Effects of elevated artificial pneumoperitoneum pressure on invasive blood pressure and levels of blood gases

Abstract

Background and objective: to evaluate the clinical, hemodynamic, gas analysis and metabolic repercussions of high transient pressures of pneumoperitoneum for a short period of time to ensure greater security for introduction of the first trocar. Methods: sixty-seven patients undergoing laparoscopic procedures were studied and randomly distributed in P12 group: n = 30 (intraperitoneal pressure [IPP] 12 mmHg) and P20 group: n = 37 (IPP of 20 mmHg). Mean arterial pressure (MAP) was evaluated by catheterization of the radial artery; and through gas analysis, pH, partial pressure of oxygen (PaO2), partial pressure of CO2 (PaCO2), bicarbonate (HCO3) and alkalinity (BE) were evaluated. These parameters were measured in both groups at time zero before pneumoperitoneum (TP0); at time 1 (TP1) when IPP reaches 12 mmHg in both groups; at time 2 (TP2) after five min with IPP = 12 mmHg in P12 and after 5 min with IPP = 20 mmHg at P20; and at time 3 (TP3) after 10 min with IPP = 12 mmHg in P12 and with return of IPP from 20 to 12 mmHg, starting 10 min after TP1 in P20. Different values from those considered normal for all parameters assessed, or the appearance of atypical organic phenomena, were considered as clinical changes. Results: there were statistically significant differences in P20 group in MAP, pH, HCO3 and BE, but within normal limits. No clinical and pathological changes were observed. Conclusions: high and transient intra-abdominal pressure causes changes in MAP, pH, HCO3 and BE, but without any clinical impact on the patient. Keywords: Artificial pneumoperitoneum, Laparoscopy, Surgical instruments, Monitoring, Intraoperative