[Hemodynamic effects of pneumoperitoneum in lithotomy position]

Area of Science:

• Cardiovascular Physiology
• Anesthesiology
• Gynecological Surgery

Context:

• Gynecological procedures often require pneumoperitoneum and specific patient positioning, such as the lithotomy position.
• These conditions can alter intraabdominal pressure and influence hemodynamic parameters.
• Understanding these effects is crucial for patient safety, especially in those with pre-existing cardiac conditions.

Purpose:

• To investigate the hemodynamic effects of varying intraabdominal pressures and patient positions during gynecological procedures.
• To assess changes in left ventricular dimensions, ejection fraction, and internal iliac vein diameter under different conditions.

Summary:

• In the lithotomy position, increased intraabdominal pressure (10-15 mmHg) elevated left ventricular end-diastolic and end-systolic areas but significantly decreased left ventricular ejection fraction and internal iliac vein diameter.
• No significant hemodynamic changes were observed in the Trendelenburg position.
• In the Anti-Trendelenburg position, left ventricular dimensions decreased, while ejection fraction remained constant and internal iliac vein diameter increased.

Impact:

• Increased intraabdominal pressure in the lithotomy position elevates intrathoracic volume and decreases left ventricular ejection fraction, potentially leading to acute heart failure in susceptible patients.
• The findings suggest that laparoscopic procedures in the horizontal lithotomy position should be avoided in patients with dilatative cardiomyopathy.
• This research provides critical insights for anesthetic management and patient selection in gynecological surgery.