Alishahi S, Francis N, CroftsnS, Duncan L, Bickel A, Cuschieri A.
Central and peripheral adverse hemodynamic changes during laparoscopic surgery
and their reversal with a novel intermittent sequential pneumatic compression
device.
Ann Surg 2001 Feb;233(2):176-82

Departments of Surgery & Molecular Oncology and Anaesthesia, Ninewells Hospital
and Medical School, University of Dundee, Dundee, Scotland.

OBJECTIVE: To study the influence of a novel intermittent sequential pneumatic
compression device (Lympha-press) on the adverse cardiac and peripheral
hemodynamic changes induced by positive-pressure pneumoperitoneum (PPPn) in
laparoscopic surgery. SUMMARY BACKGROUND DATA: Creation of PPPn is known to cause
adverse central and peripheral hemodynamic changes. An intrasubject observational
study was undertaken to quantitate these adverse changes and to assess the
influence of an intermittent sequential pneumatic compression system on these
adverse hemodynamic changes during laparoscopic surgery with PPPn. METHODS: The
study involved 16 consecutive patients undergoing laparoscopic surgery with PPPn
of 12 mmHg and 30 degrees head-up tilt position. The following peripheral
hemodynamic recordings were made using Doppler ultrasound: peak systolic velocity
(PSV), end diastolic velocity (EDV), and cross-sectional area of the femoral
vein. Central monitoring included cardiac output and stroke volume by
transesophageal Doppler, blood pressure, and pulse. The hemodynamic state based
on these parameters was assessed before induction of PPPn with the anesthetized
patient in the supine position, after induction of PPPn and head-up tilt position
with Lympha-press off, and during PPPn and head-up tilt position with
Lympha-press on, and after desufflation with the patient in the supine position
under general anesthesia. RESULTS: Positive-pressure pneumoperitoneum and the
head-up tilt position resulted in a 33% reduction in PSV, a 21% reduction in EDV,
and a 29% increase in cross-sectional area of the femoral vein. This was
associated with a 20% reduction in cardiac output and an 18% reduction in stroke
volume. Activation of Lympha-press during PPPn and the head-up tilt position
resulted in a 129% increase in PSV and a 55% increase in EDV by 55%. It also
increased the cardiac output by 27% and stroke volume by 16%, with no effect on
cross-sectional area. Compared with the pre-PPPn stage, there was no difference
in cardiac output or stroke volume, but the PSV was higher by 78% and the EDV by
32%. After abdominal desufflation in the supine position, the cardiac output and
stroke volume were restored to the pre-PPPn level, but persistent and significant
elevations were observed during the period of study in PSV, EDV, and
cross-sectional area. CONCLUSIONS: Significant and individually variable central
and peripheral hemodynamic changes are encountered during laparoscopic surgery
with PPPn and the head-up tilt position. These are reversed by intermittent
sequential pneumatic compression using Lympha-press.