Utility of transesophageal echocardiography and pulmonary artery catheterization during laparoscopic assisted abdominal aortic aneurysm repair

Abstract

Insufflation increased PAD and CVP. However, volume status as suggested by EDA and PCWP did not change. These data question the reliability of hemodynamic measurements obtained from the PAC during pneumoperitoneum and suggest that TEE may be sufficient for evaluation of volume status along with the added benefit of timely detection of ventricular wall motion abnormalities.

The effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy

“…Dorsay et al found no difference in cardiac output (CO) with pneumoperitoneum, whereas McLaughlin et al reported a reduction of 30% [4,8]. More recently, when both the thermodilution technique and the transesophageal techniques were used in the same human study, the results show no significant changes in cardiac output [3,9,10]. These studies show that pulmonary capillary wedge pressure (PCWP) increases consistently with pneumoperitoneum, but both impedance measures and measures by TEE do not show a corresponding change in left ventricular volume.…”

“…The effects of pneumoperitoneum have been studied extensively in both animals and humans [1,4,6,9]. Pneumoperitoneum has consistently been shown to increase mean arterial pressure, heart rate, and central venous pressure [3,4]. Decreases in cardiac output as great as 30% have been reported as well; however, most of these studies were conducted in young healthy women undergoing brief gynecologic procedures [2,7,11,12].…”

Comparative Effectiveness and Harms of Intraoperative Transesophageal Echocardiography in Noncardiac Surgery: A Systematic Review

“…Twelve intraoperative deaths were reported in 140 surgical patients in four non-comparative studies. 17,18,25,26 These numbers, however, do not lend themselves to even a crude estimation of TEE-associated risk of death because 2 of the 4 studies were case series of patients who had experienced cardiac arrest intraoperatively. 17,26…”

Elucidating the relationship between cardiac preload and renal perfusion under pneumoperitoneum

“…In the laboratory setting, preload may be assessed with echocardiography by measurement of the left ventricular end-diastolic diameter. Findings have shown echographic cardiac chamber measurements to be reliable measures of blood loss, suggesting that this technique is a good index of preload [6].…”