Impact of carboxyperitoneum on cardiac index in patients with morbid obesity and concurrent cardio-vascular pathology during laparoscopic bariatric interventions
Objective. To investigate the impact of carboxyperitoneum on indices of central hemodynamics in patients, suffering morbid obesity (МО) and concurrent cardio-vascular pathology (СVP) during laparoscopic bariatric interventions.
Маterials and methods. In the investigation 45 patients, having МО and the body mass index 37 - 58 kg/м2, ageing from 18 tо 61 yrs old, were included, in whom laparoscopic bariatric interventions were performed. Concurrent СVP was revealed in 100% of the patients. In all the patients intraoperatively a combined inhalation low-streaming anesthesia with sevofluran in combination with perioperative multimodal anesthesia was conducted. Indices of central hemodynamics were оbtained mathematically. Statistical elaboration of the investigation result was done with the help of the pool analysis of statistical data MedCalc v. 18.11 (MedCalc Software Inc, Broekstraat, Belgium).
Results. Using correlation analysis there was established, that a change of absolute value of the cardiac index (СІ) correlates with intraabdominal pressure (IAP) in setting of carboxyperitoneum. Strong positive linear link was revealed (r=0.83; p < 0.001) between values Δ СІ and IAP. Critical value of IAP in environment of carboxyperitoneum constitutes 15 mm Hg: sensitivity – 93.1% (95% CI – ВІ 77.2% – 99.2%), specificity – 100% (95% ВІ 79.4% – 100%), prognostication of positive result - 100% (95% ВІ 93.2% – 100%), prognostication of negative result – 88.9% (95% ВІ 67.7% – 96.8%).
Conclusion. Durable carboxyperitoneum in pressure 15 mm Hg do not lead to significant hemodynamical changes in patients with МО and coexistent СVP and is optimal for them.
2. Umar A, Mehta KS, Mehta N. Evaluation of hemodynamic changes using different intra-abdominal pressures for laparoscopic cholecystectomy. Indian J Surg. 2013 Aug;75(4):284-9. http://doi.org/10.1007/s12262-012-0484-x.
3. Ekici Y, Bozbas H, Karakayali F, Salman E, Moray G, Karakayali H, et al. Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2009 Nov;23(11):2543-9. http://doi.org/10.1007/s00464-009-0388-4.
4. Meininger D, Byhahn C, Bueck M, Binder J, Kramer W, Kessler P et al. Effects of prolonged pneumoperitoneumon hemodynamics and acid-base balance during totally endoscopic robot-assisted radical prostatectomies. World J Surg. 2002 Dec;26 (12):1423–7. http://doi.org/10.1007/s00268-002-6404-7.
5. McLaughlin JG, Scheeres DE, Dean RJ, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc. 1995 Feb;9 (2):121–4. PMID: 7597577.
6. Nguyen NT, Wolfe BM . The physiologic effects of pneumoperitoneum in the morbidly obese. Ann Surg. 2005 Feb;241(2):219–26. PMID: 15650630.
7. Sharma A, Dahiya D, Kaman L, Saini V, Behera A. Effect of various pneumoperitoneum pressures on femoral vein hemodynamics during laparoscopic cholecystectomy. Updates Surg. 2016 Jun;68(2):163-9. http://doi.org/10.1007/s13304-015-0344-x.
8. Stelfox H, Ahmed SB, Ribeiro RA, Gettings EM, Pomerantsev E, Schmidt U. Hemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and strock volume. Crit Care Med. 2006 Apr;34(4):1243–6. http://doi.org/10.1097/01.CCM.0000208358.27005.F4.
9. Gurianov VG, Liakh YuYe, Parii VD, Korotkyi OV, Chalyi OV, Chalyi KO, Tsekhmister YaV. Posibnyk z biostatystyky. Analiz rezultativ medychnykh doslidzhen u paketi EZR (R-Statistics): Navch posib. K.: Vistka; 2018. 208 s. [In Ukrainian].
10. Barczyn?ski M, Herman RM. Influence of different pressures of pneumoperitoneum on the autonomic system function during laparoscopy. Folia Med Cracov 2002;43(1-2):51–8. PMID: 12815798.
11. Sandhu T, Yamada S, Ariyakachon V, Chakrabandhu T, Chongruksut W, Ko-Iam W. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy: a prospective randomized clinical trial. Surg Endosc. 2009 May;23(5):1044–7. http://doi.org/10.1007/s00464-008-0119-2.
12. D’Ugo D, Persiani R, Pennestri F, Adducci E, Primieri P, Pende V, et al. Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients. Surg Endosc. 2000 Feb;14(2):120–2. PMID: 10656941.
13. Mertens zur Borg IR, Lim A, Verbrugge SJ, IJzermans JN, Klein J. Effect of intraabdominal pressure elevation and positioning on hemodynamic responses during carbon dioxide pneumoperitoneum for laparoscopic donor nephrectomy: a prospective controlled clinical study. Surg Endosc. 2004 Jun;18 (6):919–23. http://doi.org/10.1007/s00464-003-8817-2
14. Angioli R, Terranova C, Plotti F, Cafa EV, Gennari P, Ricciardi R et all. Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study. Arch Gynecol Obstet. 2015 Apr;291(4):865-8. http://doi.org/10.1007/s00404-014-3494-z.
15. Mulier JP, Dillemans B, Van Cauwenberge S. Impact of the patient’s body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc. 2010 Jun;24(6):1398–402. http://doi.org/10.1007/s00464-009-0785-8
16. Rosenberg J, Herring WJ, Blobner M, Mulier JP, Rahe-Meyer N, Woo T, et al. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions: A Randomized, Controlled Study. Adv Ther. 2017 Apr;34(4):925-36. http://doi.org/10.1007/s12325-017-0495-x.
This work is licensed under a Creative Commons Attribution 4.0 International License.