Transabdominal preperitoneal (
TAPP) or total extraperitoneal (
TEP)
hernioplasty are probably associated with differing degrees of CO(2) absorption which can influence
anesthetic management and perioperative morbidity. We studied 20 patients with either
TAPP or
TEP for perioperative CO(2) absorption (calculated from CO(2) elimination and metabolic CO(2) production) and ventilatory changes required to maintain normocapnia (blood gas analyses). CO(2) absorption reached plateau values in the
TAPP group, but increased over time in the
TEP group. Median CO(2) absorption during insufflation was 61 mL/min (range 43-78) for
TAPP and 114 mL/min (range 75-178) for
TEP, with a maximum of 114 mL/min (range 75-178) for
TAPP and 258 mL/min (range 112-585) for
TEP. Median minute ventilation (V(E)) required for maintaining normocapnia was 9. 5 L/min (range 7.7-11.5) for
TAPP and 12.9 L/min (range 9.0-22.6) for
TEP (P: < 0.01). Seven patients in the
TEP group required over 18 L/min V(E), although no patient in the
TAPP group required more than 14 L/min V(E). All patients in the
TEP group had significant
subcutaneous emphysema resulting in one case of delayed tracheal extubation. We conclude that CO(2) absorption is consistently less with
TAPP.
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