title: A pilot study of patients with clinically severe obesity undergoing laparoscopic surgery: evidence for impaired cardiac performance.
abstract: OBJECTIVE
  Given the propensity for heart disease in obese patients, the authors investigated the effects of pneumoperitoneum on cardiac performance.
  
  
  METHODS
  A pilot observational intraoperative study.
  
  
  METHODS
  A single-center university hospital.
  
  
  METHODS
  Patients undergoing laparoscopic gastric bypass surgery.
  
  
  METHODS
  Abdominal insufflation.
  
  
  RESULTS
  Hemodynamic, respiratory, and echocardiographic data were collected at 4 epochs: (1) baseline after the induction of anesthesia, (2) after abdominal insufflation in supine position, (3) after abdominal insufflation in the reverse Trendelenburg (RT) position, and (4) after desufflation in RT position. At epoch 1, 3 of 13 patients manifested systolic dysfunction (SD), 5 of 13 patients exhibited diastolic dysfunction (DD) according to transmitral flow (TMF) Doppler criteria, and 4 of 8 patients according to Doppler tissue imaging (DTI) criteria. With pneumoperitoneum, the total systemic resistance increased to values of 142% from baseline (p < 0.05). Compared with baseline, stroke volume decreased by 25%, cardiac output by 35%, and fractional area change by 13% (p < 0.05). Mean arterial blood pressure and heart rate remained stable. Additionally, new-onset DD manifested in 1 of 8 patients according to TMF criteria and in 3 of 4 patients according to DTI criteria. Desufflation of the abdomen reverted the diastolic function to baseline in all but 1 patient.
  
  
  CONCLUSIONS
  The study data revealed that surgical pneumoperitoneum used in patients with clinically severe obesity resulted in the deterioration of cardiac performance including the development of new-onset DD. These patients, despite their relative young age and without a history of heart failure or coronary artery disease, displayed a cardiovascular profile during laparoscopic surgery similar to that seen in patients with significant heart disease.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA. Wanda.Popescu@yale.edu
authors.forename: Wanda M
authors.initials: WM
authors.lastname: Popescu
authors.forename: Robert
authors.initials: R
authors.lastname: Bell
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Karol H
authors.initials: KH
authors.lastname: Katz
authors.forename: Albert C
authors.initials: AC
authors.lastname: Perrino
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D015390:Gastric Bypass; D006331:Heart Diseases / Q000453:epidemiology* / Q000209:etiology*; D006334:Heart Function Tests; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D010865:Pilot Projects; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011187:Posture / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance