Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig.
BACKGROUND
Studies of the hemodynamic effects associated with the pneumoperitoneum have had controversial results. We set out to investigate the effect of increased intraabdominal pressure (IAP) on cardiac output and tissue blood flow in various intraabdominal and extraabdominal organs using the color-labeled microsphere (CLM) technique.


METHODS
IAP was induced by CO2 insufflation in anesthetized pigs; 0, 5, and 10 mmHg was used in the low-pressure group and 0, 15, and 24 mmHg in the high-pressure group. Tissue blood flow (ml.min-1.g-1) and cardiac output (CO) (ml/min) were determined by the CLM technique.


RESULTS
CO decreased at IAP > or = 15 mmHg. Arterial PaCO2 and hydrogen ion concentration increased in response to all levels of IAP. Arterial PaO2, oxygen saturation, and bicarbonate ion concentration remained unchanged. Low IAP did not influence tissue blood flows in most of the organs. However, in the spleen, pancreas, esophagus, and gastric mucosal specimens, tissue blood flow was significantly decreased at 24 mmHg.


CONCLUSIONS
The level of IAP used in current practice (10-12 mmHg) appears to be safe with regard to hemodynamic variables and tissues blood flow; however, higher levels may induce a decrease in cardiac output and tissue blood flow.
Yavuz
Y
Y
National Center for Advanced Laparoscopic Surgery, Trondheim University Hospital, Olav Kyrres gt. 17, N-7006 Trondheim, Norway.
Rønning
K
K
Lyng
O
O
Mårvik
R
R
Grønbech
J E
JE
D000818:Animals; D001783:Blood Flow Velocity; D001784:Blood Gas Analysis; D002302:Cardiac Output / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D007553:Isotope Labeling; D008297:Male; D008863:Microspheres; D023421:Models, Animal; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011312:Pressure; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013552:Swine