EFFECTS OF POSTURE AND PNEUMOPERITONEUM DURING ANESTHESIA ON THE INDEXES OF LEFT-VENTRICULAR FILLING

Background. Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may caus e marked circulatory alterations. Methods. Eight anaesthetized cardiov ascularly healthy patients, scheduled for laparoscopic cholecystectomy , were studied before and during pneumoperitoneum in three different p ostures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitor ing. Results. PP significantly increased end-diastolic area (EDA) and pulmonary capillary wedge pressure (PCWP) irrespective of posture. PCW P was significantly influenced by postural changes, whereas EDA was no t. Further, changes in EDA and PCWP covaried during the investigation, but showed no linear correlation. Systolic function, measured as end- systolic area (ESA) and fractional area shortening (FAS), was not alte red. Diastolic function, as assessed by the velocity rate of the trans mitral flow during the early filling phase (E) and the atrial contract ion (A), showed no change of the E/A ratio, whereas after the inductio n of PP there was a significant reduction of the E component. Conclusi ons. In cardiovascularly healthy patients, the left ventricular volume is increased during pneumoperitoneum. Further, changes in invasive pr essure determinations (PCWP) do not correlate linearly with changes in volume indices of left ventricular filling (EDA).