HEMODYNAMIC-CHANGES AFTER RETROPERITONEAL CO2 INSUFFLATION FOR POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY

Intraoperative complications and hemodynamic alterations during poster ior capnoretroperitoneoscopic adrenalectomy in the prone position were investigated in 16 consecutive patients using invasive hemodynamic mo nitoring. Under general anesthesia with propofol and fentanyl, hemodyn amic changes were made before (M(1)) and during retroperitoneal CO2 in sufflation (15 mm Hg) [M(2)]; 20 mm Hg [M(3)]. Retroperitoneal insuffl ation resulted in a significant increase of cardiac output (+72%), str oke volume (+42%), mean arterial pressure (+39%), and mean pulmonary a rterial pressure (+36%). Although retroperitoneal inflation was pressu re (+37%), an increase of preload may have led to higher filling press ures. Heart rate, systemic vascular resistance, and pulmonary vascular resistance did not show significant changes. One pneumothorax and two cutaneous emphysemas occurred. We have demonstrated, in a small numbe r of patients, that retroperitoneal CO2 insufflation for posterior cap noretroperitoneoscopic adrenalectomy in the prone position results in hemodynamic changes without apparent adverse effects.