Pneumoperitoneum influence on the cardiovascular system evaluated by the PiCCO system

Introduction

In laparoscopy the pneumoperitoneum, increasing intra-abdominal pressure, could impair cardiac performance and determine adverse cardiopulmonary effects. We have assessed the influence of laparoscopic surgery on selected hemodynamic-volumetric parameters by the PiCCO device (pulse contour analysis and transpulmonary technique).

Methods

Under general anaesthesia 16 patients, age 62 ± 13 years, ASA II-III (exclusion criteria: cardiovascular disease, neurological disease, pulmonary disease), nine male/seven female, were enrolled in two groups: Group A eight patients submitted to laparoscopic surgery; Group B, eight patients submitted to open surgery. In this randomised, controlled study the cardiac index (CI), global ejection fraction (GEF), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), intrathoracic blood volume (ITBVI), index of ventricular contractility (Dp/Dtmax) and stroke volume index (SVI) were recorded. The hemodynamic and volumetric data are studied at T0 (after induction of anaesthesia), T1 (during pneumoperitoneum pressure at 12 ± 3 mmHg) and T2 (after deflation of the gas). Statistical analysis: ANOVA and Bonferroni multiple comparisons post-test to compare changes in the groups. All data are given as means ± SD and P < 0.05 is considered statistically significant.

Results

The hemodynamic parameters are not changed significantly between groups and in each group except for SVRI during pneumoperitoneum (P = 0.0077) (Table 1).

Table 1