Effector of Hemodynamics during Laparoscopy

CO2 Absorption or Intra-Abdominal Pressure?

Hung S Ho, Christopher J. Saunders, Robert A. Gunther, Bruce M. Wolfe

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Controversy has been raised about the effects of systemic carbon dioxide accumulation versus the intra-abdominal pressure on hemodynamics during laparoscopy. We compared the acid-base and hemodynamic changes during pneumoperitoneum in a randomized cross-over study between CO2 and nitrogen gases to test the hypothesis that the CO2 absorbed during laparoscopy, rather than the 15 mmHg intra-abdominal pressure created, accounted for these changes, Eight adult pigs were anesthetized and ventilated with a fixed minute ventilation. Metabolic function was measured from analysis of expired flow by a metabolic measurement cart. After baseline periods, animals were randomized into two groups, for 2 hr of either CO2 or nitrogen pneumoperitoneum at 15 mmHg intra-abdominal pressure, followed by 1 hr of recovery. After at least a 48-hr recovery period, the experiment was repeated with the other gas. Metabolic data revealed that there was a significant absorption of CO2 gas across the peritoneal epithelium during CO2 pneumoperitoneum. Animals insufflated with CO2 gas experienced a 75% increase in pulmonary CO2 excretion, with significant acidemia and hypercapnia, whereas there were no acid-base disturbances in those with nitrogen insufflation. Oxygen consumption remained essentially unchanged in both groups, even during pneumoperitoneum. CO2 pneumoperitoneum was also associated with systemic and pulmonary arterial hypertension and a reduction in stroke volume of up to 15%. Pneumoperitoneum alone did not compromise hemodynamics. Pneumoperitoneum using CO2 gas during laparoscopy resulted in systemic CO2 absorption across the peritoneum. This led to acidemia, hypercapnea, and depressed hemodynamics. The intra-abdominal pressure routinely used during laparoscopic surgery did not affect metabolic function, acid-base balance, or hemodynamics in the experimental model.

Original languageEnglish (US)
Pages (from-to)497-503
Number of pages7
JournalJournal of Surgical Research
Volume59
Issue number4
DOIs
StatePublished - Oct 1995

Fingerprint

Pneumoperitoneum
Laparoscopy
Hemodynamics
Pressure
Gases
Nitrogen
Insufflation
Acids
Acid-Base Equilibrium
Hypercapnia
Peritoneum
Pulmonary Hypertension
Carbon Dioxide
Oxygen Consumption
Stroke Volume
Cross-Over Studies
Ventilation
Theoretical Models
Swine
Epithelium

ASJC Scopus subject areas

  • Surgery

Cite this

Effector of Hemodynamics during Laparoscopy : CO2 Absorption or Intra-Abdominal Pressure? / Ho, Hung S; Saunders, Christopher J.; Gunther, Robert A.; Wolfe, Bruce M.

In: Journal of Surgical Research, Vol. 59, No. 4, 10.1995, p. 497-503.

Research output: Contribution to journalArticle

Ho, Hung S ; Saunders, Christopher J. ; Gunther, Robert A. ; Wolfe, Bruce M. / Effector of Hemodynamics during Laparoscopy : CO2 Absorption or Intra-Abdominal Pressure?. In: Journal of Surgical Research. 1995 ; Vol. 59, No. 4. pp. 497-503.
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