CHANGES IN SPLANCHNIC BLOOD-FLOW AND CARDIOVASCULAR EFFECTS FOLLOWINGPERITONEAL INSUFFLATION OF CARBON-DIOXIDE

Laparoscopic surgery has rapidly become a popular and widely used tech nique. Although this procedure has been shown to be generally safe, ca rdiovascular derangement related to carbon dioxide pneumoperitoneum ha s been reported. There are few data available on the relationship betw een systemic and regional hemodynamics in cases of pneumoperitoneum. C hanges in splanchnic blood flow and cardiovascular effects following a moderate increase of intraabdominal pressure (IAP) to 16 mmHg during a 3-h period were analyzed in six anesthetized dogs. After insufflatio n, cardiac output and blood flow in the superior mesenteric artery and portal vein decreased progressively and returned to the preinsufflati on values following deflation. Hepatic arterial blood flow did not cha nge significantly, perhaps due to compensatory mechanisms for maintena nce of hepatic blood flow. Mechanical compression of the splanchnic ca pillary beds due to the elevated IAP may possibly reflect the increase in systemic vascular resistance causing the decrease in cardiac outpu t. To prevent this impairment, intermittent decompression of gas durin g surgical laparoscopy is recommended.