This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Alfonsi, P. Articles by Chauvin, M. Search for Related Content PubMed PubMed Citation Articles by Alfonsi, P. Articles by Chauvin, M. Related Collections Surgery Heart Monitoring (Cardiac)

---

CARDIOVASCULAR ANESTHESIA

Cardiac Function During Intraperitoneal CO₂ Insufflation for Aortic Surgery: A Transesophageal Echocardiographic Study

Departments of Anesthesiology, Vascular Surgery, and Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, Boulogne, Cedex, France

Address correspondence and reprint requests to Antoine Vieillard-Baron, MD, PhD, Intensive Care Unit, Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92104 Boulogne, Cedex, France. Address e-mail to antoine.vieillard-baron{at}apr.ap-hop-paris.fr.

The effect of laparoscopy on cardiac function is controversial. We hypothesized that cardiac dysfunction related to increased afterload could be predominant in patients undergoing elective abdominal aortic repair. To test this hypothesis, we conducted a transesophageal echocardiographic study in 15 patients during laparoscopic aortic surgery. We systematically assessed left ventricular (LV) and right ventricular (RV) functions. Measurements were obtained in the supine position without pneumoperitoneum and with an intraabdominal pressure of 14 mm Hg. Then, patients were turned to the right lateral position without pneumoperitoneum and intraabdominal pressure was increased to 7 mm Hg and to 14 mm Hg. Pneumoperitoneum induced a 25% arterial blood pressure increase and a 38% increase in LV systolic wall stress. A 25% decrease in LV ejection fraction and an 18% decrease in LV stroke volume were observed, associated with an increase in LV end-systolic volume. LV diastolic function impairment was observed without change in LV end-diastolic volume. Respiratory alterations in superior vena cava diameter were never observed, suggesting that volume status remained optimal. Respiratory changes in RV stroke volume were increased according to intraabdominal pressure and body position, reflecting an increase in RV afterload. In conclusion, peritoneal CO₂ insufflation in patients scheduled for laparoscopic aortic surgery could impair LV and RV systolic functions as a consequence of increased afterload.

This article has been cited by other articles:

				C-C. Balick-Weber, P. Nicolas, M. Hedreville-Montout, P. Blanchet, and F. Stephan Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment Br. J. Anaesth., September 1, 2007; 99(3): 429 - 435. [Abstract] [Full Text] [PDF]

				D. Cattano, A. Nicolini, M. Genovesi, and S. Buzzigoli Laparoscopic Cholecystectomy in an Adult with Complex-Corrected Congenital Heart Disease Anesth. Analg., January 1, 2007; 104(1): 242 - 243. [Full Text] [PDF]