JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
Add like
Add dislike
Add to saved papers

Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy.

More prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. The early reports of hemodynamic changes during gynecologic laparoscopy are conflicting, and the effects of anesthesia, head-down tilt and pneumoperitoneum have not been clearly separated. Invasive hemodynamic monitoring was carried out in 20 female ASA Class I-II patients who underwent laparoscopic hysterectomy. Baseline measurements were made in the supine, supine-lithotomy and Trendelenburg (25-30 degrees) positions in awake patients. Measurements were repeated in the supine-lithotomy and Trendelenburg positions after induction of anesthesia, during laparoscopy 5 minutes after the beginning of peritoneal CO2-insufflation (intra-abdominal pressure 13-16 mmHg) and at 15-minute intervals thereafter, after laparoscopy in the Trendelenburg and supine positions, after extubation and in the recovery room at 30-minute intervals. Patients received balanced general anesthesia with isoflurane in 35% O2 in an oxygen/air mixture. End tidal PCO2 was maintained between 4.5-4.8 kPa (33-36 mmHg) by changing the minute volume of controlled ventilation. The Trendelenburg position in awake and anesthetized patients increased pulmonary arterial pressures (PAP), central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). These pressures increased further at the start of CO2-insufflation, decreased towards the end of the laparoscopy and reached pre-insufflation levels after deflation of pneumoperitoneum. The mean arterial pressure (MAP) increased at the beginning of laparoscopy in comparison with the pre-laparoscopic values. Heart rate (HR) was quite stable during laparoscopy. The cardiac index (CI) decreased with anesthesia from 3.8 to 3.2 1.min-1.m-2 and further during laparoscopy to 2.7 1.min-1.m-2, returning to pre-insufflation values soon after deflation. The stroke index (SI) changed in concert with the CI changes. The right ventricular stroke work index decreased during laparoscopy more than the left ventricular stroke work index. The right atrial pressure (CVP) exceeded the PCWP more often during laparoscopy than during any other phase of the procedure. Anesthesia and the Trendelenburg position increased the CVP, PCWP and pulmonary arterial pressures and decreased cardiac output. Pneumoperitoneum increased these pressures further mostly in the beginning of the laparoscopy, and cardiac output decreased towards the end of the laparoscopy. The risk of systemic CO2-embolus was increased during laparoscopy.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app