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CARDIOVASCULAR ANESTHESIA

The Relationship Among Carbon Dioxide Pneumoperitoneum, Vasopressin Release, and Hemodynamic Changes

Claude Mann, MD^*, Gilles Boccara, MD^*, Yvan Pouzeratte, MD^*, Jacob Eliet, MD, Claudine Serradeil-Le Gal, PhD, Christine Vergnes, MD, Daniel G. Bichet, MD^||, Gilles Guillon, PhD, Jean M. Fabre, MD, PhD^*, and Pascal Colson, MD, PhD^*

*Laboratoires d’Anesthesiologie et de Chirurgie Experimentale Faculté de Médecine, Montpellier; Centre de Pharmacologie Endocrinologie, Montpellier; Sanofi Recherche, Biochimie Exploratoire, Toulouse; Département d’Informatique Médicale, CHU Montpellier, France; and ||Centre de Recherche, Hôpital du Sacré-Coeur, Montréal, Quebec, Canada

Address correspondence and reprint requests to Claude Mann, MD, DARB, Hôpital Saint-Eloi, Montpellier 34295, France. Address e-mail to c-mann{at}chu-montpellier.fr

We assessed the role of vasopressin (VP) for the hemodynamic response to pneumoperitoneum in pigs. Four groups of anesthetized pigs were investigated. Nine pigs were intraabdominally insufflated with CO₂ and eight were intraabdominally insufflated with argon; eight pigs received an IV injection of 1 mg/kg SR 49059, a VP antagonist, before CO₂ insufflation; and six pigs received SR 49059 alone. Hemodynamics, plasma concentrations of VP and vasoactive hormones, and PaCO₂ were measured. Data were analyzed by using analysis of variance, Student’s t-test, and Mann-Whitney U-test. Five minutes after insufflation, changes in systemic vascular resistance (SVR) were significantly correlated with changes in VP (r = 0.72; P = 0.005) but not with changes in epinephrine, norepinephrine, renin activity, or PaCO₂. SVR increased during CO₂ insufflation but not during argon insufflation or CO₂ insufflation with a preceding infusion of SR 49059. The SR 49059 injection itself resulted in increases in heart rate and cardiac output and decreases in blood pressure and SVR. We conclude that, during CO₂ pneumoperitoneum in pigs, absorbed CO₂ initiates a pathophysiological process that stimulates VP release. Hence, VP most likely plays a key role in the hemodynamic response to a CO₂-induced pneumoperitoneum.

Implications: Intraabdominal insufflation of CO₂ is associated with hemodynamic and hormonal changes. Investigating CO₂ and argon-insufflated pigs and using a vasopressin antagonist, we found that CO₂ insufflation released vasopressin, which, in turn, induced hemodynamic perturbances.

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