Surgical Endoscopy

, Volume 13, Issue 4, pp 376–381 | Cite as

Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy

  • S. P. L. Dexter
  • M. Vucevic
  • J. Gibson
  • M. J. McMahon
Article

Abstract

Background: Peritoneal insufflation to 15 mmHg diminishes venous return and reduces cardiac output. Such changes may be dangerous in patients with a poor cardiac reserve. The aim of this study was to investigate the hemodynamic effects of high (15 mmHg) and low (7 mmHg) intraabdominal pressure during laparoscopic cholestectomy (LC)

Methods: Twenty patients were randomized to either high- or low-pressure capnoperitoneum. Anesthesia was standardized, and the end-tidal CO2 was maintained at 4.5 kPa. Arterial blood pressure was measured invasively. Heart rate, stroke volume, and cardiac output were measured by transesophageal doppler.

Results: There were 10 patients in each group. In the high-pressure group, heart rate (HR) and mean arterial blood pressure (MABP) increased during insufflation. Stroke volume (SV) and cardiac output were depressed by a maximum of 26% and 28% (SV 0.1 > p > 0.05, cardiac output p > 0.1). In the low-pressure group, insufflation produced a rise in MABP and a peak rise in both stroke volume and cardiac output of 10% and 28%, respectively (p < 0.05).

Conclusions: Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation.

Key words: Laparoscopic cholecystectomy — Hemodynamics — Intraabdominal pressure 

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Copyright information

© Springer-Verlag New York Inc. 1999

Authors and Affiliations

  • S. P. L. Dexter
    • 1
  • M. Vucevic
    • 2
  • J. Gibson
    • 2
  • M. J. McMahon
    • 1
  1. 1.Academic Department of Surgery, The General Infirmary, Leeds, LS1 3EXUnited Kingdom
  2. 2.Academic Department of Anaesthesia, The General Infirmary, Leeds, LS1 3EXUnited Kingdom

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