Pressure-related hemodynamic effects of CO2 pneumoperitoneum in a model of acute cardiac failure.
BACKGROUND
The adverse effects related to CO2 pneumoperitoneum (PP) have been well documented. Although these effects in the state of cardiac failure have not been investigated, it appears to be common current clinical practice to use low-pressure PP in this clinical setting, assuming it to be safer.


OBJECTIVE
The aim of our study was to compare the hemodynamic changes with the application of conventional 15 mm Hg PP versus low-pressure 10 mm Hg PP in control and acute cardiac failure (ACF) animal models.


METHODS
We studied changes in cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR), applying 10 mm Hg and 15 mm Hg CO2 PP in control and, following the pharmacological induction of acute cardiac failure, in 10 domestic pigs.


RESULTS
In control, the application of 10 mm Hg PP did not cause any significant hemodynamic changes compared to baseline parameters. The use of 15 mm Hg PP in the model with normal cardiac function, however, produced a significant change in the tested hemodynamic values: CO decreased from 3.8L/min to 2.8L/min (P =.0018); SV declined from 38 mL to 30 mL (P =.046); SVR increased from 1677 dyne.s.cm-5 to 2414 dyne.s.cm-5 (P =.049) compared to baseline. In the model of ACF induced by the intravenous infusion of sodium pentobarbital, the application of either 10 mm Hg or 15 mm Hg PP was found to have a similar hemodynamic trend: CO, 1.65 L/min vs. 1.41 L/min; SV, 23.2 L vs. 20.9 L; SVR, 2487 dyne.s.cm-5 vs. 2597 dyne.s.cm-5 (P = NS for all).


CONCLUSIONS
The application of low-pressure 10 mm Hg PP, compared to conventional 15 mm Hg PP, in the animal model of ACF does not appear to have any hemodynamic advantages.
Perry
Yaron
Y
Division of Thoracic and Foregut Surgery and the Minimally Invasive Surgery Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. perryy@msx.upmc.edu
Reissman
Petachia
P
Blumental
Michael
M
Lyass
Sergey
S
Pizov
Reuven
R
D000208:Acute Disease; D000818:Animals; D002245:Carbon Dioxide; D004195:Disease Models, Animal; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D013552:Swine
D002245:Carbon Dioxide