Splanchnic ischemia during laparoscopic cholecystectomy

Eleftheriadis, E; Kotzampassi, Katerina; Botsios, Dimitrios; Tzartinoglou, E.; Farmakis, H.; Dadoukis, J

doi:10.1007/bf00187381

Cited by 158 publications

(51 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Accordingly, at 10 mmHg pressure, only slight metabolic acidosis of short duration was observed, whereas at 15 mmHg profound acidosis of long duration and increased level of plasma lactate became evident after 90 min. 2 1 In the previous reports of tonometry during laparoscopic cholecystectomy intraabdominal pressure was 12 mmHg, 9 12-13 mmHg 10 or 15 mmHg. 1 1 Surprisingly, with saline tonometry, very low gastric intramucosal pH (7.15) 9 was seen during 12 mmHg and normal pH during 15 mmHg intraabdominal pressure.…”

Section: Discussionmentioning

confidence: 95%

“…7 The method has been improved to a clinically feasible on-line monitoring of splanchnic perfusion by new automated air tonometry. 8 Results of tonometric measurements during laparoscopic cholecystectomy have been conflicting, varying from reports of splanchnic ischemia 9 or deterioration 10 to no detectable changes. 1 1 We studied gastric air tonometry together with simultaneous measurement of arterial acid-base balance during laparoscopic cholecystectomy and immediate postoperative period.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Mäkinen

Heinonen

Klemola

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: Pneumoperitoneum can cause disturbances in acid-base balance and splanchnic perfusion. We studied the effect of ventilation on acid-base balance and gastric mucosal tonometric values in patients undergoing laparoscopic cholecystectomy. Methods: Twenty-four patients (ASA I-II) were randomly allocated into two groups. In the fixed ventilation group, ventilation was constant allowing free increase in PCO 2 , while in the constant CO 2 group end-tidal PCO 2 was fixed with ventilatory adjustment. Intraabdominal pressure was limited to 12 mmHg. Arterial acid-base balance, automated air tonometric variables and gastric mucosal to arterial PCO 2 gap were determined frequently from anesthesia induction until three hours postoperatively. Results: During pneumoperitoneum, in the fixed ventilation group arterial PCO 2 changed from 5.0 ± 0.2 to 6.6 ± 0.4 kPa and pH from 7.43 ± 0.03 to 7.33 ± 0.04, tonometric PCO 2 from 5.1 ± 0.5 to 6.9 ± 0.4 and pH from 7.44 ± 0.04 to 7.33 ± 0.04. In the constant CO 2 group these variables remained at control levels (P < 0.01 between groups). The PCO 2 gap remained unchanged without any differences between the groups. In the recovery room all measured variables were within normal range in both groups.Conclusion: Despite inter-group differences in arterial and tonometric PCO 2 and pH values during CO 2 pneumoperitoneum, the patients did not develop splanchnic hypoperfusion detectable by air tonometric method, as indicated by normal PCO 2 gap in both groups throughout the study.Objectif : Le pneumopéritoine peut causer des perturbations de l'équilibre acido-basique et de l'irrigation splanchnique. Nous avons étudié l'effet de la ventilation sur l'équilibre acido-basique et la tonométrie de la muqueuse gastrique chez des patients devant subir une cholécystectomie laparoscopique.Méthode : Vingt-quatre patients (ASA I-II) ont été répartis au hasard en deux groupes. Dans le premier groupe, à ventilation fixe, la ventilation était constante et permettait une augmentation libre de la PCO 2 , tandis que dans le second groupe, au CO 2 constant, la PCO 2 de fin d'expiration était fixe par ventilation adaptée. La pression intraabdominale était limitée à 12 mmHg. L'équilibre acido-basique artériel, les variables automatisées de la tonométrie gazeuse de la muqueuse gastrique, pour calculer l'écart de PCO 2 artériel, ont été déterminés fréquemment depuis l'induction de l'anesthésie jusqu'à trois heures après l'opération.Résultats : Pendant le pneumopéritoine, dans le groupe à ventilation fixe, la PCO 2 artérielle est passée de 5,0 ± 0,2 à 6,6 ± 0,4 kPa et le pH de 7,43 ± 0,03 à 7,33 ± 0,04; la PCO 2 tonométrique est passée de 5,1 ± 0,5 à 6,9 ± 0,4 et le pH de 7,44 ± 0,04 à 7,33 ± 0,04. Dans le groupe au CO 2 constant, ces variables ont conservé les valeurs témoins (P < 0,01 intergroupe). L'écart de PCO 2 est demeuré inchangé et sans différence intergroupe. Dans la salle de réveil, toutes les variables mesurées étaient dans les limites de la normale pour les patients des deux groupes.Conclusion : M...

show abstract

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Mäkinen

Heinonen

Klemola

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…[2] Reduced venous return and the reduction in cardiac output and accompanying mesenteric vasoconstriction and increased systemic vascular resistance has been reported to cause a significant reduction in organ perfusion and portal venous flow during the increase in IPP. [50,[58][59][60][61] The vasoconstrictive effect of CO2 also causes reduced visceral blood flow. [48] The normal mean IPP is zero or less and a clinically significant elevation of IPP up to 10 to 15 mmHg significantly decreases the abdominal splanchnic blood flow.…”

