Circulatory Effects of Carbon Dioxide Insufflation of the Peritoneal Cavity for Laparoscopy

A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy

“…The maintenance of elevated intraabdominal pressure for the duration of the procedure is associated with numerous adverse effects involving the circulatory and respiratory systems, as well as the kidneys; some of these side effects result from a positive intraperitoneal pressure itself, while others are associated with carbon dioxide absorption from the peritoneal cavity to blood [3,7,8,11].…”

Hemodynamic changes in the inferior caval vein during pneumoperitoneum

“…The systemic vascular resistance and the pulmonary vascular resistance showed similar patterns, suggesting a common humoral factor responsible for these phenomena. It has previously been speculated that the increase in vascular resistance is due to a reflex activation of sympathetic nerve activity by the surgical stimulus or afferent stimulation from the splanchnic region [11,14] or possibly due to an increase in arterial carbon dioxide tension [13]. In addition, Punnonen and Viinamäki [17] have shown that vasopressin is released during laparoscopy.…”

The effects of elevated intraabdominal pressure, hypercarbia, and positioning on the hemodynamic responses to laparoscopic colectomy in pigs

“…The explanation for these conflicting results may be the occurrence of type II statistical errors due to small sample sizes, or variability in reaching the threshold for catecholamine release, which is thought to stimulate these changes in HR and MAP. The importance of acidosis in stimulating catecholamine release and the lack of hemodynamic changes in the absence of this stimulus has been established [18]. Catecholamine release can be attributed to two factors in this instance-the stress of surgery and the stress of acidosis.…”

“…CO 2 pneumoperitoneum is most common, but it has been associated with side effects due to the transperitoneal absorption of CO 2 gas. In an attempt to avoid these problems, pneumoperitoneums have been described using alternative gases, such as helium, nitrous oxide, or argon [2,11,16,18]. Finally, the anterior abdominal wall can be lifted ventrally with an abdominal wall lifting device, thus avoiding the side effects of elevated intraabdominal pressures or gas absorption.…”