Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy.
BACKGROUND
Peritoneal insufflation to 15 mmHg diminishes venous return and reduces cardiac output. Such changes may be dangerous in patients with a poor cardiac reserve. The aim of this study was to investigate the hemodynamic effects of high (15 mmHg) and low (7 mmHg) intraabdominal pressure during laparoscopic cholestectomy (LC) METHODS: Twenty patients were randomized to either high- or low-pressure capnoperitoneum. Anesthesia was standardized, and the end-tidal CO2 was maintained at 4.5 kPa. Arterial blood pressure was measured invasively. Heart rate, stroke volume, and cardiac output were measured by transesophageal doppler.


RESULTS
There were 10 patients in each group. In the high-pressure group, heart rate (HR) and mean arterial blood pressure (MABP) increased during insufflation. Stroke volume (SV) and cardiac output were depressed by a maximum of 26% and 28% (SV 0.1 > p > 0.05, cardiac output p > 0. 1). In the low-pressure group, insufflation produced a rise in MABP and a peak rise in both stroke volume and cardiac output of 10% and 28%, respectively (p < 0.05).


CONCLUSIONS
Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation.
Dexter
S P
SP
Academic Department of Surgery, The General Infirmary, Leeds, LS1 3EX, United Kingdom.
Vucevic
M
M
Gibson
J
J
McMahon
M J
MJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure; D002302:Cardiac Output; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D018475:Head-Down Tilt; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D013318:Stroke Volume; D016896:Treatment Outcome