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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.

Journal of the American College of Surgeons
|October 1, 1995
PubMed
Summary

Massive incisional hernioplasty significantly increases intra-abdominal pressure (IAP), potentially causing dangerous drops in cardiac output. Transmural pressures, not direct central venous pressure, are better indicators of heart function post-surgery.

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Area of Science:

  • Abdominal Surgery
  • Cardiovascular Physiology
  • Hernia Repair

Background:

  • Abdominal incisional hernia repair surgery elevates intra-abdominal pressure (IAP).
  • The impact of this IAP increase on cardiocirculatory function requires investigation.

Purpose of the Study:

  • To determine if elevated intra-abdominal pressure (IAP) during incisional hernia repair affects cardiovascular function.
  • To assess the hemodynamic consequences of increased IAP in patients undergoing massive incisional hernioplasty.

Main Methods:

  • Hemodynamic measurements were taken in five patients before and after abdominal wall closure during massive incisional hernioplasty.
  • Key parameters monitored included cardiac output, heart rate, arterial pressure, central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP).

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Main Results:

  • Massive incisional hernioplasty led to a significant increase in IAP (+226%).
  • Two patients experienced a substantial decrease in cardiac output (-30%) without significant changes in heart rate or arterial pressure.
  • Decreased cardiac output was attributed to reduced venous return, despite elevated CVP and PCWP.

Conclusions:

  • Central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) are unreliable indicators of venous return during massive incisional hernioplasty due to transmitted IAP.
  • Transmural CVP and PCWP, which account for intrathoracic and intra-abdominal pressures, are more accurate clinical indicators of cardiac preload in this surgical context.