Document Detail


Splanchnic microcirculatory changes during CO2 laparoscopy.
MedLine Citation:
PMID:  9100683     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Splanchnic macrocirculatory changes during high-pressure CO2 pneumoperitoneum include a decrease in mesenteric arterial blood flow, and decreased gastric perfusion with a drop in gastric pH in experimental studies. Microcirculatory changes in abdominal organs under clinical conditions with a low pressure CO2 pneumoperitoneum are unknown. STUDY DESIGN: In 18 patients undergoing routine laparoscopy with a CO2 pneumoperitoneum (7 symptomatic cholecystolithiasis, 3 acute cholecystitis, and 8 acute appendicitis) gastric, duodenal, jejunal, colonic, hepatic, and peritoneal blood flow was measured with a custom-made laser Doppler flow probe at an intra-abdominal pressure of 0, 10, and 15 mm Hg. RESULTS: Intra-abdominal pressure elevation from 10 mm Hg to 15 mm Hg significantly decreased the blood flow in the stomach by 40 percent to 54 percent, the jejunum by 32 percent, the colon by 44 percent, the liver by 39 percent, the parietal peritoneum by 60 percent, and the duodenum by 11 percent. Splanchnic blood flow decreased with operative time at a constant intra-arterial pressure (r = 0.88, p < 0.0001). CONCLUSIONS: From our study, we concluded that laparoscopic procedures with a CO2 pneumoperitoneum should be performed at a pressure of 10 mm Hg or lower to avoid splanchnic microcirculatory disturbances.
Authors:
M K Schilling; C Redaelli; L Krähenbühl; C Signer; M W Büchler
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  184     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-04-30     Completed Date:  1997-04-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  378-82     Citation Subset:  AIM; IM    
Affiliation:
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital Bern, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Carbon Dioxide
Colon / blood supply
Duodenum / blood supply
Female
Humans
Jejunum / blood supply
Liver / blood supply
Male
Microcirculation
Middle Aged
Peritoneum / blood supply
Pneumoperitoneum, Artificial*
Pressure
Regional Blood Flow
Splanchnic Circulation*
Stomach / blood supply
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide
Comments/Corrections
Erratum In:
J Am Coll Surg 1997 Oct;185(4):423

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


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