Comparison of the Hemodynamic Effects of Gasless Abdominal Distention and CO2 Pneumoperitoneum during Incremental Positive End-Expiratory Pressure

Woolley, Daniel S.; Puglisi, R; Bilgrami, Sajad; Quinn, James V.; Slotman, Gus J.

doi:10.1006/jsre.1995.1012

Cited by 19 publications

(21 citation statements)

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“…These findings are not in accordance with a previous study in pigs which indicated that laparoscopy using abdominal wall retraction results in less cardiovascular depression compared to conventional pneumoperitoneum [11]. Others also showed that in pigs, positive and expiratory pressure (PEEP) affected hemodynamics less during AWR than during conventional pneumoperitoneum [16]. The finding that adding 5 mmHg of pneumoperitoneum results in hemodynamic changes similar to those of higher intraabdominal pressures may indicate that these changes are not caused by increased intraabdominal pressure.…”

Section: Discussioncontrasting

confidence: 86%

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Laparoscopic cholecystectomy using abdominal wall retraction

et al. 1997

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Section: Discussioncontrasting

confidence: 86%

“…The abdominal wall retractor (AWR) is a new device designed to create a good view during laparoscopic surgery without the use of a pneumoperitoneum [1,3,5,6,10,14,16]. Recently the feasibility of using the AWR for laparoscopic surgery in pigs has been analyzed [11].…”

mentioning

confidence: 99%

Laparoscopic cholecystectomy using abdominal wall retraction

et al. 1997

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“…Although ventilation with positive end-expiratory pressure significantly improves pulmonary gas exchange [33, 34]and preserves arterial oxygenation during prolonged pneumoperitoneum [35]it should be noted that positive end-expiratory pressure in the presence of elevated intra-abdominal pressure, increases the intrathoracic pressure and produces marked reduction in cardiac output. Therefore, it should be applied cautiously [36, 37, 38, 39]. A modern ventilation technique is the ‘alveolar recruitment strategy’, consisting of manual ventilation to an airway pressure of 40 cm H 2 O for 10 breaths over 1 min, followed by usual mechanical ventilation with mild positive end-expiratory pressure (5 cm H 2 O).…”

Section: Lungs and Gas Exchangementioning

confidence: 99%

Circulatory and Respiratory Complications of Carbon Dioxide Insufflation

Gutt¹,

Oniu

Mehrabi³

et al. 2004

Dig Surg

300

272

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Background: Although providing excellent outcome results, laparoscopy also induces particular pathophysiological changes in response to pneumoperitoneum. Knowledge of the pathophysiology of a CO₂ pneumoperitoneum can help minimize complications while profiting from the benefits of laparoscopic surgery without concerns about its safety. Methods: A review of articles on the pathophysiological changes and complications of carbon dioxide pneumoperitoneum as well as prevention and treatment of these complications was performed using the Medline database. Results: The main pathophysiological changes during CO₂ pneumoperitoneum refer to the cardiovascular system and are mainly correlated with the amount of intra-abdominal pressure in combination with the patient’s position on the operating table. These changes are well tolerated even in older and more debilitated patients, and except for a slight increase in the incidence of cardiac arrhythmias, no other significant cardiovascular complications occur. Although there are important pulmonary pathophysiological changes, hypercarbia, hypoxemia and barotraumas, they would develop rarely since effective ventilation monitoring and techniques are applied. The alteration in splanchnic perfusion is proportional with the increase in intra-abdominal pressure and duration of pneumoperitoneum. Conclusion: A moderate-to-low intra-abdominal pressure (<12 mm Hg) can help limit the extent of the pathophysiological changes since consecutive organ dysfunctions are minimal, transient and do not influence the outcome.

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“…29 Only one animal study has evaluated the haemodynamic changes with the use of gasless abdominal distention compared with CO 2 pneumoperitoneum. 22 In that study, performed in swine and monitored with pulmonary artery and invasive arterial catheters, the authors found that, during mechanical ventilation without positive end-expiratory pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and PaCO 2 were lower for gasless abdominal distention than for peritoneal insufflation with CO2, while the PaO 2 and the cardiac index were higher. 22 Another recent study, performed in humans, evaluated the haemodynamic effects of a conventional pneumoperitoneum with the abdominal wall lift for laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 95%

“…22 In that study, performed in swine and monitored with pulmonary artery and invasive arterial catheters, the authors found that, during mechanical ventilation without positive end-expiratory pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and PaCO 2 were lower for gasless abdominal distention than for peritoneal insufflation with CO2, while the PaO 2 and the cardiac index were higher. 22 Another recent study, performed in humans, evaluated the haemodynamic effects of a conventional pneumoperitoneum with the abdominal wall lift for laparoscopic cholecystectomy. 23 In this study, Lindgren et al 2s used a trocar which was introduced in the left upper abdomen and brought beneath the rectus abdominus muscles and falciform ligament, and then left the abdomen through an incision in the upper right abdomen.…”

Section: Discussionmentioning

confidence: 95%

Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomy

et al. 1997

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Reports of Investigation Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomyPurpose: Abdominal wall retraction (AWR) was recently proposed as an alternative for CO 2 pneumoperitoneum, In this study we evaluated the cardiorespiratory effects of AWR during laparoscopic cholecystectomy, Methods: Fifteen patients were studied during laparoscopic cholecystectomy using AWR. Monitoring included heart rate (HR), mean arterial pressure (MAP), pulse oxymetry (SpO2), end-tidal CO 2 (PETCO2), minute ventilation, and peak inspiratory pressure (PIP). Using transoesophageal echocardiography, the transgastric short axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermined periods: I) five minutes after anaesthetic induction, 2) five minutes after AVVR insertion, 3) 15 rnin after AWR insertion, and 4) after the end of surgery. Results: No change in an), measured parameter was observed over time in the AWR group except for an increase in IVlAP (P<0.05) after AWR insertion. There were no changes in EDA, ESA and EF during the study, reflecting stable global cardiac function, In addition, no embolic episodes were observed during surgery. Conclusion: Our results demonstrate that the use of gasless abdominal distention for laparoscopic cholecystectomy results in a stable haemodynamic profile in healthy patients without cardiac disease, except for a brief increase in MAP after the AWR insertion. The advantages of AWR over conventional pneumoperitoneum should be confirmed in higher risk patients in a prospective, randomized study.

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Comparison of the Hemodynamic Effects of Gasless Abdominal Distention and CO2 Pneumoperitoneum during Incremental Positive End-Expiratory Pressure

Cited by 19 publications

References 0 publications

Laparoscopic cholecystectomy using abdominal wall retraction

Laparoscopic cholecystectomy using abdominal wall retraction

Circulatory and Respiratory Complications of Carbon Dioxide Insufflation

Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomy

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