Repercussões do pneumoperitônio sobre o sistema venoso dos membros inferiores-estudo em porcas

Valezi, Antonio Carlos; Rahal, Fares

doi:10.1590/S0100-69911999000100010

Resumos

A trombose venosa profunda e a embolia pulmonar são complicações dos atos cirúrgicos nem sempre diagnosticadas. Nas operações pela via laparoscópica, a insuflação do CO2 na cavidade peritoneal é provavelmente a principal determinante da estase venosa nos membros inferiores. Este trabalho foi realizado com a finalidade de determinar a influência do pneumoperitônio na dinâmica circulatória dos membros inferiores. Distribuíram-se trinta porcas em três grupos: sem pneumoperitônio, com pneumoperitônio de 10mmHg e de l5mmHg de pressão intra-abdominal. Foram medidas a freqüência e débito cardíacos, pressão arterial média, pressão e diâmetro da artéria e veia femorais, velocidade do fluxo arterial e venoso femorais. Após a realização do pneumoperitônio foi encontrado aumento significativo na pressão e no diâmetro da veia femoral e diminuição significativa na velocidade do fluxo venoso femoral. A elevação da pressão venosa femoral e a diminuição da velocidade do fluxo venoso femoral foram mais intensas com o aumento da pressão intra-abdominal. Todos os parâmetros analisados retornaram aos valores iniciais após o esvaziamento do pneumoperitônio.

Laparoscopia; Pneumoperitônio; Estase venosa

Deep venous thrombosis and pulmonary embolism are complications of surgical procedures, the most of times underdiagnosticated. ln laparoscopic surgery, the carbon dioxide insuflation into the peritoneal cavity is probably the cause of venous stasis of the lower limbs. The purpose of this study was to verify the effects of pneumoperitoneum in the blood circulation of the lower limbs. Thirty female pigs were divided in three groups: 1- without pneumoperitoneum; I - with 10 mmHg; and II - with 15 mmHg of abdominal pressure levels. Within the clinical parameters were analysed heart rate, cardiac output and mean arterial pressure to certify that the haemodynamic changes would not be gilty for the modifications of lower limbs circulation. This analysis did not find significant changes in the groups comparation. The results showed that were not found significant changes in the pressure, diameter and flow rate in the femoral artery in the presence of pneumoperitoneum. The average femoral venous pressure found in group I was 7.2 mmHg, in group II was 10.2 mmHg (p<0.05), and in group 11I was 14 mmHg (p<0.05). The average femoral venous flow rate was 9.8 cm/sec in group I; 6.8 cm/sec in group II (p<0.05) and 5.5 cm/sec in group 11I (p<0.05).The analisys of the femoral vein diameter found that the average value of group I was 4.2 cm; group II was 5 cm (p<0.05) and group III was 5.4 cm (p<0.05). The pneumoperitoneum was found to be associated with a significant increase of the pressure and diameter of the femoral vein, and a significant decrease of its flow rate. Every parameter analysed returned to the previous values after the peritoneal gas empting.

Pneumoperitoneum; Laparoscopy; Venous stasis

ARTIGOS ORIGINAIS

Repercussões do pneumoperitônio sobre o sistema venoso dos membros inferiores-estudo em porcas

The effect of pneumoperitoneum in the blood circulation of the lower limbs-a swine model

Antonio Carlos Valezi, TCBC-PR^I; Fares Rahal, TCBC-SP^II

^IProfessor Adjunto do Setor de Cirurgia do Aparelho Digestivo da Universidade Estadual de Londrina

^IIProfessor Pleno, Livre-Docente em Cirurgia do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo

^{Endereço para correspondência} Endereço para correspondência: Dr. Antonio Car1os Va1ezi Rua Santos, 777/1.302 86020-021 - Londrina-PR

