HEMODYNAMIC-EFFECTS OF PNEUMOPERITONEUM AND THE INFLUENCE OF POSTURE DURING ANESTHESIA FOR LAPAROSCOPIC SURGERY

The laparoscopic operating technique is being applied increasingly to a variety of intra-abdominal operations. Intra-abdominal gas insufflat ion, i.e. pneumoperitoneum (PP), is then used to allow surgical access . The haemodynamic effects of PP in combination with different body po sitions have not been fully examined. Eleven patients without signs of cardiopulmonary disease were studied before and during laparoscopic c holecystectomy under propofol-fentanyl anaesthesia with controlled ven tilation. Swan-Ganz and radial arterial catheterization were used to d etermine haemodynamic data in the horizontal position, with a 15-20 de grees head-down tilt and a 15-20 degrees head-up tilt. The measurement s were repeated after insufflation of carbon dioxide to an intraabdomi nal pressure of 11-13 mmHg, as well as during surgery. The ventricular filling pressures of the heart were strictly dependent on body positi on. PP in the horizontal position increased pulmonary capillary wedge pressure by 32% (P < 0.01), central venous pressure by 58% (P < 0.01), and mean arterial pressure by 39% (P < 0.01). When PP was combined wi th a head-down tilt, there was a further increase in filling pressures by approximately 40% (P < 0.01), while the reduction in filling press ures during the head-up tilt was counteracted by PP. During PP with a head-up tilt, the filling pressures did not differ from those in the h orizontal position without PP. CI showed a certain dependency on filli ng pressures. II is concluded that PP causes signs of elevated preload and afterload. The combination of PP and a head-up tilt is associated only with signs of an elevated afterload. It is suggested that the ha emodynamic response to PP, especially in combination with a head-down tilt, may be hazardous to patients with compromised heart function.