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Intermittent Sequential Pneumatic Compression in Prevention of Venous Stasis Associated With Pneumoperitoneum During Laparoscopic Cholecystectomy

Intermittent Sequential Pneumatic Compression in Prevention of Venous Stasis Associated With... Abstract Objectives: To determine whether pneumoperitoneum and reverse Trendelenburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compression (ISPC) overcomes this impedance. Design: Using Doppler ultrasonography, peak systolic velocities in the common femoral vein were measured in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during three intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30° reverse Trendelenburg position (both with and without ISPC). Mean arterial pressure and heart rate were obtained concurrently. Measurements of preoperative and postoperative calf and thigh circumferences were obtained. Setting: A tertiary care center. Patient Participants: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria. Main Outcome Measures: Peak systolic velocity, mean arterial pressure, heart rate, and calf and thigh circumferences. Results: The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30° reverse Trendelenburg position significantly decreased peak systolic velocity in the common femoral vein from a preoperative mean of 0.24±0.025 m/s to 0.14±0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to 0.27±0.021 m/s. The mean difference between preoperative peak systolic velocity and peak systolic velocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03±0.03 m/s but was not significant. Anesthesia alone caused a mean increase in preoperative peak systolic velocity from 0.24±0.025 m/s to 0.3 ±0.032 m/s. Mean arterial pressure levels, heart rate, and calf and thigh circumferences did not change significantly. Conclusions: This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.(Arch Surg. 1993;128:914-919) References 1. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of hemodynamic and ventilatory effects of laparoscopic cholecystectomy . Arch Surg . 1991;126:997-1001.Crossref 2. Johannsen G, Anderson M, Juhl B. The effect of general anesthesia on the haemodynamic events during laparoscopy with CO2-insufflation . Acta Anaesthesiol Scand . 1989;33:132-136.Crossref 3. Elkman LG, Abrahamsson J, Biber B, Forssman L, Milsom I, Sjöqvist BA. Hemodynamic changes during laparoscopy with positive end-expiratory pressure ventilation . Acta Anaesthesiol Scand . 1988;32:447-453.Crossref 4. Muchada R, Lavandier B. Cathignol D, et al. Noninvasive hemodynamic monitoring in gynecologic laparoscopy . Ann Fr Anesth Reanim . 1986;5:14-17.Crossref 5. Liu S, Leighton T, Davis I, Klein S, Lippman M, Bongard F. Prospective analysis of cardiopulmonary responses to laparoscopic cholecystectomy . J Laparoscopic Surg . 1991;1:241-246.Crossref 6. Marshall RL, Jebsen PJR, Davie IT, Scott DB. Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy . Br J Anaesth . 1972; 44:680-684.Crossref 7. Hodgson C, McClelland RMA, Newton JR. Some effects of the peritoneal insufflation of carbon dioxide at laparoscopy . Anaesthesia . 1970;25:382-390.Crossref 8. Leighton TA, Bongard FS, Liu S, Lee T, Klein SR. Comparative cardiopulmonary effects of helium and carbon dioxide pneumoperitoneum . Surg Forum . 1991;42:485-487. 9. McKenzie R, Rajindar RK, Bedger RC. Noninvasive measurement of cardiac output during laparoscopy . J Reprod Med . 1980;24:247-250. 10. Carter SA. Hemodynamic considerations on peripheral and cerebrovascular disease . In: Zwiebel WJ, ed. Introduction to Vascular Ultrasonography . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1986:1-20. 11. Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effects of increased abdominal pressure . J Surg Res . 1981;30:249-255.Crossref 12. Beebe DS, McNevin MP, Belani KG, Letourneau JG, Crain MR, Goodale RL. Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy . Anesthesiology . 1992;77( (3A) ):A148.Crossref 13. Caprini JA, Scurr JH, Hasy JH. Role of compression modalities in a prophylactic program for deep vein thrombosis . Semin Thromb Hemost. 1988:14 ( (suppl) ):77-87. 14. Stanton JR, Freis ED, Wilkins RW. Acceleration of linear flow in the deep veins of local compression . J Clin Invest . 1949;28:553-557.Crossref 15. Clark C, Cotton LT. Blood flow in deep veins of the leg . Br J Surg . 1968;55: 211-214.Crossref 16. Doran FSA, Drury M, Sivyer A. A simple way to correct the venous stasis which occurs in the lower limbs during surgical operations . Br J Surg . 1964;511: 486-492.Crossref 17. Mittelman JS, Edwards WS, McDonald JB. Effectiveness of leg compression in preventing venous stasis . Am J Surg . 1982;144:611-613.Crossref 18. Nicolaides AN, Fernandes JF, Pollock AV. Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis . Surgery . 1980;87:69-76. 19. Muhe E. Intermittent sequential high-pressure compression of the leg: a new method of preventing deep vein thrombosis . Am J Surg . 1984;147:781-785.Crossref 20. Moneta GL, Bedford G, Beach K, Strandness DE. Duplex ultrasound assessment of venous diameters, peak velocities, and flow patterns . J Vasc Surg. 1988;8:286-291.Crossref 21. Sigel B, Ipsen J, Felix WR. The epidemiology of lower extremity deep venous thrombosis in surgical patients . Ann Surg . 1974;179:278-290.Crossref 22. Kakkar VV, Howe CT, Nicolaides AN, Renney JTG, Clarke MB. Deep vein thrombosis of the leg: is there a 'high-risk' group? Am J Surg . 1970;120:527-530.Crossref 23. Anderson FA, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worchester DVT Study . Arch Intern Med . 1991;151: 933-938.Crossref 24. Janssen HF, Schachner J, Hubbard J, Hartman JT. The risk of deep venous thrombosis: a computerized epidemiologic approach . Surgery . 1987;101:205-212. 25. Tripolitis AJ, Bodily KC, Blackshear WM, et al. Venous capacitance and outflow on the postoperative patient . Ann Surg . 1979;190:634-637.Crossref 26. Comerota AJ, Stewart GJ, Alburger PD, Smalley K, White JV. Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis . Surgery . 1989;106:301-309. 27. Schaub RD, Lynch PR, Stewart GJ. The response of canine veins to three types of abdominal surgery: a scanning and transmission electronic microscope study . Surgery . 1978;83:411-424. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Intermittent Sequential Pneumatic Compression in Prevention of Venous Stasis Associated With Pneumoperitoneum During Laparoscopic Cholecystectomy

