Top

Published in:

01-05-2009 | review article

Physiological Effects of Pneumoperitoneum

Authors: Julia E. Grabowski, Mark A. Talamini

Published in: Journal of Gastrointestinal Surgery | Issue 5/2009

Excerpt

Since its inception in the early 1980s, laparoscopy has become a widely accepted surgical approach. Smaller incisions impart several clinical benefits such as improved cosmesis, decreased pain, and an earlier return to preoperative activities.1,2 Laparoscopy, however, requires the establishment of pneumoperitoneum, which alters certain physiologic functions. We will review the physiologic effects of pneumoperitoneum (Fig. 1). …

Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A et al. Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 1998;317:103–110.PubMed

Zacks SL, Sandler RS, Rutledge R, Brown RS Jr. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 2002;97:334–340. doi:10.1111/j.1572-0241.2002.05466.x.PubMedCrossRef

Brown DR, Fishburne JI, Roberson VO, Hulka JF. Ventilatory and blood gas changes during laparoscopy with local anesthesia. Am J Obstet Gynecol 1976;124:741–745.PubMed

Safran DB, Orlando R 3rd. Physiologic effects of pneumoperitoneum. Am J Surg 1994;167:281–286. doi:10.1016/0002-9610(94)90094-9.PubMedCrossRef

Hasukic S, Mesic D, Dizdarevic E, Keser D, Hadziselimovic S, Bazardzanovic M. Pulmonary function after laparoscopic and open cholecystectomy. Surg Endosc 2002;16:163–165. doi:10.1007/s00464-001-0060-0.PubMedCrossRef

Puri GD, Singh H. Ventilatory effects of laparoscopy under general anaesthesia. Br J Anaesth 1992;68:211–213. doi:10.1093/bja/68.2.211.PubMedCrossRef

Smith I, Benzie RJ, Gordon NL, Kelman GR, Swapp GH. Cardiovascular effects of peritoneal insufflation of carbon dioxide for laparoscopy. BMJ 1971;3:410–411.PubMedCrossRef

Johannsen G, Andersen M, Juhl B. The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation. Acta Anaesthesiol Scand 1989;33:132–136.PubMedCrossRef

Baratz RA, Karis JH. Blood gas studies during laparoscopy under general anesthesia. Anesthesiology 1969;30:463–464.PubMedCrossRef

10.

Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004;21:95–105. doi:10.1159/000077038.PubMedCrossRef

11.

Hardacre JM, Talamini MA. Pulmonary and hemodynamic changes during laparoscopy—are they important? Surgery 2000;127:241–244. doi:10.1067/msy.2000.103159.PubMedCrossRef

12.

Schwenk W, Bohm B, Witt C, Junghans T, Grundel K, Muller JM. Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation. Arch Surg 1999;134:6–12. discussion 13doi:10.1001/archsurg.134.1.6.PubMedCrossRef

13.

Rasmussen JP, Dauchot PJ, DePalma RG, Sorensen B, Regula G, Anton AH et al. Cardiac function and hypercarbia. Arch Surg 1978;113:1196–1200.PubMed

14.

Diamant M, Benumof JL, Saidman LJ. Hemodynamics of increased intra-abdominal pressure: Interaction with hypovolemia and halothane anesthesia. Anesthesiology 1978;48:23–27. doi:10.1097/00000542-197801000-00005.PubMedCrossRef

15.

Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effect of increased abdominal pressure. J Surg Res 1981;30:249–255. doi:10.1016/0022-4804(81)90156-6.PubMedCrossRef

16.

Ivankovich AD, Miletich DJ, Albrecht RF, Heyman HJ, Bonnet RF. Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog. Anesthesiology 1975;42:281–287. doi:10.1097/00000542-197503000-00008.PubMedCrossRef

17.

Dexter SP, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc 1999;13:376–381. doi:10.1007/s004649900993.PubMedCrossRef

18.

McLaughlin JG, Scheeres DE, Dean RJ, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc 1995;9:121–124. doi:10.1007/BF00191950.PubMedCrossRef

19.

Kraut EJ, Anderson JT, Safwat A, Barbosa R, Wolfe BM. Impairment of cardiac performance by laparoscopy in patients receiving positive end-expiratory pressure. Arch Surg 1999;134:76–80. doi:10.1001/archsurg.134.1.76.PubMedCrossRef

20.

Williams MD, Murr PC. Laparoscopic insufflation of the abdomen depresses cardiopulmonary function. Surg Endosc 1993;7:12–16. doi:10.1007/BF00591229.PubMedCrossRef

21.

Joris J, Banache M, Bonnet F, Sessler DI, Lamy M. Clonidine and ketanserin both are effective treatment for postanesthetic shivering. Anesthesiology 1993;79:532–539. doi:10.1097/00000542-199309000-00017.PubMedCrossRef

22.

