title: The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware?
abstract: BACKGROUND
  The gynecological laparoscopic surgery requires pneumoperitoneum (PP) with CO2 gas insufflation. CO2 PP may influence cardiac automic function (CAF). This study was conducted to assess its significance and the prolonged effects of CO2 PP on the activity of the cardiac autonomic function 24 hours after the operation by heart rate turbulence (HRT) and heart rate variability (HRV), first time in the literature.
  
  
  METHODS
  Fifty patients scheduled for elective gynecologic laparoscopy were evaluated. The patients had no preexisting lung or heart disease or pathologic lung function. Conventional general anesthesia with midazolam, propofol, fentanyl, rocuronium, and sevoflurane was administered. ECG recordings were carried out between before 4 h from surgery and the beginning of anesthesia (T1), induction of PP and CO2 evacuation (T2) and a 24-h period postoperatively (T3). The Holter recordings of all patients were analyzed by HRT and HRV.
  
  
  RESULTS
  There were significant reductions in in HRV and HRT parameters peri-op period compared to the pre-op values (p < 0.05). In the first 3 h of post-op period, were calculated all HRT and some HRV (SDNN, LF) parameters were also found to be significantly reduced than the values of pre-op period (p < 0.05).
  
  
  CONCLUSIONS
  This study described adverse effects of CO2 PP on cardiac autonomic regulation in the early postoperative period according to the long-term HRV and HRT frequency analysis, for the first time in the literature. The early postoperative monitorization may supply efficacious information for arrhythmic complications.
authors: Department of Anesthesiology and Reanimation, Abant Izzet Baysal University School of Medicine, Bolu, Turkey. drtekelioglu@yahoo.com
authors: U Y
authors: UY
authors: Tekelioglu
authors: A
authors: A
authors: Erdem
authors: A
authors: A
authors: Demirhan
authors: A
authors: A
authors: Akkaya
authors: S
authors: S
authors: Ozturk
authors: M
authors: M
authors: Bilgi
authors: B
authors: B
authors: Duran
authors: M
authors: M
authors: Yazici
authors: H
authors: H
authors: Kocoglu
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology*; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D010535:Laparoscopy; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies