Effect of increasing cardiac preload, sympathetic antagonism, or vasodilation on visceral blood flow during pneumoperitoneum

Junghans, T.; Neudecker, Jens; Dörner, F; Raue, W.; Haase, Oliver; Schwenk, W.

doi:10.1007/s00423-005-0576-1

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Clips, endoloop, monopolar electrocoagulation, bipolar electrocoagulation, neodymium: yttrium aluminum garnet surgical laser, and harmonic scalpel were used to solve such problems during laparoscopy (9,11,12,14,17,34). The bipolar cautery method to seal vessels was used.…”

Section: Discussionmentioning

confidence: 99%

“…Ovariohysterectomy (OHE), the most common surgical procedure in veterinary practice, provides a method for population control and a treatment of pyometra in dogs (4,33) Clinically, multiple surgical techniques have been described for OHE in bitches, including open, laparoscopic, and laparoscopic-assisted procedures (2,8,9,11,14,17). Compared with open OHE, laparoscopic ovariohysterectomy (LOHE) has the advantages of superior visualisation, smaller abdominal incisions, less pain, and shorter convalescence (10,12,15,34).…”

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confidence: 99%

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Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Zhang

Jingtao

Liu

et al. 2013

Bulletin of the Veterinary Institute in Pulawy

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Ten mixed-breed female dogs were used in the study. Abdominal wall lifting was performed with a sterilised cotton strip. Four portal sites were used to complete gasless laparoscopic ovariohysterectomy (GLOHE) procedures. The proper and suspensor ligament, ovarian pedicle, and broad ligament of the uterus, uterine artery and vein were coagulated using bipolar electrocoagulation. After the uterine body was coagulated and cut, the end of the cervix was ligated with a loop suture. Blood samples were obtained before the surgery, immediately after the procedure, and on 1, 3, and 5 d postoperatively for the determination of interleukin-6 (IL-6) and C-reactive protein (CRP). No significant surgical complications occurred. After gasless laparoscopic ovariohysterectomy, a significantly higher serum IL-6 level was found immediately after the surgery and 1 d postoperatively when compared with the level observed after traditional laparoscopic ovariohysterectomy (LOHE). However, no significant differences were observed in CRP level between GLOHE and LOHE. GLOHE proved to be a safe and feasible procedure in bitches.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Zhang

Jingtao

Liu

et al. 2013

Bulletin of the Veterinary Institute in Pulawy

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“…Systemic intravenous administration of vasoactive agents (dombutamine, dopamine, sodium nitroprusside)34,35 are ineffectual presumably because their concentrations would be higher in well-perfused tissues and their resultant vaso-relaxation at these sites could actually result in further decreases in flow to poorly perfused regions (i.e., the steal effect). Direct application of vasodilators can improve local perfusion36 but this type of intervention is impracticable for the whole peritoneal cavity.…”

Section: Discussionmentioning

confidence: 99%

Inclusion of a Nitric Oxide Congener in the Insufflation Gas Repletes S‐Nitrosohemoglobin and Stabilizes Physiologic Status During Prolonged Carbon Dioxide Pneumoperitoneum

