caa a22 4500 47577910X CHVBK 20180406123639.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s004640000214 doi (NATIONALLICENCE)springer-10.1007/s004640000214 Time-related changes in hemodynamic parameters and pressure-derived indices of left ventricular function in a porcine model of prolonged pneumoperitoneum [Elektronische Daten] [I. G. Kaklamanos, S. Condos, R. C. Merrell] Background: Advanced laparoscopic procedures require prolonged pneumoperitoneum. Increased intra-abdominal pressure causes a number of hemodynamic changes including a drop in cardiac output, but it is unclear whether there is a direct effect on cardiac contractility. In this experimental study, we sought to determine whether there is a direct impact of pneumoperitoneum on cardiac contractility. We also examined the time-related changes taking place during the insufflation period. Methods: Six young pigs were anesthetized and mechanically ventilated. Pneumoperitoneum was established by insufflating carbon dioxide to a pressure of 15 mmHg and maintained for a period of 180 min. Hemodynamic parameters including left ventricular dP/dT were invasively recorded every 15 min. All hemodynamic changes were statistically evaluated, and parameters were correlated with time. Results: Cardiac output decreased with insufflation from a baseline of 3.37 ± 0.34 lt/min and reached the lowest value at 165 min of pneumoperitoneum (2.86 ± 0.30 l/min; p= 0.023). Systemic vascular resistance (SVR) significantly increased from 2236 ± 227 dyne/s/cm5 to a maximum of 3774 ± 324 dyne/s/cm5 (p= 0.005). Left ventricular dP/dT maximum did not change significantly with insufflation. The decrease in cardiac output strongly correlated with the increase in SVR (r=−0.949). Time of insufflation correlated with cardiac output (r=−0.762) and dP/dT maximum (r=−0.727). Conclusions: Pneumoperitoneum at 15 mmHg negatively affects cardiac output without significantly affecting cardiac contractility. A significant increase in SVR appears to be the driving event for the decreased cardiac output. Prolonged pneumoperitoneum may have an additional negative effect on hemodynamic parameters. Springer-Verlag New York Inc., 2000 Key words: Adverse effects — Cardiac contractility — Experimental — Hemodynamics — Laparoscopy — Pneumoperitoneum nationallicence Kaklamanos I. G. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut Condos S. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut Merrell R. C. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 834-838 0930-2794 14:9<834 2000 14 464 https://doi.org/10.1007/s004640000214 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000214 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kaklamanos I. G. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut NATIONALLICENCE 700 1- Condos S. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut NATIONALLICENCE 700 1- Merrell R. C. Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 834-838 0930-2794 14:9<834 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer