BACKGROUND: Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may cause marked circulatory alterations. METHODS: Eight anaesthetized cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy, were studied before and during pneumoperitoneum in three different postures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitoring. RESULTS: PP significantly increased end-diastolic area (EDA) and pulmonary capillary wedge pressure (PCWP) irrespective of posture. PCWP was significantly influenced by postural changes, whereas EDA was not. Further, changes in EDA and PCWP covaried during the investigation, but showed no linear correlation. Systolic function, measured as end-systolic area (ESA) and fractional area shortening (FAS), was not altered. Diastolic function, as assessed by the velocity rate of the transmitral flow during the early filling phase (E) and the atrial contraction (A), showed no change of the E/A ratio, whereas after the induction of PP there was a significant reduction of the E component. CONCLUSIONS: 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).
BACKGROUND: Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may cause marked circulatory alterations. METHODS: Eight anaesthetized cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy, were studied before and during pneumoperitoneum in three different postures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitoring. RESULTS: PP significantly increased end-diastolic area (EDA) and pulmonary capillary wedge pressure (PCWP) irrespective of posture. PCWP was significantly influenced by postural changes, whereas EDA was not. Further, changes in EDA and PCWP covaried during the investigation, but showed no linear correlation. Systolic function, measured as end-systolic area (ESA) and fractional area shortening (FAS), was not altered. Diastolic function, as assessed by the velocity rate of the transmitral flow during the early filling phase (E) and the atrial contraction (A), showed no change of the E/A ratio, whereas after the induction of PP there was a significant reduction of the E component. CONCLUSIONS: 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).
Authors: Simon Bergman; Arni Nutting; Liane S Feldman; Melina C Vassiliou; Christopher G Andrew; Sebastian Demyttenaere; Debbie Woo; Franco Carli; Luc Jutras; Jean Buthieu; Donna D Stanbridge; Gerald M Fried Journal: Surg Endosc Date: 2006-03-16 Impact factor: 4.584
Authors: S V Demyttenaere; L S Feldman; S Bergman; S Gholoum; C Moriello; B Unikowsky; S Fraser; F Carli; G M Fried Journal: Surg Endosc Date: 2005-12-09 Impact factor: 4.584
Authors: Fouad G Souki; Yiliam F Rodriguez-Blanco; Sravankumar Reddy Polu; Scott Eber; Keith A Candiotti Journal: BMC Anesthesiol Date: 2018-08-21 Impact factor: 2.217