Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy.
BACKGROUND
Pneumoperitoneum (PP) for laparoscopic surgery induces prompt changes in circulatory parameters. The rapid onset of these changes suggests a reflex origin, and the present study was undertaken to evaluate whether release of vasopressor substances could be responsible for these alterations. The influence of two different anesthesia techniques was also evaluated.


METHODS
American Society of Anesthesiologists (ASA) class I patients, scheduled for laparoscopic cholecystectomy, were investigated. The first group (n = 10) was anesthetized intravenously. The second group (n = 6) had inhalation anesthesia. Plasma vasopressin, catecholamines, and plasma renin activity were investigated as neurohumoral vasopressor markers of circulatory stress. The general stress response to surgery was assessed by analysis of plasma cortisol.


RESULTS
Induction of pneumoperitoneum caused no apparent activation of vasopressor substances, although several hemodynamic parameters responded promptly.


CONCLUSIONS
The hemodynamic alterations, seen at the establishment of PP during stable anesthesia, cannot be explained by elevation of vasopressor substances in circulating blood.
Odeberg
S
S
Department of Anesthesia and Intensive Care, Huddinge University Hospital, S-141 86 Huddinge, Sweden.
Ljungqvist
O
O
Svenberg
T
T
Sollevi
A
A
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002395:Catecholamines / Q000378:metabolism*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002764:Cholecystitis / Q000097:blood / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007530:Isoflurane / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011028:Pneumoperitoneum, Artificial; D012083:Renin / Q000378:metabolism*; D012084:Renin-Angiotensin System / Q000187:drug effects; D018709:Statistics, Nonparametric; D014667:Vasopressins / Q000378:metabolism*
D018685:Anesthetics, Inhalation; D002395:Catecholamines; D014667:Vasopressins; D007530:Isoflurane; D012083:Renin; D006854:Hydrocortisone