Document Detail


Effect of pneumoperitoneum on hemodynamics and inspiratory pressures during natural orifice transluminal endoscopic surgery (NOTES): an experimental, controlled study in an acute porcine model.
MedLine Citation:
PMID:  17968799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND STUDY AIM: Physiologic reactions during natural orifice transluminal endoscopic surgery (NOTES) may differ from those at laparoscopy. This experimental study assessed the effect of pneumoperitoneum induced by endoscope air pump on hemodynamics and inspiratory pressures during transgastric peritoneoscopy. METHODS: Transgastric peritoneoscopy was performed in 11 female pigs (35 - 50 kg) under general anesthesia. Five pigs with controlled insufflation and no endoscopic intervention served as controls. Cardiac index and global end-diastolic volume index (GEDVI; reflecting preload) were measured every 3 minutes by transpulmonary thermodilution. We also recorded: intra-abdominal pressure (IAP), heart rate, mean arterial pressure (MAP), systemic vascular resistance index (SVRI; reflecting afterload), peak inspiratory pressure (PIP), and oxygenation. RESULTS: One study group pig was excluded from analysis because of a major complication related to the gastric incision. In the remaining 15 animals we performed 264 paired measurements. On-demand insufflation in the study group produced wide variation in intra-abdominal pressures; the control group demonstrated minimal fluctuation around a predetermined value. In the study group, IAP and PIP correlated well ( R = 0.667, P = 0.000), with maximum PIP values of 40 mbar contrasting with the control group maximum of 26.5 mbar. Hemodynamically, there was a minor decrease of cardiac index in the study group (in contrast to the control group). Relative changes in cardiac index and IAP during transgastric peritoneoscopy correlated highly significantly ( R = - 0.416, P = 0.000). Neither group showed hemodynamic instability or decline in oxygen saturation. CONCLUSIONS: On-demand insufflation with a standard endoscopic light source/insufflator resulted in a marked median increase and wide variation in IAP throughout transgastric peritoneoscopy. Hemodynamic changes were moderate. However, major increases in PIP suggest a need for stricter control of intra-abdominal hypertension during NOTES.
Authors:
S von Delius; W Huber; H Feussner; D Wilhelm; A Karagianni; J Henke; A Preissel; A Schneider; R M Schmid; A Meining
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Endoscopy     Volume:  39     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-30     Completed Date:  2007-11-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  854-61     Citation Subset:  IM    
Affiliation:
2nd Medical Department, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. stefan_ruckert@yahoo.de
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MeSH Terms
Descriptor/Qualifier:
Abdominal Cavity / physiology
Animals
Disease Models, Animal
Equipment Design
Female
Gastrointestinal Diseases / physiopathology,  surgery
Hemodynamics / physiology*
Inhalation / physiology*
Insufflation / instrumentation*
Laparoscopes
Laparoscopy / methods*
Oximetry
Pneumoperitoneum, Artificial / methods*
Pressure
Stomach / surgery
Swine
Thermodilution / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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