Section: Intraperitoneal Pressure (Ipp)mentioning

confidence: 99%

“…For example blood flow in abdominal hypertension decreases in the stomach by 40 per cent, duodenum by 11 per cent, jejunum by 32 per cent, colon by 44 per cent, liver by 39 per cent and the parietal peritoneum by 60 per cent. [50,58,59] In an animal model, increased IPPs of 10 and 20 mmHg caused a respective decrease of 20% and 40% in mucosal blood flow in the small intestine. [62] Splanchnic perfusion changes are the result of a complex interaction between anaesthesia, the surgical insult, patient position and the nature of the gas used.…”

Section: Intraperitoneal Pressure (Ipp)mentioning

confidence: 99%

“…[1] Increased IPP is an important cause of gastrointestinal ischemia. [58,67] Impaired perfusion of splanchnic organs secondary to increased IPP and their reperfusion after the procedure represent ischemia and reperfusion (I/R) respectively. I/R injury is responsible for most of the damage complicating reversible arterial insufficiency of the intestine, provided that there is no venous congestion.…”

Section: Intraperitoneal Pressure (Ipp)mentioning

confidence: 99%

See 1 more Smart Citation

Abdominal Effects Of Laparoscopic Surgery

Tolan¹

2017

Laparosc Endosc Surg Sci

View full text Add to dashboard Cite

Pneumoperitoneum (PNP) is very commonly performed in surgical practice due to the extensive use of laparoscopic surgery. In minimally invasive surgery, there is an effort to convert all eligible surgical procedures to a laparoscopic technique, as it has fewer systemic and local surgical effects on the patient. During PNP, intraperitoneal pressure (IPP) is increased to well above normal intra-abdominal pressure in order to create an opening for visualization of the abdominal contents. The duration of these procedures can be prolonged as a result of the difficulties and complexities of these techniques. IPP has side effects on the physiology of patients, as is seen in abdominal compartment syndrome.

show abstract

Impact of Laparoscopic and Conventional Surgery on Kupffer Cells, Tumor-Associated CD44 Expression, and Intrahepatic Tumor Spread

Gutt

Kim²,

Schemmer³

et al. 2002

Arch Surg

View full text Add to dashboard Cite

Background: The oncologic feasibility of laparoscopic surgery for the cure of colorectal cancer is under debate. The effect of laparoscopic colorectal cancer resection on hepatic tumor spread has not yet been clarified. Hypothesis: Laparoscopic surgery affects cellmediated immune response and hepatic tumor spread dependent on intraperitoneal insufflation. Methods: Thirty WAG/Rij rats were randomized into 3 operative groups: carbon dioxide (CO 2) laparoscopy (n=10), "gasless" laparoscopy (n = 10), and laparotomy (n=10). To induce liver metastases, 50 000 CC531 colon carcinoma cells were injected into the portal vein during either laparoscopy or laparotomy. Twenty-eight days after injection, specimens were explanted, sectioned, and examined immunohistochemically for CC531 tumor cells (monoclonal antibody CC52), CD44v5, v6 (monoclonal antibody OX49), and Kupffer cells (monoclonal antibody HIS36). For quantification, a morphometric analysis system was applied. Data were analyzed using the Kruskal-Wallis, Dunn, and Holm tests. Results: No statistically significant differences in hepatic tumor growth were found between CO 2 laparoscopy and laparotomy (P=.37). However, compared with CO 2 laparoscopy and laparotomy, a significant decrease in intrahepatic tumor growth was found after gasless laparoscopy (P = .02). Kupffer cells had significantly decreased after CO 2 laparoscopy and laparotomy compared with after gasless laparoscopy (PϽ.001 and P=.002, respectively). CD44v5, v6 expression was significantly increased after CO 2 laparoscopy and laparotomy compared with after gasless laparoscopy (P=.002 and P=.05, respectively). Conclusions: Hepatic resistance to tumor growth is best preserved by gasless laparoscopy as opposed to CO 2 laparoscopy or laparotomy. The amount of intra-abdominal pressure with circulatory changes rather than the used gas may explain this finding. On the other hand, conventional laparoscopy vs laparotomy did not preserve hepatic immune function.

show abstract

Splanchnic ischemia during laparoscopic cholecystectomy

Abstract: It is concluded that during laparoscopic cholecystectomy abdominal organs are hypoperfused, leading to a splanchnic ischemia environment. The clinical significance of these events remains to be clarified.

Cited by 158 publications

References 10 publications

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels

Abdominal Effects Of Laparoscopic Surgery

Impact of Laparoscopic and Conventional Surgery on Kupffer Cells, Tumor-Associated CD44 Expression, and Intrahepatic Tumor Spread

Contact Info

Product

Resources

About