Kelman GR, Swapp GH, Smith I, Benzie RJ, Gordon NL. Caridac output and arterial blood-gas tension during laparoscopy. Br J Anaesth 1972;44:1155–1162. doi:10.1093/bja/44.11.1155.PubMedCrossRef

23.

Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 2002;16:1121–1143. doi:10.1007/s00464-001-9166-7.PubMedCrossRef

24.

Safran D, Sgambati S, Orlando R 3rd. Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 1993;176:548–554.PubMed

25.

Hein HA, Joshi GP, Ramsay MA, Fox LG, Gawey BJ, Hellman CL et al. Hemodynamic changes during laparoscopic cholecystectomy in patients with severe cardiac disease. J Clin Anesth 1997;9:261–265. doi:10.1016/S0952-8180(97)00001-9.PubMedCrossRef

26.

Bradley SE, Bradley GP. The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 1947;26:1010–1022. doi:10.1172/JCI101867.PubMedCrossRef

27.

Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg 1982;196:594–597. doi:10.1097/00000658-198211000-00015.PubMedCrossRef

28.

Shuto K, Kitano S, Yoshida T, Bandoh T, Mitarai Y, Kobayashi M. Hemodynamic and arterial blood gas changes during carbon dioxide and helium pneumoperitoneum in pigs. Surg Endosc 1995;9:1173–1178. doi:10.1007/BF00210922.PubMedCrossRef

29.

Rosin D, Brasesco O, Varela J, Saber AA, You S, Rosenthal RJ et al. Low-pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion. J Laparoendosc Adv Surg Tech A 2002;12:15–19. doi:10.1089/109264202753486876.PubMedCrossRef

30.

Chiu AW, Azadzoi KM, Hatzichristou DG, Siroky MB, Krane RJ, Babayan RK. Effects of intra-abdominal pressure on renal tissue perfusion during laparoscopy. J Endourol 1994;8:99–103.PubMedCrossRef

31.

London ET, Ho HS, Neuhaus AM, Wolfe BM, Rudich SM, Perez RV. Effect of intravascular volume expansion on renal function during prolonged CO₂ pneumoperitoneum. Ann Surg 2000;231:195–201. doi:10.1097/00000658-200002000-00007.PubMedCrossRef

32.

Demyttenaere S, Feldman LS, Fried GM. Effect of pneumoperitoneum on renal perfusion and function: a systematic review. Surg Endosc 2007;21:152–160. doi:10.1007/s00464-006-0250-x.PubMedCrossRef

33.

Lindstrom P, Wadstrom J, Ollerstam A, Johnsson C, Persson AE. Effects of increased intra-abdominal pressure and volume expansion on renal function in the rat. Nephrol Dial Transplant 2003;18:2269–2277. doi:10.1093/ndt/gfg362.PubMedCrossRef

34.

Lindberg F, Bergqvist D, Bjorck M, Rasmussen I. Renal hemodynamics during carbon dioxide pneumoperitoneum: an experimental study in pigs. Surg Endosc 2003;17:480–484. doi:10.1007/s00464-002-9044-y.PubMedCrossRef

35.

Kirsch AJ, Hensle TW, Chang DT, Kayton ML, Olsson CA, Sawczuk IS. Renal effects of CO2 insufflation: oliguria and acute renal dysfunction in a rat pneumoperitoneum model. Urology 1994;43:453–459. doi:10.1016/0090-4295(94)90230-5.PubMedCrossRef

36.

Lee BR, Cadeddu JA, Molnar-Nadasdy G, Enriquez D, Nadasdy T, Kavoussi LR et al. Chronic effect of pneumoperitoneum on renal histology. J Endourol 1999;13:279–282.PubMedCrossRef

37.

Hazebroek EJ, de Bruin RW, Bouvy ND, Marquet RL, Bonthuis F, Bajema IM et al. Long-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient rats. Ann Surg 2003;237:351–357. doi:10.1097/00000658-200303000-00008.PubMedCrossRef

38.

Nguyen NT, Perez RV, Fleming N, Rivers R, Wolfe BM. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. J Am Coll Surg 2002;195:476–483. doi:10.1016/S1072-7515(02)01321-2.PubMedCrossRef

39.

Nishio S, Takeda H, Yokoyama M. Changes in urinary output during laparoscopic adrenalectomy. BJU Int 1999;83:944–947. doi:10.1046/j.1464-410x.1999.00098.x.PubMedCrossRef

40.

Koivusalo AM, Kellokumpu I, Ristkari S, Lindgren L. Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method. Anesth Analg 1997;85:886–891. doi:10.1097/00000539-199710000-00032.PubMedCrossRef

41.

Chang DT, Kirsch AJ, Sawczuk IS. Oliguria during laparoscopic surgery. J Endourol 1994;8:349–352.PubMedCrossRef

42.

Viinamki O, Punnonen R. Vasopressin release during laparoscopy: role of increased intra-abdominal pressure. Lancet 1982;1:175–176.PubMed

43.