RESUMO

A trombose venosa profunda e a embolia pulmonar são complicações dos atos cirúrgicos nem sempre diagnosticadas. Nas operações pela via laparoscópica, a insuflação do CO2 na cavidade peritoneal é provavelmente a principal determinante da estase venosa nos membros inferiores. Este trabalho foi realizado com a finalidade de determinar a influência do pneumoperitônio na dinâmica circulatória dos membros inferiores. Distribuíram-se trinta porcas em três grupos: sem pneumoperitônio, com pneumoperitônio de 10mmHg e de l5mmHg de pressão intra-abdominal. Foram medidas a freqüência e débito cardíacos, pressão arterial média, pressão e diâmetro da artéria e veia femorais, velocidade do fluxo arterial e venoso femorais. Após a realização do pneumoperitônio foi encontrado aumento significativo na pressão e no diâmetro da veia femoral e diminuição significativa na velocidade do fluxo venoso femoral. A elevação da pressão venosa femoral e a diminuição da velocidade do fluxo venoso femoral foram mais intensas com o aumento da pressão intra-abdominal. Todos os parâmetros analisados retornaram aos valores iniciais após o esvaziamento do pneumoperitônio.

Unitermos: Laparoscopia; Pneumoperitônio; Estase venosa.

ABSTRACT

Deep venous thrombosis and pulmonary embolism are complications of surgical procedures, the most of times underdiagnosticated. ln laparoscopic surgery, the carbon dioxide insuflation into the peritoneal cavity is probably the cause of venous stasis of the lower limbs. The purpose of this study was to verify the effects of pneumoperitoneum in the blood circulation of the lower limbs. Thirty female pigs were divided in three groups: 1- without pneumoperitoneum; I - with 10 mmHg; and II - with 15 mmHg of abdominal pressure levels. Within the clinical parameters were analysed heart rate, cardiac output and mean arterial pressure to certify that the haemodynamic changes would not be gilty for the modifications of lower limbs circulation. This analysis did not find significant changes in the groups comparation. The results showed that were not found significant changes in the pressure, diameter and flow rate in the femoral artery in the presence of pneumoperitoneum. The average femoral venous pressure found in group I was 7.2 mmHg, in group II was 10.2 mmHg (p<0.05), and in group 11I was 14 mmHg (p<0.05). The average femoral venous flow rate was 9.8 cm/sec in group I; 6.8 cm/sec in group II (p<0.05) and 5.5 cm/sec in group 11I (p<0.05).The analisys of the femoral vein diameter found that the average value of group I was 4.2 cm; group II was 5 cm (p<0.05) and group III was 5.4 cm (p<0.05). The pneumoperitoneum was found to be associated with a significant increase of the pressure and diameter of the femoral vein, and a significant decrease of its flow rate. Every parameter analysed returned to the previous values after the peritoneal gas empting.

Key words: Pneumoperitoneum; Laparoscopy; Venous stasis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 17/6/98

Aceito para publicação em 5/10/98

Trabalho realizado no Setor de Técnica Cirúrgica e Cirurgia Experimental do Departamento de Cirurgia da Universidade Estadual de Londrina.

