Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy

Abstract

Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation.

Feasibility and Safety of Low Pressure Pneumoperitoneum for Laparoscopic Cholecystectomy: A Prospective, Randomized, Triple-Blinded Trial

“…As mentioned, this problem was partly circumvented by initially piercing the anterior abdominal fascia with a blade, and by sometimes using slightly oblique tracts. Anticipating this, others in similar situations have used a higher pressure initially for port placement [7,9,12,16]. We feel that the higher initial pressure might confound the cardiopulmonary variables in the LPLC group.…”

“…Several studies have compared the effects of reduced pressure (7-9 mm Hg) with standard pressure (12-15 mm Hg) during LC [7][8][9][10][11]. These studies illustrate the feasibility of low pressure PP, along with some advantages in terms of postoperative pain.…”

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

“…As a generalisation, pneumoperitoneum orchestrates a neurohormonal stress response which LVEF: left ventricular ejection fraction increases systemic vascular resistance, mean arterial blood pressure and heart rate [13][14][15]. These factors increase the afterload and myocardial oxygen consumption which are poorly tolerated by patients with cardiac dysfunction [16].…”

“…Some study define 'normal' insufflation pressure as 12-15 mmHg and a 'low' pressure as 5-7 mmHg [21] while a recent review arbitrarily considered anything less than 12 mmHg as low pressure [33]. Studies in healthy individuals have shown less pronounced decrease in cardiac index using low pressure peritoneal insufflation, while the pulmonary parameters have remained more or less similar in both the groups [13,34,35]. By and large, the low pressure groups have also reported less post-operative pain and diminished analgesic requirement, but such was always not the case [34].…”

Anesthesia for laparoscopic surgery

“…6 Minimizing IAP should decrease the risk of potentially significant physiologic changes. 7 In addition, hemodynamic derangement is also related to the surgical procedure. For example, surgical disruption of the esophageal hiatus during laparoscopic Nissen fundoplication may increase mediastinal and pleural pressures resulting in a significant reduction in cardiac output.…”