Myocardial hemodynamic and metabolic changes during abdominal insufflation with carbon dioxide


Katircioǧlu S., Atalay F., Keskin A., Saritaş Z., Bostanoǧlu S., YÜCEL D., ...Daha Fazla

European Surgical Research, cilt.30, sa.3, ss.205-213, 1998 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 30 Sayı: 3
  • Basım Tarihi: 1998
  • Doi Numarası: 10.1159/000008578
  • Dergi Adı: European Surgical Research
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.205-213
  • Anahtar Kelimeler: Carbon dioxide, Insufflation, carbon dioxide, Laparoscopy, Myocardial function
  • Lokman Hekim Üniversitesi Adresli: Hayır

Özet

It is a well-known fact that laparoscopic procedures performed with carbon dioxide insufflation impair myocardial function. In this study, we aimed to determine the safety limitations of various intra-abdominal pressure values during abdominal insufflation with carbon dioxide. Of the 24 mongrel dogs, 6 were assigned to one of four different pressure groups (10, 15, 20 and 30 mmHg), respectively. Cardiac output, right/left heart pressures, and the first derivative of ventricular pressure were monitored. Myocardial oxygen consumption, myocardial lactate/oxygen extraction, tissue lactate and adenosine triphosphate levels were determined. Measurements were performed initially as a control, at 15-min intervals during 1 h of insufflation and 1 h after desufflation. At 10 mmHg carbon dioxide pressure, hemodynamic and metabolic parameters were not significantly different. Cardiac output decreased significantly in the 20 and 30 mmHg groups (p < 0.05: 10, 15 vs. 20, 30 mmHg). Although cardiac output did not change at 15 mmHg, the dp/dt value was significantly reduced. Cardiac output at the 60th min was 1960 ± 75 ml/min in the 10 mmHg group, 1885 ± 40 ml/min in the 15 mmHg group, 1770 ± 45 ml/min in the 20 mmHg group and 1695 ± 40 ml/min in the 30 mmHg group. Myocardial oxygen consumption was reduced at 15, 20 and 30 mmHg (p < 0.05: 10 vs. 15, 20 and 30 mmHg). In the myocardial tissue, ATP decreased from 19 ± 2 to 12 ± 1.2 μmol/g at 15 mmHg, from 19 ± 1.9 to 9.4 ± 1.3 μmol/g at 20 mmHg and from 18 ± 3.2 to 8.2 ± 1.9 μmol/g at 30 mmHg. Changes in hemodynamic and metabolic parameters of the heart are reversible and may not lead to any significant impairments in patients having normal cardiopulmonary function, but pose a risk in patients with respiratory disease and limited myocardial reserve.