INTRAOPERATIVE RISK AND HEMODYNAMIC-EFFECTS OF THE CO2-PNEUMOPERITONEUM IN LAPAROSCOPIC SURGERY

The benefits of minimally invasive surgery led to an increasing rate o f laparoscopic procedures in older patients. These patients profit mos t from the p.op. advantages of laparoscopic surgery. On the other hand they often display cardiovascular risks with the intra-operative risk of the CO2-pneumoperitoneum still under discussion. Methods: The haem odynamic effects of CO2-pneumoperitoneum were investigated. Monitoring included cardiac output (CO), central venous pressure (CVP), pulmonar y arterial pressure (PAP) and wedge pressure (PAWP), femoral venous pr essure (FVP), intra-oesophageal pressure (IEP), systemic vascular resi stance (SVR) and transmural right-atrial pressure (TMP), and was perfo rmed in a controlled, experimental model. Results: Establishing the pn eumoperitoneum caused initially a 35% decrease in CO. SVR, as an indic ator of cardiac afterload, increased clearly. The increased intra-abdo minal pressure led to a reduction of venous reflux from the periphery and squeezed the venous reservoir within the abdominal cavity. Cardiac preload was altered, too. The elevated cardiac afterload adapted unde r pneumoperitoneum. After desufflation cardiac output rose far above n ormal. Conclusions: These results indicate a strong cardiac stress aft er insufflation and desufflation. This is caused by the increased intr a-abdominal pressure rather than by systemic effects of resorbed CO2. Laparoscopic procedures in patients with clinical signs of cardiovascu lar insufficiency should only be performed with substantial intra-oper ative monitoring. Otherwise low pressure pneumoperitoneum and/or press ure and gasless laparoscopy could be considered.