Intraperitoneal pressures and clinical parameters of total paracentesis for palliation of symptomatic ascites in ovarian cancer

Objective. The present study was designed to prospectively evaluate the int raperitoneal pressure, as well as clinical and hemodynamic effects of total paracentesis, as palliation of symptomatic ascites in ovarian cancer patie nts. Methods. Prospective study of 35 sequential total paracenteses was performe d using a Veres cannula on patients with advanced recurrent ovarian cancer with symptomatic tense ascites. Relevant clinical symptoms and patient well -being were evaluated. Vital signs, abdominal parameters, and hydrostatic i ntraperitoneal pressure were recorded before, during, and after the procedu re. Results. Intraperitoneal pressure dropped from 30 +/- 7 cmH(2)O before para centesis to 13 +/- 6 cmH(2)O after the procedure (P < 0.0001). Marked sympt omatic improvement was observed in all patients (89% complete relief, 11% p artial relief), while all the patients tolerated the procedure well without any complications. The mean volume of ascitic fluid removed was 4800 mi. M ean respiratory rate and mean heart rate were both significantly decreased following the procedure (29.3 to 21.4 respirations per min and 101.5 to 93. 6 beats per min, respectively). Mean systolic blood pressure mildly decreas ed (6.6 mmHg), while the mean diastolic blood pressure did not significantl y change. None of the patients presented signs or symptoms of hypovolemia d uring or after the total paracentesis. Conclusions. Measurement of intraperitoneal pressures during total paracent esis for tense ascites in ovarian cancer patients indicated that the severi ty of symptoms correlated with the intraperitoneal pressure prior to parace ntesis, but not with the volume of ascites. Intraperitoneal pressures measu red following total paracentesis in patients with ovarian cancer were simil ar to the baseline intraperitoneal pressure measured in patients undergoing peritoneal dialysis. (C) 1998 Academic Press.