Open AccessLeft Ventricular Loading Modifications Induced by Pneumoperitoneum
Author(s) -
P. Branche,
S. Duperret,
Pierre Sagnard,
J. Boulez,
Paul Petit,
Jean–Paul Viale
Publication year - 1998
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1097/00000539-199803000-00005
Subject(s) - pneumoperitoneum , medicine , insufflation , exsufflation , anesthesia , hemodynamics , blood pressure , afterload , mean arterial pressure , cardiology , heart rate , surgery , laparoscopy
The intraperitoneal insufflation of carbon dioxide during laparoscopic procedures is associated with an increase in mean arterial pressure and systemic vascular resistance. To evaluate the time course of the circulatory changes related to intraabdominal pressure variation, we used transesophageal echocardiography in 10 patients anesthetized for laparoscopic cholecystectomy. Left ventricular dimensions, fractional area shortening (FAS), and left ventricular afterload assessed by the left ventricular end-systolic wall stress (LVESWS) were measured from echocardiographic data before insufflation, during pneumoperitoneum, and during exsufflation. Three minutes after the onset of pneumoperitoneum, we observed a 25.7% +/- 10.5% (mean +/- SD) increase in mean arterial pressure, a 49.1% +/- 14.4% increase in LVESWS, and a 17.0% +/- 16.2% decrease in FAS. All measured variables returned to preinsufflation values after 30 min of pneumoperitoneum and thereafter were no longer significantly affected by postural changes (10 degrees head-up position) or pneumoperitoneum exsufflation. We conclude that the circulatory changes associated with pneumoperitoneum are transient and are probably mediated by factors other than intraabdominal pressure variations.