Non-invasive pulse wave analysis for monitoring the cardiovascular effects of CO2 pneumoperitoneum during laparoscopic cholecystectomy- a prospective case-series study

BMC Anesthesiology

Péter Sárkány²  Szabolcs Lengyel¹  Réka Nemes²  Lívia Orosz²  Dénes Páll¹  Csilla Molnár²  Béla Fülesdi² 

[1] 1st Department of Medicine, University of Debrecen, Medical and Health Science Centre, Nagyerdei krt. 98, H-4032 Debrecen, Hungary

[2] Department of Anesthesiology and Intensive Care, University of Debrecen, Medical and Health Science Centre, Nagyerdei krt. 98, H-4032 Debrecen, Hungary

关键词: Applanation tonometry;    Hemodynamic changes;    Laparoscopic cholecystectomy;   

Others  :  1084302
DOI  :  10.1186/1471-2253-14-98

 received in 2014-04-01, accepted in 2014-09-30,  发布年份 2014

【 摘 要 】

Background

Peritoneal insufflation results in hemodynamic changes during laparoscopic cholecystectomy. The aim of the present work is to test whether non-invasive applanation tonometry is suitable for reflecting these hemodynamic alterations.

Methods

41 patients undergoing laparoscopic cholecystectomies were monitored using the SphygmoCor pulse wave analysing system. Peripheral blood pressures (PBP), central aortic blood pressures (CBP), augmentation index (ALX@HR75) and subendocardial viability ratio (SVR) were measured at rest (Phase 1), after anesthetic induction (Phase 2), after peritoneal inflation (Phase 3) and after peritoneal deflation (Phase 4).

Results

Induction of anesthesia resulted in a statistically significant reduction in both the peripheral blood pressure and central aortic pressures, accompanied by a decrease in augmentation pressure and augmentation index. Peripheral blood pressures did not change along with the peritoneal cavity insufflation, except for a moderate increase in systolic blood pressure. In contrast to this, an increase could be observed in central aortic pressure (106.77 ± 18.78 vs. 118.05 ± 19.85 mmHg, P < 0.01) which was accompanied by increased augementation pressure (18.97 ± 10.80 vs. 31.55 ± 12.01; P < 0.001) and augmentation index (7.31 ± 5.59 vs. 12.61 ± 7.56, P < 0.001), indicating a rise in peripheral arterial stiffness.

Conclusions

The Sphigmocor pulse wave analysis system can be reliably used for detecting and monitoring cardiovascular changes occurring during laparoscopic cholecystectomy.

【 授权许可】

   
2014 Sárkány et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Struthers AD, Cuschieri A: Cardiovascular consequences of laparoscopic surgery. Lancet 1998, 352:568-570.
• [2]Wahba RW, Béïque F, Kleiman SJ: Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth 1995, 42:51-63.
• [3]O’Leary E, Hubbard K, Tormey W, Cunningham AJ: Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth 1996, 76:640-644.
• [4]Bliacheriene F, Machado SB, Fonseca EB, Otsuke D, Auler JO Jr, Michard F: Pulse pressure variation as a tool to detect hypovolaemia during pneumoperitoneum. Acta Anaesthesiol Scand 2007, 51:1268-1272.
• [5]Turkistani AA: Cardiodynamic monitoring during laparoscopic cholecystectomy. Middle East J Anesthesiol 2005, 18:435-439.
• [6]Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V, Ferrara A, Pignatelli C: Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc 2001, 15:477-483.
• [7]Feig BW, Berger DH, Dupuis JF: Hemodynamic effects of CO2 abdominal insufflation (CAI) during laparoscopy in high-risk patients. Anesth Analg 1994, 78:S109.
• [8]Joshi GP, Hein HA, Mascarenhas WL, Ramsay MA, Bayer O, Klotz P: Continuous transesophageal echo-Doppler assessment of hemodynamic function during laparoscopic cholecystectomy. J Clin Anesth 2005, 17:117-121.
• [9]Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML: Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993, 76:1067-1071.
• [10]O’Rourke MF, Pauca AL: Augmentation of the aortic and central arterial pressure waveform. Blood Press Monit 2004, 9:179-185.
• [11]Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Lamm G, Stark N, Rammer M, Eber B: Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J 2005, 26:2657-2663.
• [12]Agnoletti D, Lieber A, Zhang Y, Protogerou AD, Borghi C, Blacher J, Safar ME: Central hemodynamic modifications in diabetes mellitus. Atherosclerosis 2013, 230:315-321.
• [13]Carty DM, Neisius U, Rooney LK, Dominiczak AF, Delles C: Pulse wave analysis for the prediction of preeclampsia. J Hum Hypertens 2014, 28:98-104.
• [14]Hömme R: Anesthesia for laparoscopic interventions (German). Anaesthesist 2011, 60:175-187.
• [15]Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML: Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol 1998, 32:1389-1396.
• [16]Cinnella G, Grasso S, Spadaro S, Rauseo M, Mirabella R, Salatto P, De Capraris A, Nappi L, Greco P, Dambrosio M: Effects of Recruitment Maneuver and Positive End-expiratory Pressure on Respiratory Mechanics and Transpulmonary Pressure during Laparoscopic Surgery. Anesthesiology 2013, 118:114-122.
• [17]Safran D, Sgambati S, Orlando R 3rd: Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 1993, 176:548-554.
• [18]Dhoste K, Lacoste L, Karayan J, Lehuede MS, Thomas D, Fusciardi J: Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients. Can J Anaesth 1996, 43:783-788.