Correlación de la medición directa de la presión intraabdominal y la presión programada de insuflación de CO 2 en cirugía laparoscópica

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Resumen: Introducción: Un control de la presión intraabdominal por < 14 mmHg es fundamental para evitar alteraciones hemodinámicas durante los procedimientos laparoscópicos. La vigilancia por medio de la presión de insuflación (PInf) puede no ser confiable. Objetivo: Comparar los valores de la PInf con los medidos directamente en la cavidad abdominal (PIA) y establecer cuál correlaciona con variaciones hemodinámicas. Material y métodos: Durante ocho procedimientos laparoscópicos se tomaron mediciones PInf y PIA simultáneamente: una basal, y cada cinco minutos hasta suspensión de neumoperitoneo. Los procedimientos fueron bajo anestesia general y bloqueo neuromuscular profundo y/o intenso. Se analizó la estabilidad hemodinámica (frecuencia cardiaca, presiones arteriales y saturación periférica de oxígeno) con las mediciones de PInf y PIA. Resultados: Se analizaron 54 mediciones pareadas. La correlación entre las mediciones fue de 0.86 (p < 0.001, R2 = 0.74). Quince mediciones (27.8%) fueron iguales; en 59.3% PIA > PInf y en 14.1% PIA < PInf. Variaciones de PIA ≥ 14 mmHg se asociaron a hipertensión arterial y taquicardia, mientras PIA ≤ 11 mmHg con presiones arteriales diastólicas bajas y menor frecuencia cardiaca (< 60). Conclusiones: La vigilancia de la presión intraabdominal con la PInf puede no ser muy confiable; recomendamos su medición directa.

Translated abstract

Abstract: Introduction: An intraabdominal pressure less than 14 mmHg is fundamental to avoid hemodynamic alterations during laparoscopic procedures. The monitoring by insufflation pressure (InfP) may not be the most reliable. Objective: To compare the InfP values with those measured directly in the abdominal cavity (IAP), and to establish their correlation with hemodynamic variations. Material and methods: During eight laparoscopic procedures, we obtained InfP and IAP measures simultaneously: at baseline and every five minutes until the suspension of the pneumoperitoneum. All procedures were under general anesthesia and deep and/or intense neuromuscular blockage. We analyzed the hemodynamic stability (heart rate, arterial pressure and peripheral oxygen saturation) with the InfP and IAP measures. Results: We analyzed 54 pair measures. The correlation between measures was 0.86 (p < 0.001, R2 = 0.74). Fifteen measures (27.8%) were equal; in 59.3% IAP > InfP, and in 14.1% IAP < InfP. The variations of IAP ≥ 14 mmHg were associated with arterial hypertension and tachycardia, while IAP ≤ 11 mmHg were associated with low diastolic arterial pressures and low heart rate (< 60). Conclusions: The monitoring of the intra-abdominal pressure with InfP may not be reliable, so we recommend a direct measurement.

Related collections

Most cited references 18

Record: found
Abstract: found
Article: not found

Effect of pneumoperitoneum on renal perfusion and function: a systematic review.

G Fried, S Demyttenaere, Adina L. Feldman (2007)

The precise physiologic consequences of insufflating carbon dioxide into the abdominal cavity during laparoscopy are not yet fully understood. This systematic review aimed to investigate whether pneumoperitoneum results in decreased renal blood flow (RBF) or renal function. A literature search was conducted electronically using Medline, Embase, and the Cochrane libraries on 1 July 2005. Various combinations of the medical subject headings--renal blood flow, pneumoperitoneum, renal function, and laparoscopy--were searched in all three databases. Reference lists from articles fulfilling the search criteria were used to identify additional articles. The literature search retrieved 20 articles concerning RBF and 25 articles concerning renal function during pneumoperitoneum. It was found that 17 of the 20 studies identified a decrease in RBF, and 20 of the 25 studies identified a decrease in renal function during pneumoperitoneum. There appears to be sufficient evidence to conclude that both renal function and RBF are decreased during pneumoperitoneum. The magnitude of the decrease is dependent on factors such as preoperative renal function, level of hydration, level of pneumoperitoneum, patient positioning, and duration of pneumoperitoneum.

0 comments Cited 35 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Postoperative residual block after intermediate-acting neuromuscular blocking drugs.

Kenneth Hayes, Carolyn McCourt, D M Breslin … (2001)

The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of or =0.8 after arrival in the recovery ward were 9.2 [1-61], 6.9 [1-24] and 14.7 [1.5-83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio <0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.

0 comments Cited 35 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Laparoscopic cholecystectomy: early and late complications and their treatment.

W Wayand, A Shamiyeh (2004)

Laparoscopic cholecystectomy gained wide acceptance as treatment of choice for gallstone disease and cholecystitis. With this new technique, not only did the new era of minimal invasive surgery begin, but also the spectrum of complications changed. Laparoscopy-related complications such as access injuries and procedure-related problems are discussed in our article. Typical mishaps are reviewed according to the literature. Set-up of the pneumoperitoneum (morbidity up to 0.2%); bleeding-from trocar sites and vascular injury (mortality up to 0.2%); biliary leaks and bile duct injuries are the main topics in this article (still on a level of 0.2%-0.8%). Aetiology, diagnosis and treatment are discussed, and an overview of the most cited classifications of bile duct injuries is summarised graphically. Finally, bowel injuries as a specific complication in laparoscopy are discussed (incidence up to 0.87%). Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe laparosopic cholecystectomy.