1. Grace PA, Quereshi A, Colenian J - Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg 1991;78: 160-162.
2. Coelho ICU - Custos e benefícios da cirurgia laparoscópica. In Pinotti HW & Domene CE - Cirurgia videolaparoscópica. Săo Paulo, Robe Editora, 1993, pp 345-358.
3. Savassi-Rocha PR - Colecistectomia. In Coelho JCU, Marchesini JB, Malafaia O - Complicaçőes da Videocirurgia: da Profilaxia ao Tratamento. Rio de Janeiro, Medsi Editora, 1995, pp 183-241.
4. Bailey RW, Zucker KA, Flowers JL, et al - Laparoscopic cholecystectomy: experience with 375 consecutive patients. Ann Surg 1991; 214:531-541.
5. Meyers WC - The Southern Surgeons Club: a prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991; 324: 1.073-1.078.
6. Deziel DJ, Millikan KW, Economou S, et al - Complications of laparoscopic cholecystectomy: a national survey of 4.292 hospitals and an analysis of 77.604 cases. Am J Surg 1993;165:9-14.
7. Wittgen CM, Andrus CH, Fitzgerald SD, et al - Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991;126:997-1.001.
8. Hirvonen EA, Nuutinen LS, Kauko M - Ventilatory effects, blood gas changes, and oxygen consumption during laparoscopic hysterectomy. Anesth Analg 1995;80:961-966.
9. Lehmann LJ, Lewis MC, Goldman H, et al - Cardiopulmonary complications during laparoscopy: two cases report. South Med J 1995; 88:1.072-1.075.
10. Jorgensen JO, Lalak NJ, North L, et al- Thromboembolic complications of laparoscopic cholecystectomy. BMJ 1993;306:518-519.
11. Liew SCC & Storey DW - Laparoscopic Splenectomy. Aust NZJ Surg 1995; 65:743-5.
12. Orr KB - Laparoscopic cholecystectomy. Br Med J 1992;304:982.
13. Coelho JCU, Lemos JM, Andrade RF, et al - Colecistectomia videolaparoscópica:experięncia com 1.000 casos. Rev Med Paraná 1996;53:1-7.
14. Coelho JCU, Marchesini JB, Wiederkehr JC - Complicaçőes gerais da videocirurgia. In Coelho JCU - Aparelho digestivo - clínica e cirurgia. Rio de Janeiro, Medsi Editora, 1996, pp 1.807-1.814.
15. Chamberlain G & Brown JC Gynaecological laparoscopy: the report of a working party in a confidential enquiry of gynaecological laparoscopy. Royal College of Obstetricians and Gynaecologists, London, 1978.
16. Wilson YG, Allen PE, Skidmore R, et al - Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy. Br J Surg 1994;81:841-844.
17. Strassberger SM, Sanabria JR, Clavien PA-Complications oflaparoscopic cholecystectomy. CJS 1992;35:275-280.
18. Scott TR, Zucker KA, Bailey RW - Laparoscopic cholecystectomy: a review of 12397 patients. Surg Laparosc Endosc 1992;2: 191-198.
19. Jorgensen JO, Lalak NJ, North L, et al - Venous stasis during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994;4: 128-133.
20. Ekman LG, Abrahamsson J, Biber B, et al - Hemodynarnic changes during laparoscopy with positive end-expiratory pressure ventilation. Acta Anaesthesiol Scand 1988;32:447-453.
21. Caprini JA, ScurrJH, Hasy JH - Role of compression modalities in a prophylactic program for deep vein thrombosis. Semin Thromb Hemost 1988;14:77-87.
22. Rodrigues FCM - Efeitos do pneumoperitônio com gás carbônico e hélio na pessăo de perfusăo cerebral em modelo experimental de trauma crânio-encefálico. Săo Paulo, 1995. [Tese de Doutorado - Faculdade de Cięncias Médicas da Santa Casa de Săo Paulo]
23. Millard JA. Hill BB, Cook PS, et al- Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy. Arch Surg 1993;128:914-919.
24. Windberger U, Siegl H, Ferguson JG, et al- Hemodynarnic effects of prolonged abdominal insufflation for laparoscopic procedures. Gastroint Endoscopy 1995; 41:121-129.
²⁵
Conférence de Consensus - Prophylaxie des thromboses veineuses profondes et des embolies pulmonaires post-opératoires (chirurgie générale, gynécologique et orthopédique). J Mal Vasc 1992;17: 141-145.

Endereço para correspondência:

Dr. Antonio Car1os Va1ezi

Rua Santos, 777/1.302

86020-021 - Londrina-PR

Datas de Publicação

Publicação nesta coleção
25 Fev 2010
Data do Fascículo
Fev 1999

Histórico

Aceito
05 Out 1998
Recebido
17 Jun 1998

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Grace PA, Quereshi A, Colenian J - Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg 1991;78: 160-162.

[2] 2. Coelho ICU - Custos e benefícios da cirurgia laparoscópica. In Pinotti HW & Domene CE - Cirurgia videolaparoscópica. Săo Paulo, Robe Editora, 1993, pp 345-358.

[3] 3. Savassi-Rocha PR - Colecistectomia. In Coelho JCU, Marchesini JB, Malafaia O - Complicaçőes da Videocirurgia: da Profilaxia ao Tratamento. Rio de Janeiro, Medsi Editora, 1995, pp 183-241.

[4] 4. Bailey RW, Zucker KA, Flowers JL, et al - Laparoscopic cholecystectomy: experience with 375 consecutive patients. Ann Surg 1991; 214:531-541.

[5] 5. Meyers WC - The Southern Surgeons Club: a prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991; 324: 1.073-1.078.

