Alterations in hemodynamics and left ventricular contractility during carbon dioxide pneumoperitoneum

Abstract

Background: Carbon dioxide (CO₂) pneumoperitoneum has been shown to adversely affect hemodynamics in patients. This study specifically examines the potential contribution of altered left ventricular contractility (LVC) to hemodynamic changes observed during CO₂ pneumoperitoneum.

Methods: In a canine model, LV volumes, LV pressure, and intrathoracic and central venous pressures were recorded both at basal intra-abdominal pressure (IAP) and after CO₂ insufflation to produce IAPs of 5–25 mmHg.

Results: At IAPs greater than 15 mmHg, cardiac output and LV end-diastolic volume decreased. Mean arterial pressure and heart rate were unchanged. LVC, quantified using the linear Frank-Starling relationship, was not affected by increases in IAP.

Conclusions: This study is the first to quantify LVC during CO₂ pneumoperitoneum and demonstrates no changes in contractility over IAPs from 5 to 25 mmHg. In the dog model, any hemodynamic alterations induced by CO₂ pneumoperitoneum are secondary to altered LV preload and not alterations in contractility or LV afterload.