Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy

Background: Peritoneal insufflation to 15 mmHg diminishes venous return and reduces cardiac output. Such changes may be dangerous in patients with a p oor cardiac reserve. The aim of this study was to investigate the hemodynam ic effects of high (15 mmHg) and low (7 mmHg) intraabdominal pressure durin g laparoscopic cholestectomy (LC) Methods: Twenty patients were randomized to either high-or low-pressure cap noperitoneum. Anesthesia was standardized, and the end-tidal CO2 was mainta ined at 4.5 kPa. Arterial blood pressure was measured invasively, Heart rat e, stroke volume, and cardiac output were measured by transesophageal doppl er. Results: There were 10 patients in each group. In the high pressure group, heart rate (HR) and mean arterial blood pressure (MABP) increased during in sufflation, Stroke volume (SV) and cardiac output were depressed by a maxim um of 26% and 28% (SV 0.1 > p > 0.05, cardiac output p > 0.1), In the low-p ressure group, insufflation produced a rise in MABP and a peak rise in both stroke volume and cardiac output of 10% and 28%, respectively (p < 0.05). Conclusions: Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation.