Pneumoperitoneum in laparoscopy and preoperative antihypertensive agents: A retrospective study

Abstract

The purpose of the current study was to investigate the effects of preoperative antihypertensive agents on blood pressure (BP) changes after intraperitoneal CO 2 insufflation during laparoscopic surgery. The medical records of patients (≥50 years old) undergoing laparoscopic colon surgery were retrospectively analyzed (n=342). The patients were divided into four groups: normotensive group (group N), monotherapy with angiotensin receptor blockers (ARBs) (group A), monotherapy with calcium channel blockers (CCBs) (group C), and combination therapy with ARBs and CCBs (group AC). The systolic BP changes were investigated, and their correlations with preoperative pulse pressure were analyzed. The degree of increase from baseline BP to that after CO 2 insufflation was significantly lower in groups A [difference vs. group N, 17.8; 95% confidence interval (CI), 7.8-27.8; P=0.001) and AC (18.2; 95% CI, 8.7-27.7; P<0.001] compared with groups N and C. The incidence of intraoperative hypotension was not significantly different among the groups. In groups A and AC, the preoperative pulse pressure showed a strong correlation (r=0.73 and 0.83, respectively) with the increase in BP after CO 2 insufflation. In conclusion, patients with hypertension who received ARBs before surgery showed a strong correlation between the preoperative pulse pressure and BP fluctuation immediately after CO 2 insufflation. Small BP fluctuations are suggested to indicate the positive role of ARBs. Large randomized controlled trials are required to validate these results and assess the effect of each antihypertensive agent. This trial was registered (Trial registration:

A comparison of outcomes between laparoscopic and open adrenalectomies in dogs

“…In addition, studies in man have provided evidence that CO 2 insufflation of the peritoneum can result in increased blood pressure via increased catecholamine production, plasma renin activity, antidiuretic hormone production, and systemic vascular resistance 28 . Kim et al 29 found that standard laparoscopic CO 2 insufflation of the peritoneum resulted in a mean increase in systolic pressure of 21 ± 24 mm Hg in patients that were normotensive preoperatively. Insufflation of the peritoneal cavity to a pressure lower than 15 mm Hg can result in increased venous return from compression of the splanchnic circulation and subsequent increase in cardiac output and systemic arterial pressure 30 .…”

Laparoscopic vs. open adrenalectomy: perioperative data and survival analysis in 70 dogs with an adrenal tumor

“…This might be related to the similar surgical duration in both groups in our study, implying a comparable duration of exposure to inhalant anesthetic agents with potential blood pressure-lowering effects ( 32 , 33 ). In general, CO 2 insufflation during laparoscopic abdominal surgery has been associated with elevated arterial blood pressure ( 34 , 35 ). However, with intra-abdominal CO 2 pressure set at 8 mm Hg, no differences were found in persistent systemic hypertension or borderline hypertension during LA or OA in our study.…”