EtCO2, PIP) and hemodynamic (MAP,  HR, SpO2, temperature) parameters were measured at six time points during anaesthesia. Repeated-measures ANOVA and subgroup comparisons were performed in statistical analysis.

Results: EtCO₂ and PIP increased significantly after CO₂ insufflation (p < 0.001). Both MAP and HR initially decreased transiently and then took a stabilised course. Respiratory variations were higher in obese patients. The longer the pneumoperitoneum time,  the higher the EtCO₂ concentration.

Conclusions: CO₂ pneumoperitoneum induces a predictable but clinically important depressor effect that must be closely followed and managed accordingly, including the need for respiratory strategies to enable the control of its effects, particularly in high-risk patients.