Modifications hemodynamiques durant la cœlioscopie: étude menée par bioimpédance électrique thoracique

Abstract

In 18 women A.S.A. physical status 1, a noninvasive thoracic electrical bioimpedance method was used to evaluate haemodynamic changes during gynaecological laparoscopy. A significant decrease in cardiac index was observed after peritoneal insufflation, from 3.2 to 2.8 L.min-1.m-2 and returned to the initial values after ten minutes of Trendelenburg's position. Elevated intra-abdominal pressure was also associated with a significant increase in mean arterial pressure (from 68 to 88 mmHg) and systemic vascular resistance index (from 1620 to 2491 dyn.s.cm-5.m-2). However, values were not restored after peritoneal exsufflation: systemic vascular resistance index values remained 30 per cent higher than that before insufflation. Decreased venous return may account for the significant decrease in cardiac output but mechanical compression does not explain the persistent elevation of systemic vascular resistance.

Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery

“…These changes include hypercapnia [3, 5, 6, 10, 13]; restrictive lung syndrome development (decrease of lung compliance, total lung capacity, residual functional lung capacity); changes in ventilation/perfusion ratios with relative increase in dead space [10,13]; increase in the venous pressure distal to the obstacle by 80% at 14 mmHg [4], with decrease of the blood flow by 30% [12]; decrease of the venous return by 20% [6,14] and disturbances of the venous renal drainage [14][15][16]; increase of the systemic vascular resistance [8,10,11,17,18], which may be elevated by 50% [3]; and decrease in cardiac output and cardiac index [8-10, 14, 17].…”

Effect of intravenous clonidine premedication in patients undergoing laparoscopic cholecystectomy

“…2,4 Several mediators have been proposed: catecholamines prostaglandins, renin and vasopressin. [5][6][7][8][9][10][11] Alpha 2-adrenergic agonists have been shown to improve haemodynamic stability during gynaecologic laparoscopy. 12,13 Clonidine is a selective α-2 adrenergic receptor agonist, which is known to produce sedation, analgesia and haemodynamic stability.…”