engleski

Physiological changes in pneumoperitoneum

Pneumoperitoneum (PnP) is a complex but well-tolerated pathophysiologic state with significant hemodynamic effects due to hypercarbia and the raised intra-abdominal pressure (IAP). CO2-PnP increases respiratory rate, PaCO2, PvCO2 and PACO2, and causes acidosis. Moderate to severe hypercarbia (50-70 mmHg) has a direct myocardial depressant and vasodilatory effect. It can induce decrease in cardiac output (CO), stroke volume (SV), systemic blood pressure and pH, depending on volume insufflated and IAP. Increase in IAP raises systemic vascular resistance (SVR), MAP, HR and caval pressures, while SV falls. PnP produces a progressive fall in blood flow in the superior mesenteric artery and portal vein and reduction in CO due to reduced venous return and myocardial contractility, further exaggerated by increase in afterload and SVR. PnP decreases renal blood flow and renal function. Hemodynamic effects of PnP depend on the intraoperative position of the patient, duration of the procedure, rate of administration and volume of gas used, age of the patient and comorbid cardiopulmonary conditions.

penumoperitoneum; cardivascular changes

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