Melville RJ, Frizis HI, Forsling ML, LeQuesne LP. The stimulus for vasopressin release during laparoscopy. Surg Gynecol Obstet 1985;161:253–256.PubMed

44.

Dolgor B, Kitano S, Yoshida T, Bandoh T, Ninomiya K, Matsumoto T. Vasopressin antagonist improves renal function in a rat model of pneumoperitoneum. J Surg Res 1998;79:109–114. doi:10.1006/jsre.1998.5409.PubMedCrossRef

45.

Halverson A, Buchanan R, Jacobs L, Shayani V, Hunt T, Riedel C et al. Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc 1998;12:266–269. doi:10.1007/s004649900648.PubMedCrossRef

46.

Josephs LG, Este-McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressure. J Trauma 1994;36:815–818. iscussion 818–819doi:10.1097/00005373-199406000-00011.PubMedCrossRef

47.

Rosenthal RJ, Hiatt JR, Phillips EH, Hewitt W, Demetriou AA, Grode M. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. Surg Endosc 1997;11:376–380. doi:10.1007/s004649900367.PubMedCrossRef

48.

Este-McDonald JR, Josephs LG, Birkett DH, Hirsch EF. Changes in intracranial pressure associated with apneumic retractors. Arch Surg 1995;130:362–365. discussion 365–366.PubMed

49.

Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP. Laparoscopic surgery and the systemic immune response. Ann Surg 1998;227:326–334. doi:10.1097/00000658-199803000-00003.PubMedCrossRef

50.

Sietses C, von Blomberg ME, Eijsbouts QA, Beelen RH, Berends FJ, Cuesta MA. The influence of CO2 versus helium insufflation or the abdominal wall lifting technique on the systemic immune response. Surg Endosc 2002;16:525–528. doi:10.1007/s00464-001-0063-x.PubMedCrossRef

51.

Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, De Maio A, Talamini MA. CO2 Pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg 2003;237:343–350. doi:10.1097/00000658-200303000-00007.PubMedCrossRef

52.

Glaser F, Sannwald GA, Buhr HJ, Kuntz C, Mayer H, Klee F et al. General stress response to conventional and laparoscopic cholecystectomy. Ann Surg 1995;221:372–380. doi:10.1097/00000658-199504000-00007.PubMedCrossRef

53.

Ure BM, Niewold TA, Bax NM, Ham M, van der Zee DC, Essen GJ. Peritoneal, systemic, and distant organ inflammatory responses are reduced by a laparoscopic approach and carbon dioxide versus air. Surg Endosc 2002;16:836–842. doi:10.1007/s00464-001-9093-7.PubMedCrossRef

54.

West MA, Hackam DJ, Baker J, Rodriguez JL, Bellingham J, Rotstein OD. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg 1997;226:179–190. doi:10.1097/00000658-199708000-00010.PubMedCrossRef

55.

Hanly EJ, Fuentes JM, Aurora AR, Bachman SL, De Maio A, Marohn MR et al. Carbon dioxide pneumoperitoneum prevents mortality from sepsis. Surg Endosc 2006;20:1482–1487. doi:10.1007/s00464-005-0246-y.PubMedCrossRef

56.

Watson RW, Redmond HP, McCarthy J, Burke PE, Bouchier-Hayes D. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg 1995;82:1060–1065. doi:10.1002/bjs.1800820820.PubMedCrossRef

57.

Gutt CN, Heinz P, Kaps W, Paolucci V. The phagocytosis activity during conventional and laparoscopic operations in the rat. A preliminary study. Surg Endosc 1997;11:899–901. doi:10.1007/s004649900482.PubMedCrossRef

58.

Neuhaus SJ, Watson DI, Ellis T, Lafullarde T, Jamieson GG, Russell WJ. Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: a randomized clinical study. ANZ J Surg 2001;71:447–452. doi:10.1046/j.1440-1622.2001.02170.x.PubMedCrossRef

Title: Physiological Effects of Pneumoperitoneum
Authors: Julia E. Grabowski
Mark A. Talamini
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 5/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0662-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Physiological Effects of Pneumoperitoneum

Excerpt

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Excerpt

Please log in to get access to this content

Other articles of this Issue 5/2009

Enteral Nutrition and Biliopancreatic Diversion Effectively Minimize Impacts of Gastroparesis After Pancreaticoduodenectomy

Seasoned Surgeons Assessed in a Laparoscopic Surgical Crisis

Local Treatment for Recurrent Colorectal Hepatic Metastases after Partial Hepatectomy

Comparison of One-Stage Managements of Obstructing Left-Sided Colon and Rectal Cancer: Stent-Laparoscopic Approach vs. Intraoperative Colonic Lavage

Long-Term Follow-Up of Patients with Fulminant Clostridium difficile Colitis

Somatostatin Limits Intestinal Ischemia-Reperfusion Injury in Macaques via Suppression of TLR4-NF-κB Cytokine Pathway