A COMPARATIVE STUDY TO ASSESS EFFECTS OF PNEUMOPERITONEUM AND TRENDELENBURG POSITION ON HEMODYNAMICS AND VENTILATORY MECHANICS DURING TOTAL LAPAROSCOPIC HYSTERECTOMY IN OBESE AND NON-OBESE PATIENTS

Background:Hysterectomy is a common gynaecological surgical procedure, with Laparoscopic hysterectomy (LH) emerging as a favorable approach due to its benefits such as shorter recovery periods and reduced complications. However, the creation of pneumoperitoneum and the Trendelenburg position required for total laparoscopic hysterectomy (TLH) can induce significant hemodynamic and ventilatory changes. Methodology: Our study included 60 patients who were categorized into two groups of 30 each based on their BMI: non-obese (BMI < 30) and obese (BMI ≥ 30). All patients underwent routine pre-anaesthesia check-up followed by general anaesthesia. Diastolic blood pressure (DBP), systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP), plateau pressure (PPLAT), peak pressure (PPEAK),and driving pressure (PDRIVING), end-tidal carbon dioxide (EtCO2) as well as static (CST) and dynamic (CDYN) lung compliance were measured at different time intervals including baseline, following induction of anaesthesia, insufflation, changing to Trendelenburg position, desufflation and after extubation. Results:The heart rate decreased on induction of anesthesia in both the groups and remained lower throughout the procedure but was statistically non-significant (p>0.05). There was a rise in SBP, DBP, and MAP on insufflation and further with head-down positioning in both obese and non-obese patients, however, was statistically non-significant (p>0.05). The PPEAK, PPLAT, and PDRIVING were increased on induction, following the creation of pneumoperitoneum as well as Trendelenburg position (p<0.05). The values were higher in obese as compared to the non-obese. The static and dynamic compliance were lower at all time intervals in obese patients when compared to the non-obese group. Conclusion: Obese patients exhibit higher plateau pressure, peak inspiratory pressure, and driving pressure values, indicating increased airway resistance and potential ventilation challenges during surgery. Additionally, the reduced static and dynamic lung compliance values in obese patients suggest decreased lung elasticity and difficult ventilation.