Hemodynamic Changes

Pneumoperitoneum results in an overall decrease in preload, accompanied by an increase in afterload.

There is an increase in central venous pressure and pulmonary capillary wedge pressure with a paradoxical decrease in cardiac chamber filling.

Systemic vascular resistance and mean arterial pressure increase secondary to release of vasopressin and catecholamines from direct aortic compression by the insufflated gas.

Table 17.1. Potential gases for pneumoperitoneum and their characteristics

Gases

CO2

Air

NO2

He

O2

Combustible

No

Yes

Yes

No

Yes

Water soluble

Yes

No

No

No

No

Inert

No

Yes

Yes

Yes

No

Peritoneal irritation

Yes

Yes

No

No

Yes

Laparoscopy can also be associated with bradycardia or sinus arrest secondary to vagal stimulation from peritoneal stretching. There is also a decrease in mesenteric blood flow.

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