Millard JA, Hill BB, Cook PS, Fenoglio ME, Stahlgren LH.
Intermittent sequential pneumatic compression in prevention of venous stasis
associated with pneumoperitoneum during laparoscopic cholecystectomy.
Arch Surg 1993 Aug;128(8):914-8;discussion 918-9

Department of Surgery, Saint Joseph Hospital, Denver, Colo.

OBJECTIVES: To determine whether pneumoperitoneum and reverse Trendelenburg's
position used during laparoscopy impede common femoral venous flow and whether
calf-length intermittent sequential pneumatic compression (ISPC) overcomes this
impedance. DESIGN: Using Doppler ultrasonography, peak systolic velocities in the
common femoral vein were measured in patients undergoing laparoscopic
cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were
obtained during three intervals: preoperatively with the patients in the supine
position; after induction of general anesthesia with the patients in the supine
position; and after insufflation to 13 to 15 mm Hg with the patients in the 30
degrees reverse Trendelenburg position (both with and without ISPC). Mean
arterial pressure and heart rate were obtained concurrently. Measurements of
preoperative and postoperative calf and thigh circumferences were obtained.
SETTING: A tertiary care center. PATIENT PARTICIPANTS: A consecutive sample of 20
patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic
cholecystectomy and met the inclusion criteria. MAIN OUTCOME MEASURES: Peak
systolic velocity, mean arterial pressure, heart rate, and calf and thigh
circumferences. RESULTS: The combination of pneumoperitoneum to 13 to 15 mm Hg
and a 30 degrees reverse Trendelenburg position significantly decreased peak
systolic velocity in the common femoral vein from a preoperative mean of 0.24 +/-
0.025 m/s to 0.14 +/- 0.011 m/s, or a 42% decrease. Intermittent sequential
pneumatic compression reversed that effect, returning peak systolic velocity to
0.27 +/- 0.021 m/s. The mean difference between preoperative peak systolic
velocity and peak systolic velocity with a combination of pneumoperitoneum,
reverse Trendelenburg's position, and ISPC was 0.03 +/- 0.03 m/s but was not
significant. Anesthesia alone caused a mean increase in preoperative peak
systolic velocity from 0.24 +/- 0.025 m/s to 0.3 +/- 0.032 m/s. Mean arterial
pressure levels, heart rate, and calf and thigh circumferences did not change
significantly. CONCLUSIONS: This study demonstrated a significant reduction in
common femoral venous flow during laparoscopic cholecystectomy coincident with
pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential
pneumatic compression reversed that effect, returning peak systolic velocity to
normal.