What is a hemodynamic consequence of carbon dioxide (CO2) pneumoperitoneum?

From the Guidelines

The hemodynamic consequence of carbon dioxide pneumoperitoneum is an increase in systemic vascular resistance. When carbon dioxide is insufflated into the peritoneal cavity during laparoscopic procedures, it creates increased intra-abdominal pressure that affects cardiovascular function. This elevated pressure can lead to increased mean arterial pressure, central venous pressure, and systemic vascular resistance, which can impair cardiac function 1. The absorption of carbon dioxide from the peritoneal cavity can also cause hypercapnia, leading to sympathetic stimulation that typically increases systemic vascular resistance and mean arterial pressure rather than decreasing them.

Some key points to consider include:

• Increased intra-abdominal pressure due to pneumoperitoneum can reduce venous return to the heart, potentially decreasing cardiac preload and cardiac index 1.
• However, the most recent and highest quality evidence suggests that the primary hemodynamic consequence is an increase in systemic vascular resistance, rather than a decrease in cardiac index or mean arterial pressure 1.
• Anesthesiologists and surgeons should be aware of these hemodynamic changes during laparoscopic procedures and may need to adjust fluid management, ventilation parameters, or positioning to mitigate these effects, particularly in patients with limited cardiac reserve.
• Maintaining muscle relaxation of the abdominal muscles and reducing intra-abdominal pressure below 10-12 mmHg may help reduce the physiological effects of pneumoperitoneum and improve renal blood flow and cardiac function 1.

From the Research

Hemodynamic Consequences of Carbon Dioxide Pneumoperitoneum

• The hemodynamic effects of carbon dioxide pneumoperitoneum have been studied in various settings, including laparoscopic cholecystectomy 2, 3 and laparoscopic donor nephrectomy 4.
• The studies have shown that carbon dioxide pneumoperitoneum can cause:
  • Increase in mean arterial pressure (MAP) and systemic vascular resistance (SVR) 4, 5
  • Decrease in stroke volume (SV) and cardiac output (CO) 4
  • Increase in central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) 2, 3
  • Decrease in cardiac index (CI) 3
• However, the effects of carbon dioxide pneumoperitoneum on hemodynamics can be influenced by various factors, such as:
  • Intra-abdominal pressure (IAP) 4
  • Positioning of the patient 2
  • Ventilation protocol 6
• In some studies, low-pressure carbon dioxide pneumoperitoneum (IAP ≤ 5 mmHg) has been shown to have minimal effects on hemodynamics in young children 6.
• The hemodynamic changes caused by carbon dioxide pneumoperitoneum can be reversed after desufflation 3, 5.