Lower Extremity Venous Changes in Pneumoperitoneum During Laparoscopic Surgery

Güleç, Bülent; Öner, Köksal; Yigitler, Cengizhan; Kocaoğlu, Murat; Aydin, Yüksel; Sağlam, Mutlu

doi:10.1111/j.1445-2197.2006.03906.x

Cited by 19 publications

(9 citation statements)

References 15 publications

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“…Gülec et al reported that laparoscopy can constrict the inferior vena cava leading to stasis in the peripheral veins and pooling of blood in the lower limbs [46]. In our cohort, 61% of the patients had laparoscopic surgery, which might influence the efficacy of whole body bioimpedance spectroscopy due the reduced urinary secretion, increased abdominal pressure and venous congestion in the lower limbs.…”

Section: Discussionmentioning

confidence: 76%

Bioimpedance Spectroscopy for Assessment of Volume Status in Patients before and after General Anaesthesia

et al. 2014

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BackgroundTechnically assisted assessment of volume status before surgery may be useful to direct intraoperative fluid administration. We therefore tested a recently developed whole-body bioimpedance spectroscopy device to determine pre- to postoperative fluid distribution.MethodsUsing a three-compartment physiologic tissue model, the body composition monitor (BCM, Fresenius Medical Care, Germany) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. BCM-measurements were performed before and after standardized general anaesthesia for gynaecological procedures (laparotomies, laparoscopies and vaginal surgeries). BCM results were blinded to the attending anaesthesiologist and data analysed using the 2-sided, paired Student’s t-test and multiple linear regression.ResultsIn 71 females aged 45±15 years with body weight 67±13 kg and duration of anaesthesia 154±68 min, pre- to postoperative fluid overload increased from −0.7±1.1 L to 0.1±1.0 L, corresponding to −5.1±7.5% and 0.8±6.7% of normal extracellular volume, respectively (both p<0.001), after patients had received 1.9±0.9 L intravenous crystalloid fluid. Perioperative urinary excretion was 0.4±0.3 L. The increase in extracellular volume was paralleled by an increase in total body fluid volume, while intracellular volume increased only slightly and without reaching statistical significance (p = 0.15). Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r2 = 0.65), but was not associated with change in intracellular volume (r2 = 0.01).ConclusionsRoutine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment. BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies.

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Section: Discussionmentioning

confidence: 76%

Bioimpedance Spectroscopy for Assessment of Volume Status in Patients before and after General Anaesthesia

et al. 2014

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“…Pathophysiological factors that may lead to VTE following laparoscopic cholecystectomy include obstruction to venous outflow during surgical pneumoperitoneum and activation of the coagulation system. Decreased blood velocity or decreased venous outflow in the femoral veins during surgical CO 2 pneumoperitoneum was observed by several [22][23][24][25][26][27][28] but not all investigators. 29 Graded compression stockings reduced or abolished decreased blood velocity in one 26 but not in another investigation.…”

Section: Discussionmentioning

confidence: 98%

Pulmonary Embolism and Deep Venous Thrombosis Following Laparoscopic Cholecystectomy

Stein

Matta

Sabra

2013

Clin Appl Thromb Hemost

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There is considerable uncertainty related to the thromboembolic risk after laparoscopic cholecystectomy. Patients with pulmonary embolism (PE), deep venous thrombosis (DVT), or venous thromboembolism (VTE) at hospital discharge following laparoscopic cholecystectomy were identified from the Nationwide Inpatient Sample. From 1998 through 2009, 4 107 430 laparoscopic cholecystectomies were performed. The in-hospital prevalence of PE was 0.15%, DVT was 0.40%, and VTE was 0.53%. The prevalence of PE increased from 0.04% in patients aged 21 to 30 years to 0.31% in patients aged 71 to 80 years. Deaths due to in-hospital PE were 780 (0.02%) of the 4 107 430 laparoscopic cholecystectomies. The rate of death increased with age. The prevalence of VTE following laparoscopic cholecystectomy is low and fatal PE is rare. The risk of VTE increased with age, as did the risk of death in those who had PE. These data may be useful in assessing the use of thromboprophylaxis in patients undergoing laparoscopic cholecystectomy.

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“…The increased IAP and reverse Trendelenburg position during laparoscopy have been shown to reduce femoral venous flow. 47,48 Nguyen et al 49 reported that increased IAP and reverse Trendelenburg positioning are independent factors that resulted in decreased femoral peak systolic velocity.…”

Section: Changes In Renal Functionmentioning

confidence: 99%

Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance

Hasukic¹

2014

WJOLS

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Background: Knowledge of the pathophysiological basis of laparoscopic procedures, in particular the impact of CO 2pneumoperitoneum (PNP) on the body, can prevent onset of complications during laparoscopy.Design and Methods: Standard intra-abdominal pressure (IAP), which is used during laparoscopic surgery, is 12 to 15 mm Hg. The direct effect of CO 2 -pneumoperitoneum is a consequence of the mechanical action of the gas, and increased intra-abdominal pressure. The indirect effect of CO 2 -pneumoperitoneum caused by the absorption of gas from the abdomen. Analysis of articles that evaluated the effects of CO 2 -pneumoperitoneum on the body and intra-abdominal organs contributes to an even better use of the laparoscopic method. Results:The results of numerous experimental and clinical studies have confirmed that increased IAP and CO 2 -pneumoperi toneum intraoperatively causing reduction the portal venous blood flow, increasing venous stasis, reduced glomerular filtration, reduced Tiffeneau-index and pulmonary compliance what it can lead to hemodynamic and cardiac disorders. Consecutive intraoperative acidosis and hipercarbia impact the function of intra-abdominal organs and heart. Conclusion:To avoid the side effects of CO 2 -pneumoperitoneum, which is important in patients with ASA II and more often as necessary to be operate with low pressure (IAP: 6-8 mm Hg) or use gasless laparoscopy.

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Lower Extremity Venous Changes in Pneumoperitoneum During Laparoscopic Surgery

Abstract: The degree of intra-abdominal pressure affects the haemodynamics of the peripheral veins. Pneumoperitoneum during laparoscopy causes stasis in the peripheral veins. It is reasonable to use routine prophylaxis for deep vein thrombosis, in the light of these findings.

Cited by 19 publications

References 15 publications

Bioimpedance Spectroscopy for Assessment of Volume Status in Patients before and after General Anaesthesia

Bioimpedance Spectroscopy for Assessment of Volume Status in Patients before and after General Anaesthesia

Pulmonary Embolism and Deep Venous Thrombosis Following Laparoscopic Cholecystectomy

Co2-Pneumoperitoneum in Laparoscopic Surgery: Pathophysiologic Effects and Clinical Significance

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