Summary
Recently we have used the laparoscope to remove the gallbladder in critically ill patients in order to spare them the operative trauma of laparotomy. However, increased intraperitoneal pressure may have deleterious cardiopulmonary effects. This was investigated in a dog model. Insufflation of the abdomen with carbon dioxide decreased the mean cardiac output to less than 80% of baseline (P<0.004). This was aggravated by the reverse Trendelenburg position and partially alleviated by the Trendelenburg position. Mean arterialPCO2 and mean peak airway pressure significantly rose. These effects are of doubtful clinical significance in the majority of patients. However, to extend the benefits of laparoscopy to patients with decreased cardiopulmonary reserve, hemodynamic and carbon dioxide monitoring should be used because measures to improve venous return, augment cardiac output, and counteract the increase inPCO2 and peak airway pressure may be required.
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References
Brantley JC, Riley PM (1988) Cardiovascular collapse during laparoscopy: a report of two cases. Am J Obstet Gynecol 159: 735–737
Ho HS, Gunther RA, Wolfe BM (1992) Intraperitoneal carbon dioxide insufflation and cardiopulmonary functions; laparoscopic cholecystectomy in pigs. Arch Surg 127: 928–933
Johannsen G, Andersen M, Juhl B (1989) The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation. Acta Anaesthesiol Scand 33: 132–136
Kashtan J, Green JF, Parsons EQ, Holcroft JW (1981) Hemodynamic effects of increased abdominal pressure. J Surg Res 30: 249–255
Leighton TA, Bongard FS, Liu SY, Lee TS, Klein SR (1991) Comparative cardiopulmonary effects of helium and carbon dioxide pneumoperitoneum Surg Forum IX: 485–487
Lenz RJ, Thomas TA, Wilkins DG (1976) Cardiovascular changes during laparoscopy, studies of stroke volume and cardiac output using impedance cardiography. Anaesthesia 31: 4–12
Liu SY, Leighton T, Davis I, Klein S, Lippmann M, Bongard F (1991) Prospective analysis of cardiopulmonary responses to laparoscopic cholecystectomy. J Laparoendosc Surg 1: 241–246
Marshall RL, Jebson PJR, Davie IT, Scott DB (1972) Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy. Br J Anaesth 44: 680–684
Marshall RL, Jepson PJR, Davie IT, Scott B (1972) Circulatory effects of peritoneal insufflation with nitrous oxide. Br J Anaesth 44: 1183–1187
McKenzie R, Wadhwa RK, Bedger RC (1980) Noninvasive measurement of cardiac output during laparoscopy. J Reprod Med 24: 247–250
Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH, Gravenstein JS (1978) Cardiac function and hypercarbia. Arch Surg 113: 1196–1200
Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS (1991) Laparoscopic cholecystectomy, treatment of choice for symptomatic cholelithiasis. Ann Surg 213: 665–677
Torrielli R, Cesarini M, Winnock S, Cabiro C, Mene JM (1990) Hemodynamic changes during celioscopy: a study carried out using thoracic electric bioimpedance. Can J Anaesth 37: 46–51
Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL (1991) Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 126: 997–1001
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Williams, M.D., Murr, P.C. Laparoscopic insufflation of the abdomen depresses cardiopulmonary function. Surg Endosc 7, 12–16 (1993). https://doi.org/10.1007/BF00591229
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DOI: https://doi.org/10.1007/BF00591229