Reversal of Adverse Hemodynamic Effects of Pneumoperitoneum by Pressure Equilibration

Abstract

The creation of positive-pressure pneumoperitoneum during laparoscopic operations can lead to adverse hemodynamic changes, mainly decreased cardiac output. We hypothesized that pneumatic compression sleeves worn on the legs during pneumoperitoneum could abolish the pressure gradient between the abdominal cavity and the legs and so eliminate these adverse hemodynamic changes. Design: Prospective, randomized, controlled clinical trial with an additional calibration group. Setting: A regional referral center. Patients: Forty-five consecutive patients undergoing laparoscopic cholecystectomy who developed hemodynamic changes on induction of positive-pressure pneumoperitoneum were randomized to 3 groups. Interventions: Low-pressure, nonsequential pneumatic compression sleeves, wrapped around the legs, were used to equilibrate the pressure gradient in the study group and to gradually exceed it in the calibration group. In the control group, no sleeves were used. Main Outcome Measures: Transesophageal Dop-pler cardiac output, stroke volume, and systemic vascular resistance were monitored noninvasively. Results: The creation of positive-pressure pneumoperitoneum caused a significant decrease of cardiac output and stroke volume and increased systemic vascular resistance. In the experimental groups of patients, pressurizing the sleeves to the pneumoperitoneal pressure caused a significant increase of cardiac output (from 4.82 to 6.74 L/min), increased stroke volume, and decreased systemic vascular resistance (PϽ.001). This was not seen in the control group. Additional gradual pressure increase in the sleeves of the calibration group produced no further improvement. Releasing the pressure abolished the hemodynamic advantages. Conclusions: Applying pressure on the legs equivalent to the positive-pressure pneumoperitoneum improves hemodynamic performance during pneumoperitoneum by nullifying the pressure gradient that is responsible for the adverse consequences. This might be of major practical value, especially for cardiac patients undergoing prolonged laparoscopic operations.

Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis

“…These changes in turn lead to a decrease in oxygenation ratio and an abrupt rise in the central venous pressure as demonstrated in Figure 2 [4,6]. It is well known that small changes in intra-abdominal pressure affect cardiac output [16][17][18] due to the reduction in the venous return by narrowing of the vena cava associated with a reduction of the abdominal blood volume and an increase in splanchnic vascular resistance [19,20]. Blood volume plays a major role for establishment and maintenance of adequate systemic as well as regional perfusion as reduction of venous return is a critical factor when the blood volume is low [10].…”

Sitoreduktif Cerrahi ve HIPEK’te Anestezi ve Perioperatif Bakim

“…Batın içindeki basınç değişiklikleri kardiyak outputu etkiler. Splenik damar direncinin artması, abdominal kan miktarının azalması venöz dönüşü azaltır (19,20). Sistemik ve bölgesel perfüzyonun idame ettirilmesinde kan volümü önemli rol oynar (7).…”

Keyless Abdominal Rope-lifting Surgery (KARS)

“…Gasless nature of KARS avoids pneumoperitoneum associated side effects like hypercapnia, acidosis, gas embolism, pneumothorax, subcutaneous emphysema, deep venous thrombosis, instability of the hemo-dynamics, decrease in renal functions, and peritoneal oxidative stress [5][6][7]10,11,[25][26][27]. Although the operative time and patient position limit the use of regional (spinal and epidural) anesthesia in KARS, gasless surgery is also more optimal for regional anesthesia.…”

“…Researchers have conducted and published numerous trails in order to minimize the side effects and maximize the advantages of laparoscopic surgery [10][11][12][13][14][15]. Keyless Abdominal Rope-lifting Surgery (KARS) is one of the laparoscopic surgery techniques claiming to improve the outcomes of laparoscopic surgery [16,17].…”