Effect of posture and prolonged pneumoperitoneum on intraoperative and postoperative outcomes during gynecological laparoscopic surgery

Abdalla, Esam E.-D.M.; Gad, Umm K.A.; Hassan, Zein E.-A.Z.; El-Shafy, Sayed K.A.; Mohamed, Fatma N.A.

doi:10.4103/JCMRP.JCMRP_43_20

Effect of posture and prolonged pneumoperitoneum on intraoperative and postoperative outcomes during gynecological laparoscopic surgery

Authors

Abstract

Introduction
Laparoscopic surgery is a common daily performed procedure. It has the advantages of small incision, better cosmetic aspects, less postoperative pain, and rapid recovery to daily activities. Pneumoperitoneum and increased intraabdominal pressure can induce many pathophysiologic disturbances, requiring the anesthesiologist to be well alert during the operation for necessary management.
Patients and methods
This is a prospective, observational clinical study. A total of 60 consecutive patients scheduled for gynecological laparoscopic surgery were recruited from the Gynecological and Obstetrics Department. Selected patients were divided into two groups according to the duration in Trendelenburg positioning: group I (<1 h) and group II (>1 h). A preoperative anesthetic assessment was carried out, and a standardized general anesthesia technique and monitoring were followed for all patients of the two groups. Pneumoperitoneum was generated by the insufflation of gas (CO) into the peritoneal cavity.
Results
On the evaluation of the effect of prolonged pneumoperitoneum and position of patents on intraoperative hemodynamics, mean arterial blood pressure was significantly decreased (in group II) at time M3 (average mean blood pressure during Trendelenburg position till recovery). Heart rate also significantly decreased (in group II) at time heart rate 3 (average heart rate during Trendelenburg position till recovery). Intraabdominal pressure significantly decreased in group II at time intraabdominal pressure 4 (average time during positioning), and pulmonary function test parameters were significantly decreased after recovery.
Conclusion
Prolonged laparoscopic gynecological surgery can markedly affect intraoperative hemodynamics and postoperative respiratory function.

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