Impact of carbon dioxide and helium insufflation on cardiorespiratory function during prolonged pneumoperitoneum in an experimental rat model

Hazebroek, Eric J.; Haitsma, Jack J.; Lachmann, Burkhard; Steyerberg, Ewout W.; Bruin, Ron W. F. de; Bouvy, Nicole D.; Bonjer, H. Jaap

doi:10.1007/s00464-001-8248-x

Cited by 33 publications

(25 citation statements)

References 19 publications

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“…It may expose the infant to the risk of per-operative acidosis and alteration of the cerebral circulation because it is correlated with high CO 2 arterial pressure and low pH. 17,18 For controlling ETCO 2 and counterbalancing a reduced respiratory compliance induced by insufflation, 19 a great increase in ventilatory minute volume (22.6% in our series, 40% for Fujimoto 10 ) and PIP was essential. However, it was applied to neonatal lungs that are highly sensitive to both volume and pressure.…”

Section: Discussionmentioning

confidence: 70%

Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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ABSTRACT. Objectives. Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of videosurgery in neonates and to determine the risk factors of per-operative complications.Methods. From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula.Results. Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6°C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O 2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO 2 , surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation.Conclusion. The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. ABBREVIATIONS. ETCO 2 , end-tidal pressure of CO 2 ; O 2 sat, oxygen saturation; HR, heart rate; PIP, peak inflating pressure.

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Section: Discussionmentioning

confidence: 70%

Tolerance of Laparoscopy and Thoracoscopy in Neonates

et al. 2005

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“…As a result, mixed venous and central venous oxygen saturation may fall. Similar effects are encountered during laparoscopic surgery and these changes place the patient with IAH at risk of deep venous thrombosis and pulmonary embolism at the time of abdominal decompression [20,21]. Lower extremity hydrostatic venous pressure increases and clinical examination may show venous stasis, edema and leg ulcers in cases of chronic IAH, as seen with obesity.…”

Section: Effect Of Intra-abdominal Hypertension On Preload Pathophysimentioning

confidence: 88%

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

Malbrain

Waele²,

Keulenaer³

2015

Anaesthesiol Intensive Ther

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The effects of increased intra-abdominal pressure (IAP) on cardiovascular function are well recognized and include a combined negative effect on preload, afterload and contractility. The aim of this review is to summarize the current knowledge on this topic. The presence of intra-abdominal hypertension (IAH) erroneously increases barometric filling pressures like central venous (CVP) and pulmonary artery occlusion pressure (PAOP) (since these are zeroed against atmospheric pressure). Transmural filling pressures (calculated by subtracting the pleural pressure from the end-expiratory CVP value) may better reflect the true preload status but are difficult to obtain at the bedside. Alternatively, since pleural pressures are seldom measured, transmural CVP can also be estimated by subtracting half of the IAP from the end-expiratory CVP value, since abdominothoracic transmission is on average 50%. Volumetric preload indicators, such as global and right ventricular end-diastolic volumes or the left ventricular end-diastolic area, also correlate better with true preload. When using functional hemodynamic monitoring parameters like stroke volume variation (SVV) or pulse pressure variation (PPV) one must bear in mind that increased IAP will increase these values (via a concomitant increase in intrathoracic pressure). The passive leg raising test may be a false negative in IAH. Calculation of the abdominal perfusion pressure (as mean arterial pressure minus IAP) has been shown to be a better resuscitation endpoint than IAP alone. Finally, it is re-assuring that transpulmonary thermodilution techniques have been validated in the setting of IAH and abdominal compartment syndrome. In conclusion, the clinician must be aware of the different effects of IAH on cardiovascular function in order to assess the volume status accurately and to optimize hemodynamic performance.

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“…However, this is not conclusive due to the small testing population. Prior studies have indicated blood gas alterations as CO 2 is insufflated and diffuses into the bloodstream [20][21][22]. However, since gas insufflation did not produce a significant visual benefit, its use for optic nerve sheath fenestration may not be required.…”

Section: Discussionmentioning

confidence: 99%

“…However, this process has caused deviations in reference blood pH, pCO 2 , and HCO 3 À levels [20][21][22]. It is unknown if CO 2 insufflation in the orbit has potential for adverse consequences or is beneficial for accessing posterior orbital contents, and this study aimed to answer this question as well.…”

Section: Introductionmentioning

confidence: 94%

Endoscopic free electron laser technique development for minimally invasive optic nerve sheath fenestration

2007

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Impact of carbon dioxide and helium insufflation on cardiorespiratory function during prolonged pneumoperitoneum in an experimental rat model

Abstract: The cardiorespiratory changes during prolonged pneumoperitoneum in spontaneously breathing rats are similar to those seen in clinical practice. Therefore, studies conducted in this animal model can provide valuable physiological data relevant to the study of laparoscopic surgery.

Cited by 33 publications

References 19 publications

Tolerance of Laparoscopy and Thoracoscopy in Neonates

Tolerance of Laparoscopy and Thoracoscopy in Neonates

What every ICU clinician needs to know about the cardiovascular effects caused by abdominal hypertension

Endoscopic free electron laser technique development for minimally invasive optic nerve sheath fenestration

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