Laparoscopic insufflation of the abdomen depresses cardiopulmonary function

Recently we have used the laparoscope to remove the gallbladder in critically ill patients in order to spare them the operative trauma of laparotomy. However, increased intraperitoneal pressure may have deleterious cardiopulmonary effects. This was investigated in a dog model. Insufflation of the abdomen with carbon dioxide decreased the mean cardiac output to less than 80% of baseline (P < 0.004). This was aggravated by the reverse Trendelenburg position and partially alleviated by the Trendelenburg position. Mean arterial PCO2 and mean peak airway pressure significantly rose. These effects are of doubtful clinical significance in the majority of patients. However, to extend the benefits of laparoscopy to patients with decreased cardiopulmonary reserve, hemodynamic and carbon dioxide monitoring should be used because measures to improve venous return, augment cardiac output, and counteract the increase in PCO2 and peak airway pressure may be required.