H. Gebhardt et al., INTRAOPERATIVE RISK AND HEMODYNAMIC-EFFECTS OF THE CO2-PNEUMOPERITONEUM IN LAPAROSCOPIC SURGERY, Minimally invasive therapy & allied technologies, 5(2), 1996, pp. 207-210
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.