Cardiovascular Effects and Acid-Base and Blood Gas Changes During Laparoscopy

Intra-abdominal pressure monitoring in liver transplant recipients: a prospective study

“…It has been suggested that loading patients with intravenous fluids may prevent the deleterious effects of IAH [3,27] because it counteracts the reduced cardiac output caused by the diminished preload due to the fact that venous return to the heart is hampered by abdominal hypertension-induced compression of the inferior and superior venous cava compartments [2,10,28]. Our experience indicates that this therapeutic approach can successfully keep stable the hemodynamic parameters of the transplanted patients but does not necessarily prevent the onset of renal dysfunction.…”

“…High IAP can also reduce total lung capacity, residual functional capacity, and residual volume [17], all of which give rise to ventilation/perfusion anomalies and hypoventilation, with consequent hypoxia and hypercapnia [2,10,24,28].…”

Hemodynamic effects of laparoscopy

“…The potential for adverse hemodynamic effects during laparoscopy has been previously reported in the gynecological literature [3,4]. The rarity of hemodynamic compromise during tubal ligation clearly supports the safety of laparoscopy in young healthy patients.…”

Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

“…Those authors did not establish parameters to evaluate possible changes in respiratory function and gas exchange. In addition, the effect of each preset pressure level (10,15,20,25,and 30 mmHg) was evaluated at the exact moment it was reached, without taking into consideration the cumulative effect of duration of pneumoperitoneum for enough time to insert the first trocar. This hindered assessment of the clinical effects resulting from the duration of pneumoperitoneum rather than from the level of intraperitoneal pressure reached [30].…”

“…Studies have demonstrated that patients submitted to high intraperitoneal pressure for longer periods of time can present decreased cardiac output, decreased venous return, increased mean arterial pressure, increased systemic vascular resistance, altered renal perfusion and glomerular filtration rate, and ischemia-reperfusion injury of intra-abdominal organs [15][16][17][18][19][20][21]. Therefore, most authors have proposed that intraperitoneal pressure remain at 12 mmHg and never above 15 mmHg during laparoscopic procedures [22][23][24][25][26][27][28][29].…”