PURPOSE: To asses the differences between the two methods and to validate the 12 mmHg CO2 pneumoperitoneum as a safe target with respect to the abdominal perfusion pressure (APP).
METHODS: Our study included 22 ASA I and II patients who underwent laparoscopic cholecystectomy divided equally in two groups (normal weight and obese). Throughout the surgical procedure they were monitored according to the ASA standard and had NICO (cardiac output by partial CO2 reinhalation). After the induction, a urinary catheter was inserted and IAP was measured with the AbViser device. A 12 mmHg CO2 pneumoperitoneum was realized and IAP was measured in supine, 20º left lateral tilt and 30º Fowler before and after insufflation and supine before and after exuffation.
RESULTS: While the hemodynamic variables did not significantly change throughout the surgical procedure, IAP increased significantly after CO2 insufflation (p< 0.001 for both groups) and APP decreased (p>0.05) but settled above the 60 mmHg threshold for poor perfusion. The body weight had no impact on results (p 0.6125) while the recording moment was responsible for 33.31% of the variations observed (p< 0.0001). The differences between the estimated and measured IAP was 5.8mmHg, while the transvesically measured values were constantly higher.
CONCLUSION: A 12 mmHg CO2 pneumoperitoneum does not impede an optimal organ perfusion pressure in patients undergoing laparoscopic cholecystectomy. The differences between the two methods do not depend on body weight.
CLINICAL IMPLICATIONS: Trends are to be taken into account, not absolute values.
DISCLOSURE: Ruxandra Copotoiu, No Financial Disclosure Information; No Product/Research Disclosure Information