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Plasma catecholamines and haemodynamic changes during pneumoperitoneum

K Myre1, M Rostrup, T Buanes

  • 1Department of Anaesthesiology, Ullevål Hospital, University of Oslo, Norway.

Acta Anaesthesiologica Scandinavica
|May 23, 1998
PubMed
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Carbon dioxide insufflation during laparoscopic surgery increases arterial noradrenaline, a stress hormone, but not adrenaline. This rise in noradrenaline correlates with increased blood pressure and peripheral resistance.

Area of Science:

  • Anesthesiology
  • Cardiovascular Physiology
  • Surgical Endocrinology

Background:

  • Carbon dioxide (CO2) insufflation is standard in laparoscopic surgery, inducing hemodynamic and hormonal changes.
  • Previous studies on sympathetic responses to laparoscopic surgery have yielded conflicting results.
  • Limited research has isolated the effects of CO2 insufflation itself on sympathetic and hemodynamic responses.

Purpose of the Study:

  • To investigate the sympathetic and hemodynamic responses specifically to CO2 insufflation (pneumoperitoneum).
  • To measure both arterial and venous plasma catecholamines, with arterial levels being a sensitive indicator of sympathetic activity.
  • To explore the association between hemodynamic changes and sympathetic responses during pneumoperitoneum.

Main Methods:

Related Experiment Videos

  • Plasma adrenaline and noradrenaline levels were measured from the radial artery and superior vena cava before and after CO2 insufflation in 11 subjects.
  • Invasive hemodynamic monitoring was performed throughout the procedure.
  • Arterial and venous plasma catecholamine differences were analyzed to assess sympathetic activity.

Main Results:

  • Arterial plasma noradrenaline significantly increased post-insufflation (P = 0.003), while arterial adrenaline remained unchanged.
  • No significant change was observed in the arterial-superior vena cava difference for noradrenaline, suggesting no increased sympathetic activity in that specific drainage area.
  • Heart rate and cardiac index were stable, but total peripheral resistance and mean arterial blood pressure increased (P = 0.002). A strong correlation was found between increased arterial noradrenaline and increased total peripheral resistance (r = 0.69, P = 0.01).

Conclusions:

  • Pneumoperitoneum leads to an increase in plasma noradrenaline, which is linked to elevated total peripheral resistance.
  • Plasma adrenaline levels do not change, and there is no evidence of generalized sympathetic activation.
  • The observed increase in noradrenaline likely results from localized sympathetic nervous system activation, potentially in the inferior vena cava's drainage area.