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CARDIOVASCULAR ANESTHESIA

Hemodynamic Effects of Portal Triad Clamping With and Without Pneumoperitoneum: An Echocardiographic Study

François Decailliot, MD^*, Birgit Streich, MD^*, Yves Heurtematte, MD^*, Philippe Duvaldestin, MD^*, Daniel Cherqui, MD, and François Stéphan, MD, PhD^*

*Service d’Anesthésie-Réanimation Chirurgicale and Service de Chirurgie Digestive, Assistance Publique-Hôpitaux de Paris Hôpital Henri Mondor and Université Paris XII, Créteil, France

Address correspondence and reprint requests to François Stéphan, MD, PhD, Département d’Anesthésie-Réanimation, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France. Address e-mail to francois.stephan{at}hmn.ap-hop-paris.fr.

The decrease of cardiac index observed during portal triad clamping (PTC) with and without pneumoperitoneum has been studied only with right heart catheterization. To better understand this decrease of cardiac index, we investigated the balance between the adequacy of preload and the ability of the heart to pump against an increased afterload, by using transesophageal echocardiography. Ten patients with PTC performed during laparoscopy and 10 with PTC performed during laparotomy were studied. Five minutes after PTC, the stroke volume, the left ventricular (LV) fractional area change (FAC), and the LV end-systolic wall stress (LVESWS) were measured as the conventional hemodynamic variables. Regional wall motion abnormalities (RWMA) were also recorded. In the laparotomy group, LV end-diastolic area decreased, and LVESWS did not increase significantly. FAC remained stable, and one patient developed RWMA. In the laparoscopic group, LV end-diastolic area remained stable, and LVESWS increased. FAC decreased significantly, and five patients developed RWMA. A decrease in preload was the main important change in the laparotomy group, and in the laparoscopic group a decrease in LV function was demonstrated that was likely a consequence of decreased LV preload and increased LV afterload. However, these did not necessitate stopping the procedure or releasing PTC in these study patients without cardiac disease.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999