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Hemodynamic alterations during massive incisional hernioplasty
A Pierri1, G Munegato, L Carraro
1Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Italy.
Background:
The operative treatment of a large abdominal incisional hernia increases intra-abdominal pressure (IAP). This study was done to verify if this IAP elevation acts on the cardiocirculatory function.
Study Design:
Hemodynamic measurements were performed in five patients who underwent massive incisional hernioplasty before and after abdominal wall closure.
Results:
Reduction of a large abdominal hernia increases (+226 percent) IAP, which can produce serious hemodynamic alterations, manifested in two patients by a fall of cardiac output (-30 percent), without significant variations of heart rate and arterial pressure. Cardiac output is decreased secondary to decreased venous return, despite the increase in measured central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP).
Conclusions:
During massive incisional hernioplasty, CVP cannot be used as an indicator of venous return to the heart as it reflects a composite of venous filling pressure, pleural pressure, and transmitted IAP. Transmural CVP and PCWP, and not directly measured CVP and PCWP, should be used as clinical indicators of venous return to the heart in this situation.