INTERMITTENT SEQUENTIAL PNEUMATIC COMPRESSION IN PREVENTION OF VENOUSSTASIS ASSOCIATED WITH PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

Objectives: To determine whether pneumoperitoneum and reverse Trendele nburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compres sion (ISPC) overcomes this impedance. Design: Using Doppler ultrasonog raphy, peak systolic velocities in the common femoral vein were measur ed in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during thr ee intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30-degrees reverse Trendelenburg position (both with and withou t ISPC). Mean arterial pressure and heart rate were obtained concurren tly. Measurements of preoperative and postoperative calf and thigh cir cumferences were obtained. Setting: A tertiary care center. Patient Pa rticipants: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria. Main Outcome Measures: Peak systolic velo city, mean arterial pressure, heart rate, and calf and thigh circumfer ences. Results: The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30-degrees reverse Trendelenburg position significantly decrease d peak systolic velocity in the common femoral vein from a preoperativ e mean of 0.24 +/- 0.025 m/s to 0.14 +/- 0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, r eturning peak systolic velocity to 0.27 +/- 0.021 m/s. The mean differ ence between preoperative peak systolic velocity and peak systolic vel ocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03 +/- 0.03 m/s but was not significant, Anes thesia alone caused a mean increase in preoperative peak systolic velo city from 0.24 +/- 0.025 m/s to 0.3 +/- 0.032 m/s. Mean arterial press ure levels, heart rate, and calf and thigh circumferences did not chan ge significantly. Conclusions: This study demonstrated a significant r eduction in common femoral venous flow during laparoscopic cholecystec tomy coincident with pneumoperitoneum and reverse Trendelenburg's posi tion. Intermittent sequential pneumatic compression reversed that effe ct, returning peak systolic velocity to normal.