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References (31)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1993.01420200088016
Publisher site
See Article on Publisher Site

Abstract

Abstract Objectives: To determine whether pneumoperitoneum and reverse Trendelenburg's position used during laparoscopy impede common femoral venous flow and whether calf-length intermittent sequential pneumatic compression (ISPC) overcomes this impedance. Design: Using Doppler ultrasonography, peak systolic velocities in the common femoral vein were measured in patients undergoing laparoscopic cholecystectomy with peritoneal insufflation of carbon dioxide. Measurements were obtained during three intervals: preoperatively with the patients in the supine position; after induction of general anesthesia with the patients in the supine position; and after insufflation to 13 to 15 mm Hg with the patients in the 30° reverse Trendelenburg position (both with and without ISPC). Mean arterial pressure and heart rate were obtained concurrently. Measurements of preoperative and postoperative calf and thigh circumferences were obtained. Setting: A tertiary care center. Patient Participants: A consecutive sample of 20 patients 30 to 70 years of age (15 women and five men) who underwent laparoscopic cholecystectomy and met the inclusion criteria. Main Outcome Measures: Peak systolic velocity, mean arterial pressure, heart rate, and calf and thigh circumferences. Results: The combination of pneumoperitoneum to 13 to 15 mm Hg and a 30° reverse Trendelenburg position significantly decreased peak systolic velocity in the common femoral vein from a preoperative mean of 0.24±0.025 m/s to 0.14±0.011 m/s, or a 42% decrease. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to 0.27±0.021 m/s. The mean difference between preoperative peak systolic velocity and peak systolic velocity with a combination of pneumoperitoneum, reverse Trendelenburg's position, and ISPC was 0.03±0.03 m/s but was not significant. Anesthesia alone caused a mean increase in preoperative peak systolic velocity from 0.24±0.025 m/s to 0.3 ±0.032 m/s. Mean arterial pressure levels, heart rate, and calf and thigh circumferences did not change significantly. Conclusions: This study demonstrated a significant reduction in common femoral venous flow during laparoscopic cholecystectomy coincident with pneumoperitoneum and reverse Trendelenburg's position. Intermittent sequential pneumatic compression reversed that effect, returning peak systolic velocity to normal.(Arch Surg. 1993;128:914-919) References 1. Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL. Analysis of hemodynamic and ventilatory effects of laparoscopic cholecystectomy . Arch Surg . 1991;126:997-1001.Crossref 2. Johannsen G, Anderson M, Juhl B. The effect of general anesthesia on the haemodynamic events during laparoscopy with CO2-insufflation . Acta Anaesthesiol Scand . 1989;33:132-136.Crossref 3. Elkman LG, Abrahamsson J, Biber B, Forssman L, Milsom I, Sjöqvist BA. Hemodynamic changes during laparoscopy with positive end-expiratory pressure ventilation . Acta Anaesthesiol Scand . 1988;32:447-453.Crossref 4. Muchada R, Lavandier B. Cathignol D, et al. Noninvasive hemodynamic monitoring in gynecologic laparoscopy . Ann Fr Anesth Reanim . 1986;5:14-17.Crossref 5. Liu S, Leighton T, Davis I, Klein S, Lippman M, Bongard F. Prospective analysis of cardiopulmonary responses to laparoscopic cholecystectomy . J Laparoscopic Surg . 1991;1:241-246.Crossref 6. Marshall RL, Jebsen PJR, Davie IT, Scott DB. Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy . Br J Anaesth . 1972; 44:680-684.Crossref 7. Hodgson C, McClelland RMA, Newton JR. Some effects of the peritoneal insufflation of carbon dioxide at laparoscopy . Anaesthesia . 1970;25:382-390.Crossref 8. Leighton TA, Bongard FS, Liu S, Lee T, Klein SR. Comparative cardiopulmonary effects of helium and carbon dioxide pneumoperitoneum . Surg Forum . 1991;42:485-487. 9. McKenzie R, Rajindar RK, Bedger RC. Noninvasive measurement of cardiac output during laparoscopy . J Reprod Med . 1980;24:247-250. 10. Carter SA. Hemodynamic considerations on peripheral and cerebrovascular disease . In: Zwiebel WJ, ed. Introduction to Vascular Ultrasonography . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1986:1-20. 11. Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effects of increased abdominal pressure . J Surg Res . 1981;30:249-255.Crossref 12. Beebe DS, McNevin MP, Belani KG, Letourneau JG, Crain MR, Goodale RL. Evidence of venous stasis after abdominal insufflation for laparoscopic cholecystectomy . Anesthesiology . 1992;77( (3A) ):A148.Crossref 13. Caprini JA, Scurr JH, Hasy JH. Role of compression modalities in a prophylactic program for deep vein thrombosis . Semin Thromb Hemost. 1988:14 ( (suppl) ):77-87. 14. Stanton JR, Freis ED, Wilkins RW. Acceleration of linear flow in the deep veins of local compression . J Clin Invest . 1949;28:553-557.Crossref 15. Clark C, Cotton LT. Blood flow in deep veins of the leg . Br J Surg . 1968;55: 211-214.Crossref 16. Doran FSA, Drury M, Sivyer A. A simple way to correct the venous stasis which occurs in the lower limbs during surgical operations . Br J Surg . 1964;511: 486-492.Crossref 17. Mittelman JS, Edwards WS, McDonald JB. Effectiveness of leg compression in preventing venous stasis . Am J Surg . 1982;144:611-613.Crossref 18. Nicolaides AN, Fernandes JF, Pollock AV. Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis . Surgery . 1980;87:69-76. 19. Muhe E. Intermittent sequential high-pressure compression of the leg: a new method of preventing deep vein thrombosis . Am J Surg . 1984;147:781-785.Crossref 20. Moneta GL, Bedford G, Beach K, Strandness DE. Duplex ultrasound assessment of venous diameters, peak velocities, and flow patterns . J Vasc Surg. 1988;8:286-291.Crossref 21. Sigel B, Ipsen J, Felix WR. The epidemiology of lower extremity deep venous thrombosis in surgical patients . Ann Surg . 1974;179:278-290.Crossref 22. Kakkar VV, Howe CT, Nicolaides AN, Renney JTG, Clarke MB. Deep vein thrombosis of the leg: is there a 'high-risk' group? Am J Surg . 1970;120:527-530.Crossref 23. Anderson FA, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worchester DVT Study . Arch Intern Med . 1991;151: 933-938.Crossref 24. Janssen HF, Schachner J, Hubbard J, Hartman JT. The risk of deep venous thrombosis: a computerized epidemiologic approach . Surgery . 1987;101:205-212. 25. Tripolitis AJ, Bodily KC, Blackshear WM, et al. Venous capacitance and outflow on the postoperative patient . Ann Surg . 1979;190:634-637.Crossref 26. Comerota AJ, Stewart GJ, Alburger PD, Smalley K, White JV. Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis . Surgery . 1989;106:301-309. 27. Schaub RD, Lynch PR, Stewart GJ. The response of canine veins to three types of abdominal surgery: a scanning and transmission electronic microscope study . Surgery . 1978;83:411-424.

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1993

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