The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

Abstract

BackgroundIncreased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery.MethodsThis study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration.ResultsThe comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001).ConclusionsPneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts.Trial registrationDate of registration 21/07/2016, ISRCTN Registry ( No:ISRCTN15164056, registered retrospectively).

The effect of different pressures of pneumoperitoneum on the dimensions of internal jugular vein – A prospective double-blind, randomised study

“…Pinar HU et al , found an increase in CSA of IJV and SCV with pneumoperitoneum of 12 mmHg at both expiration and inspiration, which decreased to prior values on desufflation. [ 7 ] This was similar to the findings of the current study, however, different pressures of pneumoperitoneum were not used in their study. Low pressure pneumoperitoneum decreases postoperative pain, analgesic consumption and seems to improve perioperative functioning of the liver and kidney.…”

“…The duration of surgery was recorded. Pinar HU et al ,[ 7 ] in their study observed a 20% increase in IJV CSA as significant. We considered a 30% increase in CSA of IJV as significant and with a standard deviation of 0.622, to achieve a confidence level of 95% and power of 80% had to enrol 68 patients in each group.…”

“…Though there was an increase in HR and mean arterial pressure (MAP) in the two groups, the authors found a decrease in stroke volume and cardiac output in the 15 mmHg group by 10 and 26%, respectively. [ 7 ] McLaughlin et al ,[ 18 ] in their study reported that with a pneumoperitoneum of 15 mmHg, there was a 60% increase in MAP and a 30% fall in stroke volume and cardiac output. [ 7 ] Another study reported an increase in venous return with an IAP less than 15 mmHg due to squeezing of the venous bed and a fall in venous return and blood pressure due to compression of the inferior vena cava with an IAP of 15 mmHg or more.…”

“…[ 7 ] McLaughlin et al ,[ 18 ] in their study reported that with a pneumoperitoneum of 15 mmHg, there was a 60% increase in MAP and a 30% fall in stroke volume and cardiac output. [ 7 ] Another study reported an increase in venous return with an IAP less than 15 mmHg due to squeezing of the venous bed and a fall in venous return and blood pressure due to compression of the inferior vena cava with an IAP of 15 mmHg or more. [ 19 ] In our study, there were no significant changes in the HR, SBP and DBP between the groups.…”

Influence of various positive airway pressure levels on catheterization of the right internal jugular vein

“…Sustained PAP usage is linked to an increased likelihood of hypotensive events. [18][19][20][21] Limitations of the study…”