SAFE INTRAABDOMINAL PRESSURE OF CARBON-DIOXIDE PNEUMOPERITONEUM DURING LAPAROSCOPIC SURGERY

Background. The deliberate induction of carbon dioxide pneumoperitoneu m during laparoscopic surgery could be a possible source of cardiovasc ular collapse. The effects of elevated intraabdominal pressure (IAP) o n systemic hemodynamics and splanchnic blood flow created by insufflat ion of carbon dioxide were examined in anesthetized dogs. Methods. Ste pwise increases in IAP of 8 (n = 7), 12 (n = 7), and 16 (n = 7) mm Hg were applied to determine the threshold pressure that had minimum infl uence on these hemodynamics. Hemodynamic parameters were measured at b aseline and 1, 2, and 3 hours after the start of insufflation. Results . At an IAP of 16 mm Hg, cardiac output was decreased significantly by 1 hour after the start of insufflation and became progressively lower during the procedure. Systemic vascular resistance was elevated signi ficantly in parallel with the change in cardiac output. Although hepat ic arterial blood flow was not decreased significantly, portal venous and superior mesenteric arterial blood flows were diminished significa ntly at 16 mm Hg, resulting in a decrease in total hepatic blood flow. No significant changes were observed in these parameters at 8 or 12 m m Hg. Conclusions. Based on these results, an IAP from 8 to 12 mm Hg i s recommended for laparoscopic surgery, to avoid complications caused by hemodynamic derangements.