Alterations in hemodynamics and left ventricular contractility during carbon dioxide pneumoperitoneum.
BACKGROUND
Carbon dioxide (CO2) pneumoperitoneum has been shown to adversely affect hemodynamics in patients. This study specifically examines the potential contribution of altered left ventricular contractility (LVC) to hemodynamic changes observed during CO2 pneumoperitoneum.


METHODS
In a canine model, LV volumes, LV pressure, and intrathoracic and central venous pressures were recorded both at basal intra-abdominal pressure (IAP) and after CO2 insufflation to produce IAPs of 5-25 mmHg.


RESULTS
At IAPs greater than 15 mmHg, cardiac output and LV end-diastolic volume decreased. Mean arterial pressure and heart rate were unchanged. LVC, quantified using the linear Frank-Starling relationship, was not affected by increases in IAP.


CONCLUSIONS
This study is the first to quantify LVC during CO2 pneumoperitoneum and demonstrates no changes in contractility over IAPs from 5 to 25 mmHg. In the dog model, any hemodynamic alterations induced by CO2 pneumoperitoneum are secondary to altered LV preload and not alterations in contractility or LV afterload.
Marathe
U S
US
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Lilly
R E
RE
Silvestry
S C
SC
Schauer
P R
PR
Davis
J W
JW
Pappas
T N
TN
Glower
D D
DD
D000818:Animals; D002245:Carbon Dioxide / Q000494:pharmacology*; D002302:Cardiac Output / Q000187:drug effects; D004285:Dogs; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D009200:Myocardial Contraction / Q000187:drug effects; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D013318:Stroke Volume / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
D002245:Carbon Dioxide