Anestezjologia intensywna terapia · 2008
[Haemodynamics during gynaecological laparoscopy].
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Skorzyński Wojciech, Jakiel Grzegorz, Przesmycki Krzysztof
Аннотация
BACKGROUND: Gynaecological laparoscopic (GL) surgery can be prolonged and may be associated with significant cardiovascular compromise. Recent experimental studies suggest that prolonged pneumoperitoneum can cause cardiac depression and a decrease in cardiac index. The goal of the study was to compare haemodynamics before and after CO2 desufflation, performed at the end of surgery.
METHODS: This study included ASA I and II women undergoing GL under general anaesthesia. After induction, an oesophageal Doppler device (TED) probe (Arrow HemoSonic 100) was inserted and the following values were recorded every 5 min: aortic blood flow (ABF), total systemic vascular resistance (TSVRa), mean acceleration (Acc), peak velocity (PV) heart rate (HR) and mean arterial pressure (MAP).
RESULTS: Fifty-seven patients were enrolled in the study. MAP and TSVRa increased after CO2 insufflation, and decreased at the end of GL in all groups. TSVRa significantly increased at the end of GL, before CO2 desufflation in all procedures lasting more that 60 min, when compared to those lasting less than 60 min. A significant decrease in ABF was observed before desufflation in GL lasting more than 60 min vs. those lasting less than 30 min. CO2 desufflation was associated with an increase in ABF in all groups. Contractility (Acc, PV) significantly decreased during surgery and increased after desufflation in operations lasting 30-60 min or those lasting more than 60 min, compared to short procedures (<30 min).
DISCUSSION AND CONCLUSION: Prolonged pneumoperitoneum caused significant, time-dependent compromise of aortic blood flow and heart contractility. Changes were directly related to increased abdominal pressure and increased with prolonged surgery. This may be of special importance in patients with cardiovascular diseases.
METHODS: This study included ASA I and II women undergoing GL under general anaesthesia. After induction, an oesophageal Doppler device (TED) probe (Arrow HemoSonic 100) was inserted and the following values were recorded every 5 min: aortic blood flow (ABF), total systemic vascular resistance (TSVRa), mean acceleration (Acc), peak velocity (PV) heart rate (HR) and mean arterial pressure (MAP).
RESULTS: Fifty-seven patients were enrolled in the study. MAP and TSVRa increased after CO2 insufflation, and decreased at the end of GL in all groups. TSVRa significantly increased at the end of GL, before CO2 desufflation in all procedures lasting more that 60 min, when compared to those lasting less than 60 min. A significant decrease in ABF was observed before desufflation in GL lasting more than 60 min vs. those lasting less than 30 min. CO2 desufflation was associated with an increase in ABF in all groups. Contractility (Acc, PV) significantly decreased during surgery and increased after desufflation in operations lasting 30-60 min or those lasting more than 60 min, compared to short procedures (<30 min).
DISCUSSION AND CONCLUSION: Prolonged pneumoperitoneum caused significant, time-dependent compromise of aortic blood flow and heart contractility. Changes were directly related to increased abdominal pressure and increased with prolonged surgery. This may be of special importance in patients with cardiovascular diseases.