Elsevier

Gastrointestinal Endoscopy

Volume 41, Issue 2, February 1995, Pages 121-129
Gastrointestinal Endoscopy

Original article
Hemodynamic effects of prolonged abdominal insufflation for laparoscopic procedures

https://doi.org/10.1016/S0016-5107(05)80593-0Get rights and content

Abdominal insufflation for laparoscopic procedures leads to numerous hemodynamic effects. We focused on blood flow distribution and arterial and venous pressure changes during CO2 insufflation at an intra-abdominal pressure of 12 mm Hg. Three segments of the vascular system were investigated (intrathoracic, cranial extrathoracic, caudal extrathoracic) in supine animals at insufflation, during a 90-minute period of pneumoperitoneum, and at desufflation. Except for instrumentation of the animals, no further surgery was performed. At insufflation (+5 minutes), cardiac output increased from 2.7±0.5 to 3.3±1.1 L/min while heart rate decreased from 138±26 to 128±17 beats per minute. Increases in jugular venous (from 6±1 to 11±4 mm Hg) and atrial (right, from 7±1 to 12±3; left, from 12±4 to 17±5 mm Hg) pressures occurred uniformly during inspiration. The great variance in atrial pressures during ventilation was not associated with changes in stroke volume, as the effective transmural filling pressures remained nearly constant. The increase in femoral venous pressure occurring during both inspiration and expiration (from 10±2 to 18±4 mm Hg) exceeded the increase in right atrial and jugular venous pressures during inspiration. Parallel increases were noted in arterial pressures (carotid, from 119±15 to 129±9; femoral, from 122±16 to 133±10 mm Hg), left ventricular pressure (from 133±17 to 143±10 mm Hg), and carotid and femoral flow (carotid, from 174±71 to 195±70; femoral, from 66±25 to 73±40 (NS) mL/min). During pneumoperitoneum, arterial pressures, and flows, dLVP/dt, and tension time index decreased continuously below baseline while venous and atrial pressures were maintained. Heart rate increased at pneumoperitoneum. At desufflation, atrial and venous pressures decreased as they were directly related to mechanical strain, whereas the blood flows increased again. Abdominal insufflation was associated with increased cardiac output, cardiac contractility, and arterial pressures, at least initially. Although caudal venous resistance increased, blood flow distribution was not affected.

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