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Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning
Author(s) -
Hofer C. K.,
Zalunardo M. P.,
Klaghofer R.,
Spahr T.,
Pasch T.,
Zollinger A.
Publication year - 2002
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2002.t01-1-460313.x
Subject(s) - pneumoperitoneum , supine position , medicine , anesthesia , cardiac index , stroke volume , central venous pressure , hemodynamics , cardiac output , blood volume , venous return curve , blood pressure , head down tilt , heart rate , surgery , laparoscopy
Background: It is still controversial whether elevated cardiac filling pressures after the onset of pneumoperitoneum are the consequence of increased intrathoracic pressure or of increased venous return. The aim of this study was to assess the effects of pneumoperitoneum and body positioning on intrathoracic blood volume (ITBV). Methods: Thirty anesthetized patients were randomly assigned to have CO 2 ‐pneumoperitoneum (13 mmHg) either in a supine, in a 15° head‐up tilt or in a 15° head‐down tilt position. Measurements of ITBV and hemodynamics by the double indicator method were recorded after induction of anesthesia and application of a fluid bolus (Lactated Ringer's solution 10 ml/kg), after positioning and after induction of pneumoperitoneum. Results: Intrathoracic blood volume index (ITBVI) increased significantly after induction of pneumoperitoneum in all body positions (supine: from 18.5 ± 3.3 –20.2 ± 5.2 ml/kg (+6%) head‐up from 16.7 ± 3.8 – 17.4 ± 3.7 ml/kg (+16%) and head‐down: from 19.8 ± 5.6 – 20.5 ± 5.9 ml/kg (+14%)). Heart rate did not change significantly in any of the groups. Cardiac index showed a statistically significant change in the head‐down position with pneumoperitoneum (−11%). A good correlation was found for stroke volume (SV) with ITBV ( r = 0.79), but not with central venous pressure ( r = 0.26). Systemic vascular resistance index increased significantly in all three groups (supine +6%, head‐up +16%, head‐down position +14%). Conclusion: The present study indicates that the onset of pneumoperitoneum, even with moderate intra‐abdominal pressures, is associated with an increased intrathoracic blood volume in ASA I/II patients.