Insufflation profile and body position influence portal venous blood flow during pneumoperitoneum.
BACKGROUND
We investigated changes in portal venous blood flow (PVBF) during carbon dioxide (CO2) pneumoperitoneum to evaluate the effects of different insufflation profiles and body positions.


METHODS
An established rat model was extended by implanting a portal vein flow probe that would enable us to measure PVBF for 60 min [t0-t60] in animals subjected to a CO2 pneumoperitoneum with an intraabdominal pressure (IAP) of 9 mmHg. Forty-eight male Sprague-Dawley rats were randomized into the following four experimental and two control groups: decompression group D1 ( n = 8), desufflation for 1 min every 14 min; decompression group D2 ( n = 8), desufflation for 5 min, after 27 min; position group P1 ( n = 8), 35 degrees head-up position; position group P2 ( n = 8), 35 degrees head-down position; negative control group C1 ( n = 8), no insufflation; positive control group C2 ( n = 8), constant IAP of 9 mmHg for 60 min.


RESULTS
Pneumoperitoneum and body positions, respectively, reduced PVBF [t1-t60] significantly ( p < 0.001) by 32.0% C2, 32.8% D1, 31.1% D2, 40.8% P1, and 48.5% P2, as compared to PVBF at t0 in each group. There was a significant difference in PVBF reduction between P1 and P2 and also between C2 and both P1 and P2 ( p < 0.04).


CONCLUSIONS
CO2 pneumoperitoneum reduces PVBF significantly (>30%). Extreme body positions (35 degrees tilt) significantly intensify PVBF reduction. PVBF reduction is significantly more dramatic in subjects placed in a 35 degrees head-down position. Short desufflation periods did not improve mean PVBF, but it may have beneficial immunological and oncological effects that warrant further investigation.
Department of General Surgery, Marienhospital, Stuttgart, Germany.
C N
CN
Gutt
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CG
Schmedt
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Schmandra
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O
Heupel
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Schemmer
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Büchler
D000818:Animals; D002245:Carbon Dioxide; D018475:Head-Down Tilt / Q000009:adverse effects; D007327:Insufflation; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008099:Liver / Q000098:blood supply* / Q000503:physiopathology; D008102:Liver Circulation; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011168:Portal System / Q000503:physiopathology*; D011169:Portal Vein; D011312:Pressure; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D016683:Supine Position
D002245:Carbon Dioxide