title: Variance of cardiorespiratory parameters during gynaecological surgery with CO2-pneumoperitoneum.
abstract: Laparoscopic procedures with CO2-pneumoperitoneum are used widely in gynaecology and surgery. The effects of a 15 degrees head-down position, different intra-abdominal pressures (IAP) and CO2-insufflation flows on cardiorespiratory parameters were studied prospectively in 18 gyneacologic patients under general anaesthesia. The 15 degrees head-down position led to significant changes in heart rate (-6%) and in central venous pressure (+53%). Furthermore, significant changes under commonly used conditions for gynaecological laparoscopy (IAP 9mmHg, CO2-insufflation flow 2.41/ min., 15 degrees head-down position) were found in heart rate (+16%), systolic blood pressure (+21%), diastolic blood pressure (+26%), central venous pressure (+57%), peak inspiratory pressure (+26%), end-tidal CO2-concentration (+19%), central venous pCO2 (+21%), and central venous pH (-7%). On examination of variable pressure and insufflation flows (IAP 3, 9, and 15mmHg; CO2-insufflation flows 1.2, 2.4, and 6.0 1/min.), increasing changes in heart rate (7% - 24%), diastolic blood pressure (22% - 33%), central venous pressure (30% - 59%) and peak inspiratory pressure (10% - 43%) correlated with increasing IAP. However, they were independent of CO2-insufflation flows. The results demonstrate that CO2-pneumoperitoneum causes marked changes in cardiorespiratory parameters, but these do not exceed levels commonly regarded as safe in ASA class I and II patients.
authors.affiliation: Department of Anaesthesiology, University of Tuebingen School of Medicine, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schleifer
authors.forename: U
authors.initials: U
authors.lastname: Bissinger
authors.forename: H
authors.initials: H
authors.lastname: Guggenberger
authors.forename: D
authors.initials: D
authors.lastname: Heuser
mesh_terms: D000005:Abdomen; D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000097:blood / Q000378:metabolism; D002496:Central Venous Pressure; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D018475:Head-Down Tilt; D006321:Heart / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D006863:Hydrogen-Ion Concentration; D001239:Inhalation; D007327:Insufflation / Q000379:methods; D010535:Laparoscopy; D008168:Lung / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D011446:Prospective Studies; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen