ISSN : 1302-7123 | E-ISSN : 1308-5123
Relationship between Gastric pH Measurement and Intra-abdominal Pressure in Patients Undergoing Laparoscopic Surgery [SETB]
SETB. 2020; 54(4): 463-468 | DOI: 10.14744/SEMB.2020.34437

Relationship between Gastric pH Measurement and Intra-abdominal Pressure in Patients Undergoing Laparoscopic Surgery

Ayse Surhan Cinar1, Pinar Sayin1, Mustafa Fevzi Celayir2
1Department of Anesthesiology and Reanimation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
2Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey

Objectives: Laparoscopic surgery (LS) is a safe and widely used technique. During LS, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences, such as elevated intra-abdominal pressure (IAP) and hypercarbia. Splanchnic and cardiovascular blood flow can be affected by the elevated IAP, which can result in ischemia in the splanchnic region prior to hemodynamic changes. Changes in gastric pH may be an early precursor of changes in splanchnic blood circulation. This study investigated the relationship between gastric pH measurement and IAP in patients undergoing LS.
Methods: This study included 49 patients aged 18–65 years with American Society of Anesthesiologists (ASA) physical status I – III who were undergoing elective laparoscopic cholecystectomy. A gastric pH tonometer probe was applied using an orogastric catheter. Simultaneously, insufflation pressure, cardiac apex beat (CAB), and mean arterial blood pressure (MAP) values were recorded. Indirect IAP was then measured through the bladder. Measurements were performed at baseline; at 15, 30, and 60 minutes after onset of insufflation (AI 15, AI 30, and AI 60, respectively); and at the end of insufflation (EI). Two pH measurements were obtained with a gastric tonometer pH probe, using an automated function of the gastric tonometer to improve measurement reliability.
Results: IAP was significantly higher than baseline at AI 15, AI 30, AI 60, and EI (p<0.001). The pH1 and pH2 levels were significantly lower at AI 15 and AI 30, compared with baseline (p<0.001). There were no significant differences between pH1 and pH2 measurements at AI 60 and EI. Compared with baseline, CAB was significantly lower at AI 15, AI 30, AI 60, and EI (p=0.001, p<0.001, p=0.006). There were no statistically significant differences in MAP changes at any time point.
Conclusion: Elevated IAP caused by CO2 insufflation during LS led to reductions of pH1 and pH2. There was a correlation between gastric pH measurement and IAP. Measurement of gastric pH may be useful to assess blood circulation in the splenic area during LS.

Keywords: elevated intra-abdominal pH, gastric pH, laparoscopic surgery.

Relationship between Gastric pH Measurement and Intra-abdominal Pressure in Patients Undergoing Laparoscopic Surgery

Ayse Surhan Cinar1, Pinar Sayin1, Mustafa Fevzi Celayir2
1Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul
2Sağlık Bilimleri Üniversitesi, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul

Objective: Laparoscopic surgery (LS) is a safe and widely used technique. During LS, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences, such as elevated intra-abdominal pressure (IAP) and hypercarbia. Splanchnic and cardiovascular blood flow can be affected by the elevated IAP, which can result in ischemia in the splanchnic region prior to hemodynamic changes. Changes in gastric pH may be an early precursor of changes in splanchnic blood circulation. This study investigated the relationship between gastric pH measurement and IAP in patients undergoing LS.
Materials & Methods: This study included 49 patients aged 18 – 65 years with American Society of Anesthesiologists (ASA) physical status I – III who were undergoing elective laparoscopic cholecystectomy. A gastric pH tonometer probe was applied using an orogastric catheter. Simultaneously, insufflation pressure, cardiac apex beat (CAB), and mean arterial blood pressure (MAP) values were recorded. Indirect IAP was then measured through the bladder. Measurements were performed at baseline; at 15, 30, and 60 minutes after onset of insufflation (AI 15, AI 30, and AI 60, respectively); and at the end of insufflation (EI). Two pH measurements were obtained with a gastric tonometer pH probe, using an automated function of the gastric tonometer to improve measurement reliability.
Results: IAP was significantly higher than baseline at AI 15, AI 30, AI 60, and EI (p < 0.001). The pH1 and pH2 levels were significantly lower at AI 15 and AI 30, compared with baseline (p < 0.001). There were no significant differences between pH1 and pH2 measurements at AI 60 and EI. Compared with baseline, CAB was significantly lower at AI 15, AI 30, AI 60, and EI (p = 0.001, p < 0.001, p = 0.006). There were no statistically significant differences in MAP changes at any time point.
Conclusion: Elevated IAP caused by CO2 insufflation during LS led to reductions of pH1 and pH2. There was a correlation between gastric pH measurement and IAP. Measurement of gastric pH may be useful to assess blood circulation in the splenic area during LS. (SETB-2020-06-107)

Anahtar Kelimeler: laparoscopic surgery, gastric pH, elevated intra-abdominal pH

Ayse Surhan Cinar, Pinar Sayin, Mustafa Fevzi Celayir. Relationship between Gastric pH Measurement and Intra-abdominal Pressure in Patients Undergoing Laparoscopic Surgery. SETB. 2020; 54(4): 463-468

Corresponding Author: Pinar Sayin
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