title: Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy.
abstract: High intra-abdominal pressure and reverse Trendelenburg position during laparoscopic cholecystectomy (LC) are risk factors for venous stasis in lower extremity. Lower limb venous stasis is one of the major pathophysiological elements involved in the development of peri-operative deep vein thrombosis. Low pressure pneumoperitoneum (7-10 mmHg) has been recommended in patients with limited cardiac, pulmonary or renal reserve. The purpose of this study was to observe the effect of various pneumoperitoneum pressures on femoral vein (FV) hemodynamics during LC. A total of 50 patients undergoing elective LC were enrolled and they were prospectively randomized into two groups containing 25 patients each. In group A high pressure pneumoperitoneum (14 mmHg) and in group B low pressure pneumoperitoneum (8 mmHg) was maintained. Comparison of pre-operative and post-operative coagulation profile was done. Preoperative and intraoperative change in femoral vein diameter (FVD) (AP and LAT), cross-sectional area (CSA) and peak systolic flow (PSF) during varying pneumoperitoneum pressure was recorded in FV by ultrasound Doppler. First measurement (pre-operative) was carried out just after the induction of anesthesia before creation of pneumoperitoneum and second measurement (intra-operative) was taken just before completion of surgery with pneumoperitoneum maintained. Changes in coagulation parameters were less significant at low pressure pneumoperitoneum. There was statistical significant difference in the pre-operative and intra-operative values of FVD, CSA and PSF in both groups when analyzed independently (P = 0.00). There was no significant difference in pre-operative values of FVD, CSA and PSF (P > 0.05) among two groups but when the comparison was made between the intra-operative values, there was significant increase in FVD (AP) (P = 0.016), CSA (P = 0.00) and decrease in PSF (P = 0.00) at high pressure pneumoperitoneum. This study provides evidence of using low pressure pneumoperitoneum during LC as changes in FV hemodynamics and coagulation parameters were less pronounced at low pressure pneumoperitoneum.
authors: Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors: Ankush
authors: A
authors: Sharma
authors: Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. dahiyadivya@yahoo.com.
authors: Divya
authors: D
authors: Dahiya
authors: Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors: Lileswar
authors: L
authors: Kaman
authors: Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors: Vikas
authors: V
authors: Saini
authors: Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors: Arunanshu
authors: A
authors: Behera
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011379:Prognosis; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods
keywords: Femoral vein diameter; Femoral vein hemodynamics; Hypercoagulability; Laparoscopic cholecystectomy; Low pressure pneumoperitoneum