Abstract
Superior vena cava (SVC) and inferior vena cava (IVC) pressures were measured serially during laparoscopic cholecystectomy in which the intra-abdominal pressure was maintained at 12mmHg. The influences of alteration of position from 15 degrees head-down to 15 degrees head-up and of the operative procedure of holding the gallbladder up to the right subphrenic space on SVC and IVC pressures were mild. IVC pressure was maintained almost equal to the intra-abdominal pressure during prolonged continuous pneumoperitoneum lasting longer than 60min, while SVC pressure did not change significantly during operation. The discrepancy between SVC and IVC pressures underwent no change during continuous pneumoperitoneum.
Highlights
Various experimental studies have previously shown that critical changes in cardiovascular response or intra-abdominal visceral blood flow may be induced by high intra-abdominal pressure, exceeding 20 or 40mmHg, but that these changes are mild when the intra-abdominal pressure is lower than 20 mmHg 1’2’3’.Laparoscopic cholecystectomy with pneumoperitoneum under general anesthesia has been accepted as a procedure safe with regard to systemic hemo-dynamics if intra-abdominal pressure is maintained below 15mmHg
Recent studies of ours have demonstrated that prolonged continuous pneumoperitoneum may result in transient decreases in effective renal plasma flow and urine output even if intraabdominal pressure is maintained at 12 mmHg during laparoscopic cholecystectomy[45] We suspect that these changes in renal hemodynamics are due to the elevated pressure in the inferior vena cava and renal vein associated with elevated intra-abdominal pressure
Results of another study suggested that cardiac output was increased following the elevation of Superior vena cava (SVC) pressure by Starling’s law when the intra-abdominal pressure was less than 25 mmHg8
Summary
Laparoscopic cholecystectomy with pneumoperitoneum under general anesthesia has been accepted as a procedure safe with regard to systemic hemo-dynamics if intra-abdominal pressure is maintained below 15mmHg. Recent studies of ours, have demonstrated that prolonged continuous pneumoperitoneum may result in transient decreases in effective renal plasma flow and urine output even if intraabdominal pressure is maintained at 12 mmHg during laparoscopic cholecystectomy[45] We suspect that these changes in renal hemodynamics are due to the elevated pressure in the inferior vena cava and renal vein associated with elevated intra-abdominal pressure. No previous study has examined in detail the serial changes in intra-abdominal venous pressure which occur during laparoscopic cholecystectomy in the clinical setting when intra-abdominal pressure is less than 15 mmHg. The purpose of this study is to determine the influences of prolonged continuous pneumoperitoneum, intra-operative head-up or head-down position and operative procedures on pressure in the inferior vena cava during surgery
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