Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling

Abstract

In cardiovascularly healthy patients, the left ventricular volume is increased during pneumoperitoneum. Further, changes in invasive pressure determinations (PCWP) do not correlate linearly with changes in volume indices of left ventricular filling (EDA).

Alterações hemodinâmicas durante o pneumoperitônio em cães ventilados com volume e pressão controlados

“…Adding to these observations, it was also seen that mean blood pressure values have remained stable for both groups throughout the experiment. These results contrast with most literature data, which present vasopressin plasma concentrations increase 23,24 and consequent increase in systemic vascular resistance indices, with increases also in mean blood pressure values 24,26,27 . Animals' maintenance with normal P ET CO 2 values is also considered a major factor for the absence of mean blood pressure variation.…”

“…Somando-se a estas observações, verifica-se também que os valores da pressão arterial média permaneceram estáveis, em ambos os grupos, no transcorrer do experimento. Estes resultados contrastam com a maioria dos dados de literatura, os quais apresentam aumento nas concentrações plasmáticas da vasopressina 23,24 e conseqüente aumento nos índices de resistência vascular sistêmica, com aumentos também nos valores da pressão arterial média 24,26,27 . A manutenção dos animais com valores de P ET CO 2 dentro dos limites da normalidade também é considerada fator importante para a ausência de variação da pressão arterial média.…”

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…Laparoscopic surgery can be dangerous in patients with Fontan physiology if intra-abdominal pressure rises too high. Whereas intra-abdominal pressures of <15 mm Hg do not appear to adversely affect cardiac performance in patients with 2-ventricle circulation, [480][481][482] a similar threshold for those with Fontan physiology is not known. Case reports have shown that laparoscopic surgery can be performed with acceptable risk if intraabdominal pressures are <10 mm Hg in patients with Fontan physiology.…”

Anesthesia for laparoscopic surgery

“…5 Furthermore, the cardiopulmonary effects are proportional to the magnitude of IAP attained during laparoscopy with the significant changes occurring at pressures greater than 12 mmHg. 6 Minimizing IAP should decrease the risk of potentially significant physiologic changes.…”

“…Compression of the abdominal organs (e.g., liver and spleen) as a result of increased IAP and increased sympathetic output may be one of the causes of increased cardiac filling pressures. 5 In addition, the cardiac filling pressures may reflect the increased intrathoracic pressures caused by pneumoperitoneum.…”