Shimazutsu¹,

Uemura²,

Auten³

et al. 2009

Clinical Translational Sci

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IntroductionRecent advances in operative procedures and surgical instrumentation have enabled the application of laparoscopic techniques to more complex surgeries. However, complex procedures require extended insuffl ation times (typically greater than 3 hours) 1-6 and consequently patients undergo prolonged periods of elevated intraabdominal pressure. And while the benefi ts of using minimally invasive techniques for longer procedures are presumed to be similar to those obtained for "simple" laparoscopic surgeries, it is now recognized that carbon dioxide (CO 2 ) pneumoperitoneum and the resultant rise in intra-abdominal pressure can produce reductions in organ blood fl ow, acidosis, and alterations in cardiovascular and respiratory status, 5-10 all of which can impact postoperative organ function and patient recovery; the severity of these eff ects correlates to the duration of insuffl ation. 11To some extent, the acidosis and systemic effects of pneumoperitoneum can be controlled by altering ventilation rates and/or administration of vasoactive agents but such interventions have minimal ability to preserve end-organ blood fl ow and oxygen delivery. Th is is because local tissue blood fl ow, rather than blood oxygen content, is the primary determinant of oxygen delivery. Local tissue perfusion is regulated by a physiological response termed hypoxic vasodilation in which tissue oxygen requirements are directly coupled to blood fl ow, the domain of nitric oxide (NO) bioactivity.12 Second to second changes in microcirculatory fl ow are controlled by complex interactions between oxygen, NO, and hemoglobin (Hb) within the red blood cell with Hb serving as an oxygen sensor and as a hypoxia-responsive transducer of NO signals. 13,14 Vasodilation by S-nitrosoHb (SNO-Hb; i.e., release of NO bioactivity) is linked to Hb desaturation and provides a regulated mechanism for matching blood fl ow and oxygen delivery with local metabolic demand. 15Decreased levels and/or impaired processing of SNO-Hb have been observed in disparate diseases characterized by tissue hypoxemia; [16][17][18][19][20][21][22] where examined, red blood cells from these patients exhibited impaired vasodilatory capacity. Such data suggest that red blood cell derived NO bioactivity plays an important role in the respiratory cycle and that impairment of this activity might contribute to the pathophysiology of ischemic conditions. Based on these fi ndings, we reasoned that insuffl ationinduced reductions in splanchnic blood fl ow may be due, at least in part, to alterations (reductions) in SNO-Hb homeostasis. By extension, an intervention directed toward increasing NO bioactivity could potentially ameliorate pneumoperitoneuminduced reductions in organ blood fl ow. Th eoretical support for this hypothesis comes from the observations that reductions in blood pH, as occur during CO 2 pneumoperitoneum, accelerate SNO-Hb decay 23,24 and increased mechanical ventilation (as may be initiated to control hybercarbia) increases the concentration of exhaled NO 25 b...

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“…Alterations in hepatic blood flow are also known. An increase in the portal flow has been reported for the head‐down position as well as a decrement for the head‐up position (19). Significant changes in the cardiac output, the stroke volume, the mean artery pressure, or the systemic vascular resistance have also been documented as a result of the combination of the anti‐Trendelemburg position and the creation of the pneumoperitoneum (2, 20).…”

mentioning

confidence: 94%

Effects of pneumoperitoneum and body position on the morphology of abdominal vascular structures analyzed in MRI

Moyano-Cuevas

Sánchez‐Margallo

Maestre-Antequera

et al. 2012

Magnetic Resonance Imaging

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Purpose: To analyze the complications of laparoscopy in different vascular structures using magnetic resonance imaging (MRI). MRI has become a key tool in laparoscopic surgery. During these procedures, pneumoperitoneum creation and placing the patient in the surgical position provoke different changes in the splachnic circulation. Materials and Methods:Ten pigs were included in the study. MRI studies of the abdominal area were carried out in four different situations of abdominal pressure and body position.Results: Changes in the area of the lumen of the portal vein and the abdominal aorta were analyzed in all situations. A significant reduction in the area of the abdominal aorta was observed after the pneumoperitoneum in supine and anti-Trendelemburg position. The lumen of the portal vein was significantly reduced in all analyzed situations except when placing the patient in anti-Trendelemburg without pneumoperitoneum, in which case the area was increased. Conclusion:The creation of pneumoperitoneum provokes morphological changes in the lumen of different abdominal vessels as a consequence of the increase of pressure. Furthermore, the combination of pneumoperitoneum together with the anti-Trendelemburg position results in a more significant reduction of the lumen of the portal vein and the abdominal aorta.

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Effect of increasing cardiac preload, sympathetic antagonism, or vasodilation on visceral blood flow during pneumoperitoneum

Cited by 6 publications

References 28 publications

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Gasless Laparoscopic Ovariohysterectomy and Comparison of Serum Levels of Interleukin-6 and C-Reactive Protein after Lohe and Traditional Laparoscopic Ovariohysterectomy in Bitches

Inclusion of a Nitric Oxide Congener in the Insufflation Gas Repletes S‐Nitrosohemoglobin and Stabilizes Physiologic Status During Prolonged Carbon Dioxide Pneumoperitoneum

Effects of pneumoperitoneum and body position on the morphology of abdominal vascular structures analyzed in MRI

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