title: Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy?
abstract: BACKGROUND
  Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia.
  
  
  METHODS
  Fifty American Society of Anesthesiologist (ASA) I-III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups.
  
  
  RESULTS
  PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24.
  
  
  CONCLUSIONS
  Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.
authors.affiliation: Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Donmez
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Uzman
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Dogan
authors.initials: D
authors.lastname: Yildirim
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Hut
authors.affiliation: Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Huseyin Imam
authors.initials: HI
authors.lastname: Avaroglu
authors.affiliation: Department of Anesthesiology and Reanimation, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Duygu Ayfer
authors.initials: DA
authors.lastname: Erdem
authors.affiliation: Department of Ear Nose Throat Surgery, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Erdinc
authors.initials: E
authors.lastname: Cekic
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Fazilet
authors.initials: F
authors.lastname: Erozgen
keywords: Activated partial thromboplastin time; D-dimer; Fibrinogen; General anesthesia; International normalized ratio; Laparoscopic cholecystectomy; Pneumoperitoneum; Prothrombin time; Thrombin time