Pneumoperitoneum In Laparoscopic Cholecystectomy Research Articles

Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation.

To investigate the influence of increased intra-abdominal pressure during pneumoperitoneum on splanchnic circulation. Open study. University hospital, Sweden. Five otherwise healthy patients (mean age of 34 years), undergoing laparoscopic cholecystectomy. Arterial and hepatic vein catheterization and simultaneous arterial and hepatic vein blood gas sampling in the awake state, during anaesthesia, after the establishment of pneumoperitoneum (intra-abdominal pressure level 11-13 mmHg) and after 30 and 60 minutes of pneumoperitoneum. Hepatic blood flow was estimated by the continuous infusion method and used as a measure of splanchnic blood flow. Splanchnic oxygen consumption was calculated according to the Fick principle. Splanchnic blood flow and splanchnic oxygen consumption were not affected by pneumoperitoneum at this level of intra-abdominal pressure.

Swan-Ganz catheter-induced tricuspid regurgitation during pneumoperitoneum for laparoscopic cholecystectomy

The occurrence of Swan-Ganz (S-G) catheter-induced tricuspid regurgitation (TR) was investigated using transesophageal echocardiography in four patients who underwent laparoscopic cholecystectomy with 12-mmHg pneumoperitoneum. Before pneumoperitoneum, TR was not detected in any of the four patients, despite the presence of an inserted S-G catheter; however, it was detected after completion of 12-mmHg pneumoperitoneum in one of the four patients. This TR was diminished after depneumoperitoneum and the employment of a retraction method by which the intra-abdominal pressure became equal to the atmospheric pressure. This TR was not recognized after the removal of the S-G catheter during 12-mmHg pneumoperitoneum in the same patient. There is a possibility that the S-G catheter induces TR during 12-mmHg pneumoperitioneum.

Right atrial to left atrial shunt through foramen ovale during pneumoperitoneum for laparoscopic cholecystectomy

A 62-year old female patient in whom paradoxical right atrial to left atrial shunt flow through the foramen ovale was detected by transesophageal echocardiography during pneumoperitoneum for laparoscopic cholecystectomy was reported. This patient had a history of mitral valve replacement with residual tricuspid valve regurgitation. It was considered that the onset of paradoxical interatrial shunting through the foramen ovale might be caused not only by mechanical ventilation with positive end-expiratory pressure but also by pneumoperitoneum, especially in patients with heart disease, even if the intra-abdominal pressure was maintained at 12 mmHg.