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Canadian Journal of Anaesthesia

, Volume 44, Issue 5, pp 467–472 | Cite as

Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomy

  • Pierre Couture
  • Daniel Boudreault
  • François Girard
  • Dominique Girard
  • Richard Ratelle
Reports of Investigation

Abstract

Purpose

Abdominal wall retraction (AWR) was recently proposed as an alternative for CO2 pneumopentoneum. In this study we evaluated the cardiorespiratory effects of AWR during laparoscopic cholecystectomy.

Methods

Fifteen patients were studied during laparoscopic cholecystectomy using AWR. Monitoring included heart rate (HR). mean arterial pressure (MAP), pulse oxymetry (SpO2), end-tidal CO2 (P1, CO2), minute ventilation, and peak inspiratory pressure (PIP). Using transoesophageal echocardiography, the transgastric short axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermined periods: I) five minutes after anaesthetic induction, 2) five minutes after AWR insertion, 3) 15 min after AWR insertion, and 4) after the end of surgery.

Results

No change in any measured parameter was observed over time in the AWR group except for an increase in MAP (P < 0.05) after AWR insertion. There were no changes in EDA, ESA and EF dunng the study, reflecting stable global cardiac function. In addition, no embolic episodes were observed dunng surgery.

Conclusion

Our results demonstrate that the use of gasless abdominal distention for laparoscopic cholecystectomy results in a stable haemodynamic profile in healthy patients without cardiac disease, except for a bnef increase in MAP after the AWR insertion. The advantages of AWR over conventional pneumoperitoneum should be confirmed in higher risk patients in a prospective, randomized study.

Keywords

Laparoscopic Cholecystectomy Mean Arterial Pressure Peak Inspiratory Pressure Scopic Cholecystectomy Laparoscopic Cholecys 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

La rétraction de la paroi abdominale (RPA) a éte récemment proposée comme solution de rechange au pneumopéntome au CO2. Cette étude évalue les effets cardiorespiratoires de la RPA pendant la cholécystectomie laparoscopique.

Méthodes

Quinze patients ont été étudiés pendant une cholécystectomie laparoscopique avec RPA. Le monitorage comprenait la fréquence cardiaque (FC), la pression arténelle moyenne (PAM), I’oxymétne de pouls (SpO2). le CO2 télé-expiratoire (PETCO2) et la pression inspiratoire de pointe (PIP). Par échocardiographie transoesophagienne, on a obtenu une image du I’axe court transgastrique avec lequel étaient dénvées les surfaces télédiastolique (STD), télésystolique (STS) et la fraction d’éjection (FE). Ces paramètres étaient mesurés à des pénodes prédéterminées: I) cinq minutes après l’induction de I’anesthésie, 2) cinq minutes après I’insertion de la RPA, 3) 15 minutes après I’insertion de la RPA, et 4) une fois la chirurgie terminée.

Résułtats

Aucun changement des paramètres mesurés n’a été observé dans le groupe RPA à part une augmentation de la PAM (P < 0,05) après I’insertion de la RPA. La STD. la STA et la FE n’ont pas changé pendant I’étude. ce qui reflète la stabilité de la fonction cardiaque globale. En outre, on n’a pas observé d’épisodes emboliques pendant la chirurgie.

Conclusion

Nos résultats montrent que la distension abdominale sans insufflation gazeuse procure un profil hémodynamique stable chez des patients bien portants, à I’exception d’une brève augmentation de la PAM après I’insertion de la RPA. L’avantage de la RPA sur le pneumopéritoine conventionnel devrait être confirmé chez des patients à risque plus éléve par une étude prospective et aléatoire randomisée.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Pierre Couture
    • 1
  • Daniel Boudreault
    • 1
  • François Girard
    • 1
  • Dominique Girard
    • 1
  • Richard Ratelle
    • 2
  1. 1.Department of AnaesthesiologyUniversité de Montréal, Hôpital Notre-DameMontréalCanada
  2. 2.Department of SurgeryUniversité de Montréal, Hôpital Notre-DameMontréalCanada

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