Surgical endoscopy
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Comparative Study
Hemodynamics during laparoscopy in the supine or prone position. An experimental study.
During laparoscopy elevations in arterial pressure and a decrease in cardiac output have been reported. Laparoscopic surgery performed in the prone position may be advantageous for some surgical procedures, but the hemodynamic effects of pneumoperitoneum in this position have not been studied. ⋯ Increases in intraabdominal pressure did not result in decreased cardiac output or in a reduction of oxygen transport and consumption in either position. These results suggest that laparoscopy in the prone position does not result in more severe hemodynamic depression than laparoscopy in the supine position.
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Review Case Reports
Laparoscopic bilateral inguinal hernia repair under local anesthesia.
A case report of the laparoscopic repair of bilateral inguinal hernias performed under local anesthesia with intravenous sedation is presented. The combination of nitrous oxide for peritoneal insufflation and an ultrasonically activated scalpel for dissection made the procedure feasible. It is hoped that this technique can extend laparoscopic surgery to patients who are poor candidates for general anesthesia.
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Although pneumoperitoneum has been well tolerated in a predominantly healthy population, there is concern that an increased intraperitoneal pressure may be poorly tolerated in patients with marginal cardiopulmonary function. The purpose of this study was to demonstrate noninvasively the hemodynamic effects of carbon dioxide pneumoperitoneum utilizing biplane transesophageal echocardiography. Fourteen otherwise-healthy patients undergoing nonemergent laparoscopic cholecystectomy were studied using bi-plane transesophageal echocardiography under a standardized anesthetic protocol utilizing isoflurane, fentanyl, and vecuronium bromide. ⋯ Head-up tilt of 20 degrees further decreased CI to 2.98 l/min/m2 (-11%) and SVI to 40.3 ml/beat/m2 (-22%) while HR increased by a total of 14% and MAP by 19%. As laparoscopic techniques are applied to a broader population, the impact of small but significant decrements in cardiac function become increasingly important. This study demonstrates that the combination of CO2 pneumoperitoneum and the reverse Trendelenburg position does adversely effect cardiac output.