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01-11-2018

Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial

Authors: Youn Joung Cho, Hyesun Paik, Seung-Yong Jeong, Ji Won Park, Woo Young Jo, Yunseok Jeon, Kook Hyun Lee, Jeong-Hwa Seo

Published in: Surgical Endoscopy | Issue 11/2018

Abstract

Background

Higher intra-abdominal pressure may impair cardiopulmonary functions during laparoscopic surgery. While 12–15 mmHg is generally recommended as a standard pressure, the benefits of lower intra-abdominal pressure are unclear. We thus studied whether the low intra-abdominal pressure compared with the standard pressure improves cardiopulmonary dynamics during laparoscopic surgery.

Methods

Patients were randomized according to the intra-abdominal pressure and neuromuscular blocking levels during laparoscopic colorectal surgery: low pressure (8 mmHg) with deep-block (post-tetanic count 1–2), standard pressure (12 mmHg) with deep-block, and standard pressure with moderate-block (train-of-four count 1–2) groups. During the laparoscopic procedure, we recorded cardiopulmonary variables including cardiac index, pulmonary compliance, and surgical conditions. We also assessed postoperative pain intensity and recovery time of bowel movement. The primary outcome was the cardiac index 30 min after onset of laparoscopy.

Results

Patients were included in the low pressure with deep-block (n = 44), standard pressure with deep-block (n = 44), and standard pressure with moderate-block (n = 43) groups. The mean (SD) of cardiac index 30 min after laparoscopy was 2.7 (0.7), 2.7 (0.9), and 2.6 (1.0) L min⁻¹ m⁻² in each group (P = 0.715). The pulmonary compliance was higher but the surgical condition was poorer in the low intra-abdominal pressure than the standard pressure (both P < 0.001). Other variables were comparable between groups.

Conclusion

We observed few cardiopulmonary benefits but poor surgical conditions in the low intra-abdominal pressure during laparoscopy. Considering cardiopulmonary dynamics and surgical conditions, the standard intra-abdominal pressure may be preferable to the low pressure for laparoscopic surgery.

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Title: Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial
Authors: Youn Joung Cho
Hyesun Paik
Seung-Yong Jeong
Ji Won Park
Woo Young Jo
Yunseok Jeon
Kook Hyun Lee
Jeong-Hwa Seo
Publication date: 01-11-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6204-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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