Effect of intraabdominal pressure elevation and positioning on hemodynamic responses during carbon dioxide pneumoperitoneum for laparoscopic donor nephrectomy: A prospective controlled clinical study

I. R.A.M. Mertens Zur Borg*, A. Lim, S. J.C. Verbrugge, J. N.M. Ijzermans, J. Klein

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

49 Citations (Scopus)

Abstract

Background: Carbon dioxide (CO2) pneumoperitoneum (PP) increases mean arterial blood pressure (MAP) and systemic vascular resistance (SVR) but decreases stroke volume (SV) and cardiac output (CO). This study evaluated the hemodynamic effects of elevated intraabdominal pressure (IAP) occurring during laparoscopic donor nephrectomy (LDN). Methods: Twenty-two patients undergoing LDN were investigated and hemodynamic parameters, P vCO2 (carbon dioxide partial pressure), and VCO 2 (carbon dioxide production) were monitored during the procedure. Before and after PP, IAP was raised from 12 to 20 mmHg and the hemodynamic effects were measured every 30 s. Results: During IAP of 12 mmHg and stable serum CO2, there was no change in SV compared to preinsufflation levels. When IAP was elevated from 12 to 20 mmHg, SV initially decreased (p < 05), followed by an increase in MAP and SVR (p < 0.05). Conclusion: This study shows that with the fluid and ventilation protocol used, PP has no significant effect on SV at an IAP of 12 mmHg, whereas increasing IAP to 20 mmHg does. In this study, the hemodynamic effects induced by CO2 PP of 12 mmHg are not due to changes in serum CO2. Compression of the venous system during a PP of 20 mmHg reduces preload, with an subsequent increase in SVR.

Original languageEnglish
Pages (from-to)919-923
Number of pages5
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number6
Early online date27 Apr 2004
DOIs
Publication statusPublished - Jun 2004

Bibliographical note

© Springer-Verlag New York, LLC 2004

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