Intra-abdominal pressure (IAP) and hypoperfusion of splanchnic organs after major abdominal surgery
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KeywordsEpidural Analgesia Epidural Anaesthesia Indocyanine Green Colonic Resection Urinary Catheter
An increased IAP plays a leading role in hypoperfusion of splanchnic organs after major abdominal surgery.
Patients and methods
Patients undergoing major (> 2 hours) abdominal surgery were eligible. After induction of anaesthesia, a urinary catheter and a gastric tonometry tube were inserted. Postoperatively all patients were admitted to the surgical ICU. IAP was measured in the urinary bladder (50 cm3 saline) after transfer to the ICU (T0) and then at T1, T6, T12, T18, and T24. Air tonometry was monitored automatically (Datex, Finland) in 10-min intervals, and arterial blood gases analysed at the same intervals. IAP was measured to allow calculation of pCO2gap. At T1 and T6 the indocyanine green (ICG) plasma disappearance rate (PDR) was measured with LIMON (Pulsion, Germany) after injection of 0.25 mg/kg ICG. This abstract summarises data of the first five patients undergoing elective colonic resection due to cancer. Data are presented as median (range). Nonparametric ANOVA for repeated measures was used for statistical analysis and P < 0.05 considered significant.
Five patients aged 70 (48–72) years underwent uncomplicated operations of > 2 hour duration in combined general and epidural anaesthesia and were extubated in the operating room. In all epidural analgesia was given during the study. At T0 IAP was 11 (8–14) mmHg and did not change significantly during the study: T1 9 (8–10), T6 9 (7–11), T12 9 (8–11), T18 11 (10–16) and T24 12 (2–15) mmHg. Only two patients had an increased IAP > 15 mmHg at T18 and T24, respectively. In these patients the abdominal perfusion pressure (MAP-IAP) at critical time points was > 70 mmHg without use of vasopressors. At T0 the pCO2gap was -0.1 (-0.7–0.3) kPa and developed as follows: T1 0.3 (0.1–1.3); 0.6 (-0.3 to 1,9); T12 0.2 (-0.2 to 1.8); T18 0.6 (0.3–0.9) and T24 0.2 (0–0.4); time effect NS. pCO2gap > 1 kPa was measured four times in three patients – at these time points a corresponding IAP was 10 mmHg maximum. The ICG PDR was normal in all patients 33.6 (24.2–36.4)%/min at T1 and did not change significantly up to T6 (27.5 [22.9–29.2] %/min).
Our pilot data suggest that, in patients after uncomplicated colonic surgery, an increased IAP to clinically significant values is rare. Hypoperfusion of gastric mucosa and liver hypoperfusion/dysfunction is also very rare.
Supported by IGA grant 7144-3.