[6] 6. Deziel DJ, Millikan KW, Economou S, et al - Complications of laparoscopic cholecystectomy: a national survey of 4.292 hospitals and an analysis of 77.604 cases. Am J Surg 1993;165:9-14.

[7] 7. Wittgen CM, Andrus CH, Fitzgerald SD, et al - Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991;126:997-1.001.

[8] 8. Hirvonen EA, Nuutinen LS, Kauko M - Ventilatory effects, blood gas changes, and oxygen consumption during laparoscopic hysterectomy. Anesth Analg 1995;80:961-966.

[9] 9. Lehmann LJ, Lewis MC, Goldman H, et al - Cardiopulmonary complications during laparoscopy: two cases report. South Med J 1995; 88:1.072-1.075.

[10] 10. Jorgensen JO, Lalak NJ, North L, et al- Thromboembolic complications of laparoscopic cholecystectomy. BMJ 1993;306:518-519.

[11] 11. Liew SCC & Storey DW - Laparoscopic Splenectomy. Aust NZJ Surg 1995; 65:743-5.

[12] 12. Orr KB - Laparoscopic cholecystectomy. Br Med J 1992;304:982.

[13] 13. Coelho JCU, Lemos JM, Andrade RF, et al - Colecistectomia videolaparoscópica:experięncia com 1.000 casos. Rev Med Paraná 1996;53:1-7.

[14] 14. Coelho JCU, Marchesini JB, Wiederkehr JC - Complicaçőes gerais da videocirurgia. In Coelho JCU - Aparelho digestivo - clínica e cirurgia. Rio de Janeiro, Medsi Editora, 1996, pp 1.807-1.814.

[15] 15. Chamberlain G & Brown JC Gynaecological laparoscopy: the report of a working party in a confidential enquiry of gynaecological laparoscopy. Royal College of Obstetricians and Gynaecologists, London, 1978.

[16] 16. Wilson YG, Allen PE, Skidmore R, et al - Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy. Br J Surg 1994;81:841-844.

[17] 17. Strassberger SM, Sanabria JR, Clavien PA-Complications oflaparoscopic cholecystectomy. CJS 1992;35:275-280.

[18] 18. Scott TR, Zucker KA, Bailey RW - Laparoscopic cholecystectomy: a review of 12397 patients. Surg Laparosc Endosc 1992;2: 191-198.

[19] 19. Jorgensen JO, Lalak NJ, North L, et al - Venous stasis during laparoscopic cholecystectomy. Surg Laparosc Endosc 1994;4: 128-133.

[20] 20. Ekman LG, Abrahamsson J, Biber B, et al - Hemodynarnic changes during laparoscopy with positive end-expiratory pressure ventilation. Acta Anaesthesiol Scand 1988;32:447-453.

[21] 21. Caprini JA, ScurrJH, Hasy JH - Role of compression modalities in a prophylactic program for deep vein thrombosis. Semin Thromb Hemost 1988;14:77-87.

[22] 22. Rodrigues FCM - Efeitos do pneumoperitônio com gás carbônico e hélio na pessăo de perfusăo cerebral em modelo experimental de trauma crânio-encefálico. Săo Paulo, 1995. [Tese de Doutorado - Faculdade de Cięncias Médicas da Santa Casa de Săo Paulo]

[23] 23. Millard JA. Hill BB, Cook PS, et al- Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy. Arch Surg 1993;128:914-919.

[24] 24. Windberger U, Siegl H, Ferguson JG, et al- Hemodynarnic effects of prolonged abdominal insufflation for laparoscopic procedures. Gastroint Endoscopy 1995; 41:121-129.

[25] ²⁵
Conférence de Consensus - Prophylaxie des thromboses veineuses profondes et des embolies pulmonaires post-opératoires (chirurgie générale, gynécologique et orthopédique). J Mal Vasc 1992;17: 141-145.

Brasil

Brasil

Repercussões do pneumoperitônio sobre o sistema venoso dos membros inferiores-estudo em porcas

The effect of pneumoperitoneum in the blood circulation of the lower limbs-a swine model

Resumos

Endereço para correspondência:

Datas de Publicação

Histórico