Hemodynamics during laparoscopic extra- and intraperitoneal insufflation

Bannenberg, J. J. G.; Rademaker, B. M. P.; Froeling, F.M.J.A.; Meijer, Daniëlle

doi:10.1007/s004649900485

Cited by 34 publications

(19 citation statements)

References 11 publications

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“…On raising the aIAP to 20 cm H 2 O, Ppa, Pcv, mean arterial, and occlusion pressures all increased, with an increase in heart volume and no change in Q (frequency and stroke volume). These findings are consistent both with experimental (10,11) and clinical data (12)(13)(14) during laparoscopy associated with pneumoperitoneum. Most of these studies reported increases of mean arterial pressure and Ppa and an enlargement of the right and left heart sections as seen by transesophageal echocardiogra- phy (15,16).…”

Section: Discussion Healthy Lungssupporting

confidence: 90%

An Increase of Abdominal Pressure Increases Pulmonary Edema in Oleic Acid–induced Lung Injury

Quintel

Pelosi

Caironi

et al. 2004

Am J Respir Crit Care Med

169

108

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Increased abdominal pressure is common in intensive care unit patients. To investigate its impact on respiration and hemodynamics we applied intraabdominal pressure (aIAP) of 0 and 20 cm H 2 O (pneumoperitoneum) in seven pigs. The whole-lung computed tomography scan and a complete set of respiratory and hemodynamics variables were recorded both in healthy lung and after oleic acid (OA) injury. In healthy lung, aIAP 20 cm H 2 O significantly lowered the gas content, leaving the tissue content unchanged. In OAinjured lung at aIAP 0 cm H 2 O, the gas content significantly decreased compared with healthy lung. The excess tissue mass (edema) amounted to 30 Ϯ 24% of the original tissue weight (455 Ϯ 80 g). The edema was primarily distributed in the base regions and was not gravity dependent. Heart volume, central venous, pulmonary artery, wedge, and systemic arterial pressures significantly increased. At aIAP 20 cm H 2 O in OA-injured lung, the central venous and pulmonary artery pressures further increased. The gas content further decreased, and the excess tissue mass rose up to 103 Ϯ 37% (tissue weight 905 Ϯ 134 g), with homogeneous distribution along the cephalocaudal and sternovertebral axis. We conclude that in OAinjured lung, the increase of IAP increases the amount of edema.Keywords: intraabdominal pressure; acute respiratory distress syndrome; pulmonary edema; lung mechanics; computed tomography scanThe importance of intraabdominal pressure (IAP) in acute lung injury and acute respiratory distress syndrome has been recently suggested (1). For a long time any change in respiratory mechanics in patients with acute lung injury/acute respiratory distress syndrome was attributed to lung mechanics, whereas chest wall mechanics was assumed to be normal. However, few studies in which chest wall elastance was actually measured have showed that it was abnormal in a substantial proportion of patients with acute lung injury/acute respiratory distress syndrome (2-4). We (5) and others (6) have described different chest wall mechanics in patients with pulmonary and extrapulmonary acute respiratory distress syndrome, mainly due to different IAP values.However, apart from respiratory mechanics, the increased intrathoracic pressure caused by chest wall impairment may have important consequences on hemodynamics (7). We investigated the effect of changing IAP during controlled mechanical ventilation in healthy and diseased lungs. Surprisingly, the increase of IAP had an unexpected impact on lung edema, likely related to its formation and clearance. We wish to report our findings and METHODS(Additional details about Methods are provided in an online supplement.)The study group consisted of seven anesthetized and paralyzed domestic pigs (41 Ϯ 4 kg) ventilated throughout the experiment in supine position, with a Vt of 12 ml/kg, respiratory rate of 12-14 breaths/minute, positive end-expiratory pressure of 5 cm H 2 O, and Fi O 2 of 1.0. The animals were fully instrumented for hemodynamic monitoring (carotid artery, right atrium, mea...

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Section: Discussion Healthy Lungssupporting

confidence: 90%

An Increase of Abdominal Pressure Increases Pulmonary Edema in Oleic Acid–induced Lung Injury

Quintel

Pelosi

Caironi

et al. 2004

Am J Respir Crit Care Med

169

108

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“…To date, there are no studies measuring cardiac output during extraperitoneal CO 2 insufflation in humans. In contrast to the findings of Bannenberg et al [1], moderate decreases in cardiac output during intraperitoneal insufflation have been described in humans [4]. However, whether the differences between the two methods with respect to hemodynamic changes are of any clinical consequence remains to be determined.…”

Section: Discussioncontrasting

confidence: 52%

“…In our patients, cardiac output was not measured. Bannenberg et al [1] observed significant increases in cardiac output during intraperitoneal CO 2 insufflation, but not during extraperitoneal insufflation. Their studies were performed with pigs, so the hemodynamic results may be different from the hemodynamic changes observed in humans.…”

Section: Discussionmentioning

confidence: 99%

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Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy

et al. 2004

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“…The use of laparoscopy in patients with congenital heart disease is controversial. Although the hemodynamic effects of laparoscopic procedures are well understood in the patient with a normal heart [17][18][19][20][21][22], the predictable depression of preload and CO may not be tolerated in patients with some types of congenital heart disease. The current literature reports both acceptable and unacceptable results with laparoscopy in pediatric cardiac patients, and there is also mounting concern that some categories of cardiac patients are at high risk of perioperative morbidity and mortality associated with even trivial procedures [23][24][25].…”

Section: Hemodynamic Effects Of a Pa Bandmentioning

confidence: 98%

Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature

Pierce

Sharma

Hunter

et al. 2012

Journal of Clinical Anesthesia

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Hemodynamics during laparoscopic extra- and intraperitoneal insufflation

Cited by 34 publications

References 11 publications

An Increase of Abdominal Pressure Increases Pulmonary Edema in Oleic Acid–induced Lung Injury

An Increase of Abdominal Pressure Increases Pulmonary Edema in Oleic Acid–induced Lung Injury

Prolonged intraperitoneal versus extraperitoneal insufflation of carbon dioxide in patients undergoing totally endoscopic robot-assisted radical prostatectomy

Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature

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