| The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum. | |
| | |
MedLine Citation:
|
PMID: 9869728 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND AND METHODS: To find an intra-abdominal pressure (IAP) range for laparoscopic procedures that elicits only moderate splanchnic and pulmonary hemodynamic and metabolic changes, including hepatic and intestinal tissue pH and superficial hepatic blood flow, we installed an IAP of 7 and 14 mm Hg each for 30 minutes in 10 healthy pigs (30 +/- 4 kg). RESULTS: In parallel with the increase of IAP, the mean transmural pulmonary artery pressure increased (from 25 +/- 3 to 27 +/- 4 at 7 mm Hg IAP and 30 +/- 6 mm Hg at 14 mm Hg IAP, p < 0.05); the pulmonary artery-to-pulmonary capillary wedge pressure gradient also increased (from 17 +/- 2.7 to 21 +/- 3 mm Hg at 7 mm Hg IAP and 24 +/- 4.2 mm Hg at 14 mm Hg IAP, p < 0.01), and the arterial oxygenation decreased (p < 0.005). Relevant changes at an IAP of 14 mm Hg were observed in right atrial pressure during inspiration (from 7 +/- 2 to 12 +/- 3 mm Hg, p < 0. 0001) and in abdominal aortic flow (from 1.43 +/- 0.4 to 1.19 +/- 0. 3 L/min, p < 0.01). However, transmural right atrial pressure and cardiac output remained essentially unchanged. Portal and hepatic venous pressure increased in parallel with the IAP (portal: from 12 +/- 3 to 17 +/- 3 at 7 mm Hg IAP and 22 +/- 3 mm Hg at 14 mm Hg IAP, p < 0.01; hepatic venous: from 8 +/- 3 to 14 +/- 6 at 7 mm Hg IAP and 19 +/- 6 mm Hg at 14 mm Hg IAP, p < 0.005), but the transmural portal and hepatic venous pressures decreased (p < 0.01), indicating decreased venous filling. Portal flow was maintained at 7 mm Hg but decreased at 14 mm Hg from 474 +/- 199 to 395 +/- 175 mL/min (p < 0. 01), whereas hepatic arterial flow remained stable. Hepatic superficial blood flow decreased during insufflation and increased after desufflation. Tissue pH fell together with portal and hepatic venous pH (intestinal: from 7.323 +/- 0.05 to 7.217 +/- 0.04; hepatic: from 7.259 +/- 0.04 to 7.125 +/- 0.06, both p < 0.01) at 14 mm Hg. CONCLUSION: The hemodynamic and metabolic derangement in the pulmonary and splanchnic compartments are dependent on the extent of carbon dioxide pneumoperitoneum. The effect of low IAP (7 mm Hg) on splanchnic perfusion is minimal. However, higher IAPs (14 mm Hg) decrease portal and superficial hepatic blood flow and hepatic and intestinal tissue pH. |
| | |
Authors:
|
U B Windberger; R Auer; F Keplinger; F Längle; G Heinze; M Schindl; U M Losert |
Related Documents
:
|
9483778 - Design and preliminary results of an ultrasound applicator for interstitial thermal coa... 11497098 - Telemetric blood pressure monitoring in conscious rats before and after compression inj... 7591018 - Endogenous marinobufagenin-like immunoreactive factor and na+, k+ atpase inhibition dur... 17328278 - Brain tissue oxygen monitoring in pediatric patients with severe traumatic brain injury. 8063868 - Nmr imaging of the apparent diffusion coefficient (adc) for the evaluation of metabolic... 7883288 - Cardiovascular responses to phenylephrine and sodium nitroprusside during acute coronar... |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: Gastrointestinal endoscopy Volume: 49 ISSN: 0016-5107 ISO Abbreviation: Gastrointest. Endosc. Publication Date: 1999 Jan |
Date Detail:
|
Created Date: 1999-02-19 Completed Date: 1999-02-19 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0010505 Medline TA: Gastrointest Endosc Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 84-91 Citation Subset: IM |
Affiliation:
|
Institute of General Electrics and Electronics, Vienna University of Technology, Austria. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Abdomen
/
physiology* Animals Bile Acids and Salts / blood Blood Flow Velocity Blood Gas Analysis Carbohydrates / blood Carbon Dioxide / administration & dosage Extracellular Space / metabolism Hematocrit Hydrogen-Ion Concentration Lung / blood supply* Pneumoperitoneum, Artificial* Potassium / blood Pressure Pulmonary Circulation / physiology* Sodium / blood Splanchnic Circulation / physiology* Spleen / blood supply* Swine Transaminases / blood |
| Chemical | |
Reg. No./Substance:
|
0/Bile Acids and Salts; 0/Carbohydrates; 124-38-9/Carbon Dioxide; 7440-09-7/Potassium; 7440-23-5/Sodium; EC 2.6.1.-/Transaminases |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Ability of naloxone to enhance the colonoscopic appearance of normal colon vasculature and colon vas...
Next Document: Endoscopic treatment of Zenker's diverticulum.