Surveillance hémodynamique non invasive dans la cœlioscopie gynécologique

Abstract

A new non-invasive haemodynamic monitoring technique was investigated on twenty female patients submitted to gynaecological laparoscopy under general anaesthesia. Continuous aortic output was measured with an echo-Doppler oesophageal probe specially developed by the authors. Peritoneal insufflation was performed with an average of 4±0.750 1 CO 2 at an average insufflation rate of 0.666 1 · min −1; intraperitoneal pressure increased on average by 11.57±1.60 mmHg during insufflation. Aortic output changes were related to changes in the patient's position. In initial horizontal dorsal decubitus position, average aortic output was 2.83±0.642 1 · min −1. Trendelenburg position (28±2°) induced a transient 9.54 % increase (p <0.05), while a return to the horizontal position was marked by an 11.3 % increase (p <0.01) of the aortic output. No significant change was observed during insufflation and exsufflation (−2.13 and −5.3 % respectively). Mean arterial pressure rose by 16.4 % after insufflation (initial values : 90±15.08 mmHg; p<0.01). Total vascular systemic resistances were significantly higher at the end of insufflation (2.999±376 dyn · cm · s −5; + 18.04 %; p <0.05). Heart rate did not change significantly. Aortic output monitoring with this non-invasive, easy-to-handle technique enabled early detection of haemodynamic changes during laparoscopy. These changes frequently preceded significant blood pressure or heart rate variations.