THE EFFECTS OF THE LATERAL POSITION ON CARDIOPULMONARY FUNCTION DURING LAPAROSCOPIC UROLOGICAL SURGERY

Laparoscopic urological surgery is usually performed transperitoneally with retroperitoneal insufflation of carbon dioxide (CO2) in the late ral position We studied whether a difference in the side of lateral po sition affected hemodynamic and pulmonary functions during pneumoperit oneum. Fifteen patients (eight in the right and seven in the left late ral position) undergoing elective laparoscopic urological surgery were studied under general anesthesia. Hemodynamic variables and blood gas data were recorded. Before insufflation, mean arterial pressure (MAP) , mean pulmonary arterial pressure (MPAP), central venous pressure (CV P), and pulmonary capillary wedge pressure (PCWP) in the right lateral position were higher than those in the left lateral position. Pneumop eritoneum increased MAP, MPAP, CVP, PCWP, and cardiac index but decrea sed systemic vascular resistance in the right lateral position. Simila r changes occurred during pneumoperitoneum in the left lateral positio n, but the changes were less than those in the right lateral position. The respiratory index (Pao(2)/PAo(2)), intrapulmonary shunt, and Spo( 2) did not change during pneumoperitoneum in either lateral position. Changing the side of the lateral position affected hemodynamic functio n but did not affect pulmonary oxygenation during pneumoperitoneum. Im plications: The right and left lateral positions produced different he modynamic changes during laparoscopic urological surgery. The increase s in preload and cardiac index and the decrease in systemic vascular r esistance were greater in the right than in the left lateral position. Respiratory changes were not affected differently between the right a nd left lateral positions.