Improving the adverse changes in cardiac autonomic nervous control during laparoscopic surgery, using an intermittent sequential pneumatic compression device.
BACKGROUND
The creation of positive pressure pneumoperitoneum (PP) may lead to adverse cardiovascular effects during laparoscopic operations. It can also lead to increased sympathetic cardiac activity, that might have serious consequences. We hypothesized that by reversing the hemodynamic effects, the use of intermittent sequential pneumatic compression device (Lympha-press) on the lower extremities would lead to improved cardiac autonomic control.


METHODS
This was a prospective cohort study, in which patients served as their own control. Fifteen patients without cardiorespiratory disease undergoing elective laparoscopic cholecystectomy were enrolled prospectively. The activity of the cardiac autonomic nervous system was evaluated by using spectral analysis of heart rate variability, with the Del Mar Avionics 363 (Irvine, California), based on the fast Fourier transformation. The Lympha-press was manipulated several minutes after induction of PP. In each frequency band we measured and compared the power values during anesthesia against those of PP, as well as those of PP against those recorded during activation of Lympha-press.


RESULTS
Creation of PP caused increased sympathetic activity, as was manifested by increased power of the low frequency band. Manipulation of the Lympha-Press compression device caused increased parasympathetic activity, as was evident by significant increased power of the high frequency band in all patients.


CONCLUSIONS
Using an intermittent sequential pneumatic compression device during laparoscopic cholecystectomy may improve cardiac autonomic control by enhancing protective parasympathetic activity. That may have clinical significance, especially in patients suffering from cardiac disease, by improving heart rate variability and elevating the threshold of the occurrence of ventricular arrhythmia.
Bickel
Amitai
A
Department of Surgery, Western Galilee Hospital, Nahariya, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. amitai@netvision.net.il
Yahalom
Malka
M
Roguin
Nathan
N
Ivry
Shimon
S
Breslava
Jona
J
Frankel
Roman
R
Eitan
Arie
A
D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation; D011446:Prospective Studies