Unusually High Intra-abdominal Opening Pressure Confirmed by Simultaneous Gastric Pressure Measurement during Laparoscopy

Richard Matulewicz,Stephen H Loring,Antonio R Gargiulo,Massimo Ferrigno

doi:10.2174/1874321801206010012

Abstract

A 28 year-old obese woman was scheduled for robot-assisted bilateral tubal re-anastomosis under general anesthesia and neuromuscular blockade. As part of a respiratory mechanics study, gastric pressure (Pga) was measured. At the beginning of the operation, the surgeon repeatedly inserted a Veress needle consistently measuring an unusually high opening pressure of 15 mmHg, at a time when Pga was 12.5 mmHg. Based on the elevated Pga values, we inferred that the high opening pressure was a valid intra-peritoneal pressure, rather than a sign of incorrect needle placement; therefore, the surgeon proceeded with uneventful insufflation of the peritoneal cavity. This patient exhibited an unusually high opening intra-abdominal pressure that likely reflected her high degree of central obesity. Simultaneous Pga determination proved valuable in confirming intra-peritoneal location of the tip of Veress needle and may be a viable method of corroborating high opening pressures despite safe needle positions in laparoscopic cases.

Highlights

Pneumoperitoneum is routinely used by surgeons to facilitate organ visualization and surgical manipulations during laparoscopic procedures
Intra-abdominal pressure (IAP) is frequently measured through a urinary bladder catheter. With this technique, which included emptying the bladder subsequently irrigating with 50cc of normal saline, Sanchez et al, [8] measured in 52 non-obese individuals an average intraabdominal pressure (IAP) of 5 mmHg, with a wide range of 0.2 to 11.8 mmHg. They found a positive correlation between IAP and a patient’s body mass index (BMI), with average pressures of 8.9 [range 4.5 to 16.2 mmHg] and 8.4 mmHg [range 4.7 to 10.2 mmHg] in obese and morbidly obese patients, respectively
It could be argued that the large variability in these measurements of IAP may be due to different distributions of fat in those patients

Summary

Introduction

Pneumoperitoneum is routinely used by surgeons to facilitate organ visualization and surgical manipulations during laparoscopic procedures. An opening intra-abdominal pressure of 12 mmHg (16.3 cm H2O) or less at the time of insufflation with the Veress needle is considered physiological [1].

Results

Conclusion