HEMODYNAMIC-EFFECTS OF PNEUMOPERITONEUM DURING GYNECOLOGIC LAPAROSCOPIC SURGERY

Our objective was to determine the hemodynamic effects of insufflation during gynecologic laparoscopic surgery using noninvasive hemodynamic monitoring. Between June 1994 and January 1995, patients undergoing s cheduled laparoscopic surgery for benign gynecologic indications were recruited for perioperative hemodynamic monitoring by thoracic electri cal bioimpedance (BoMed, Irvine, CA). After induction of general anest hesia, baseline hemodynamic parameters were obtained. A pneumoperitone um (CO2) was created to 12 mm Hg, and hemodynamic parameters were agai n recorded. Hemodynamic parameters were likewise recorded at 10 min po stinsufflation, immediately predeflation, immediately postdeflation, a nd 10 min postdeflation. Mean values (+/-SE) were plotted on a line ba r graph and evaluated statistically by analysis of variance for repeat ed measures (ANOVA), alpha = 0.01. Insufflation significantly affected the systemic vascular resistance index and mean arterial pressure (p = 0.004 and p = 0.01). Specifically, insufflation increased the mean a rterial pressure and systemic vascular resistance index, and desufflat ion had the opposite effect. A mirrored effect on cardiac index was li kewise noted (p = 0.005). Although insufflation appeared to increase t he heart rate, this effect was not significant. Likewise, the stroke i ndex was not affected by insufflation.