Summary
Laparoscopic surgery has rapidly become a popular and widely used technique. Although this procedure has been shown to be generally safe, cardiovascular derangement related to carbon dioxide pneumoperitoneum has been reported. There are few data available on the relationship between systemic and regional hemodynamics in cases of pneumoperitoneum. Changes in splanchnic blood flow and cardiovascular effects following a moderate increase of intraabdominal pressure (IAP) to 16 mmHg during a 3-h period were analyzed in six anesthetized dogs. After insufflation, cardiac output and blood flow in the superior mesenteric artery and portal vein decreased progressively and returned to the preinsufflation values following deflation. Hepatic arterial blood flow did not change significantly, perhaps due to compensatory mechanisms for maintenance of hepatic blood flow. Mechanical compression of the splanchnic capillary beds due to the elevated IAP may possibly reflect the increase in systemic vascular resistance causing the decrease in cardiac output. To prevent this impairment, intermittent decompression of gas during surgical laparoscopy is recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anderson RJ, Cronin RE, McDonald KM, Schrier RW (1976) Mechanisms of portal hypertension-induced alteration in renal hemodynamics, renal water excretion, and renin secretion. J Clin Invest 58: 964–970
Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ (1985) Cardiovascular responses to elevation of intro-abdominal hydrostatic pressure. Am J Physiol 248: R208-R213
Caldwell CB, Ricotta JJ (1987) Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 43: 14–20
Cohn R, Kountz S (1963) Factors influencing control of arterial circulation in the liver of the dog. Am J Physiol 205: 1260–1264
Cullen DJ, Coyle JP, Teplick R, Long MC (1989) Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 17: 118–121
Drost CJ, Thomas CG, Sellers AF (1979) In vivo validation of the transit-time ultrasonic volume flow meter. Proc 7th New England (Northeast) Bioeng Conf: 220–223
Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy—preliminary report of 36 cases. Ann Surg 211: 60–62
Epstein RM, Wheeler HO, Frumin J, Habif DV, Papper EM, Bradley SE (1961) The effect of hypercapnia on estimated hepatic blood flow, circulating splanchnic blood volume, and hepatic sulfobromophthalein clearance during general anesthesia in man. J Clin Invest 40: 592–598
Greenway CV, Oshiro G (1972) Intrahepatic distribution of portal and hepatic arterial blood flows in anaesthetized cats and dogs and the effects of portal occlusion, raised venous pressure and histamine. J Physiol 227: 473–485
Ivankovich AD, Albrecht RF, Zahed B, Bonnet RF (1974) Cardiovascular collapse during gynecological laparoscopy. Ill Med J 145: 58–61, 77
Ivankovich AD, Miletich DJ, Albrecht RF, Heyman HJ, Bonnet RF (1975) Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog. Anesthesiology 42: 281–287
Johnson PC (1964) Review of previous studies and current theories of autoregulation. In: PC Johnson (ed) Autoregulation of Blood Flow. Am Heart Assoc, New York, pp 1–9
Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effects of increased abdominal pressure. J Surg Res 30: 249–255
Motew M, Ivankovich AD, Bieniarz J, Albrecht RF, Zahed B, Scommegna A (1973) Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am J Obstet Gynecol 115: 1002–1012
Punnonen R, Viinamäki O (1982) Vasopressin release during laparoscopy: role of increased intra-abdominal pressure. Lancet No. 8264: 175–176
Reddick ED, Olsen DO (1989) Laparoscopic laser cholecystectomy. Surg Endosc 3: 131–133
Shelly MP, Robinson AA, Hesford JW, Park GR (1987) Haemodynamic effects following surgical release of increased intraabdominal pressure. Br J Anaesthesiol 59: 800–805
The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. New Engl J Med 324: 1073–1078
Toomasian JM, Glavinovich G, Johnson MN, Gazzaniga AB (1978) Hemodynamic changes following pneumoperitoneum and graded hemorrhage in the dog. Surg Forum 29: 32–33
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ishizaki, Y., Bandai, Y., Shimomura, K. et al. Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc 7, 420–423 (1993). https://doi.org/10.1007/BF00311734
Issue Date:
DOI: https://doi.org/10.1007/BF00311734