Document Detail

Increased mediastinal pressure and decreased cardiac output during laparoscopic Nissen fundoplication.
MedLine Citation:
PMID:  9288140     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is gaining popularity. Although the hemodynamic effects of the typical pneumoperitoneum have been studied, the additional consequences of the hiatal dissection necessary for LNF have not. METHODS: Seven female pigs were anesthetized, intubated, and ventilated with a volume ventilator and hemodynamic and mechanical pressure monitoring devices were placed. Pressures were recorded every 15 minutes for 1 hour after each of four interventions: (1) anesthesia induction, (2) CO2 pneumoperitoneum (15 mm Hg), (3) LNF, and (4) release of pneumoperitoneum (and removal of ports). RESULTS: Right atrial, inferior vena caval, mediastinal, pleural, airway, and pulmonary capillary wedge pressures all increased after pneumoperitoneum (p < 0.05). Only mediastinal pressure (8.6 vs 13.7 mm Hg, pneumoperitoneum vs LNF; p < 0.05) and pleural pressure (2.6 vs 3.5 mm Hg, pneumoperitoneum vs LNF; p < 0.05) showed a further significant increase after LNF. In addition, cardiac output fell significantly after LNF (5.9 vs. 4.6 L/min; p < 0.05). Mediastinal pressure and cardiac output remained significantly altered after the release of pneumoperitoneum. CONCLUSIONS: Surgical disruption of the esophageal hiatus during LNF causes both increased mediastinal and pleural pressure and a significant reduction in cardiac output. These findings uncover a previously unsuspected physiologic detriment that may occur during LNF.
M A Talamini; M Mendoza-Sagaon; C A Gitzelmann; S Ahmad; R Moesinger; M Kutka; T Toung
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgery     Volume:  122     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-10-02     Completed Date:  1997-10-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  345-52; discussion 352-3     Citation Subset:  AIM; IM    
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA.
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MeSH Terms
Anesthesia, General
Blood Pressure
Carbon Dioxide
Cardiac Output*
Mediastinum / physiology*
Monitoring, Intraoperative
Pneumoperitoneum, Artificial
Respiration, Artificial
Vascular Resistance
Reg. No./Substance:
124-38-9/Carbon Dioxide

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