Hemodynamic effects of portal triad clamping with and without pneumoperitoneum: an echocardiographic study.

Abstract:

: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.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Decailliot F,Streich B,Heurtematte Y,Duvaldestin P,Cherqui D,Stéphan F

doi

10.1213/01.ANE.0000144592.20499.12

subject

Has Abstract

pub_date

2005-03-01 00:00:00

pages

617-22, table of contents

issue

3

eissn

0003-2999

issn

1526-7598

pii

100/3/617

journal_volume

100

pub_type

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