Laparoscopic surgery: A randomised controlled trial comparing intraoperative hemodynamic parameters and arterial-blood gas changes at two different pneumoperitoneal pressure values

• Published in: Annals of medicine and surgery Vol. 81; p. 104562
• Main Authors: Eva, Intagliata, Rosario, Vecchio, Guglielmo, Rosolia, Clarissa, Vizzini, Federica, Lo Presti, Emma, Cacciola, Rosaria, Cacciola Rossella, Veronica, Vecchio
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2022; Elsevier
• Subjects: Hemodynamic parameters; Hemogasanalytic alterations; Laparoscopic surgery; Pneumoperitoneum pressure; Randomised Controlled Trial; Hemodynamic parameters; Hemogasanalytic alterations; Laparoscopic surgery; Pneumoperitoneum pressure
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2022.104562

The benefits of laparoscopic surgery are well known. However, clinic and metabolic consequences of pneumoperitoneum, achieved by insufflation of gas carbon dioxide, are still debated. Cardiovascular system suffering due to the compression of intra-abdominal venous structures can cause life-threatening complications. Increased partial pressure of carbon dioxide induces metabolic acidosis with further vascular suffering. Pneumoperitoneum reduces the pulmonary exchange volumes and bring renal suffering. The aim of this study is to evaluate the alterations in hemodynamic and hemogasanalysis parameters during the laparoscopic surgery at different pressure settings of pneumoperitoneum in order to assess the best pressure value. We evaluated and compared intraoperative hemodynamic and hemogasanalytic alterations in two groups of patients respectively subdue to laparoscopic cholecystectomy at a pneumoperitoneum pressure of 12 mmHg (group A) and at a pressure of 8 mmHg (group B). In both groups, after the induction of anesthesia we observed a flexion in the heart rate, with no significant difference between the two groups. During the intervention, group A showed a significantly higher respiratory rate than the group B. The average blood pressure decreased mostly in group B. The oxygen saturation increased at the end of the procedure in group A, more than in the group B. The pH value was higher in group B. The hydrogen carbonate ion settled at lower levels in group A. Although significant differences between the two groups were appreciated on several parameters, they were never of such magnitude to prefer the induction of pneumoperitoneum at 8 mmHg. •Pneumoperitoneum induces hemogasanalytic and hemodynamic alterations.•Different settings in pneumoperitoneum pressure cause different levels of hemodynamic and hemogasanalytic alterations.•A pneumoperitoneum pressure value that could conciliate either the reduced alterations in hemodynamic and hemogasanalytic parameters and the surgeon's needs for surgical intervention and safety, has to be established.