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Abstract
Aim. To study the influence of carboxyperitoneum and Trendelenburg position on hemodynamic values in patients with morbid obesity.
Materials and Methods. A single-center non-randomized prospective study was performed. Inclusion criteria were operable endometrial cancer and a BMI of more than 40 kg/m2. All patients underwent laparoscopic panhysterectomy. Exclusion criteria were oncologic diseases other than endometrial cancer, failure to meet the inclusion criteria, laparotomy, decompensation of the cardiovascular system, respiratory system pathology, ASA grade 4-5, BMI less than 40 km/m2, surgical intervention that lasted less than 45 min, conversion to laparotomy.
Hemodynamic values were assessed with invasive monitoring system (FloTrac) at six time points: before and after the induction of general anesthesia, after applying carboxyperitoneum and transfer to Trendelenburg position, at 30th, 60th and 90th min of surgery, after abdominal desufflation and reversion from Trendelenburg position.
Results. The study included 69 female patients. The mean age was 57 ± 8 years (confidence interval 46-65, 95 %). All patients had BMI more than 40 km/m2, ASA grade 3. MBP before the induction of general anesthesia was 110 mmHg (Q₁–Q₃ — 104-117), and baseline cardiac output (CO) was 6 L/min (Q₁–Q₃ — 5-7). Median MBP decreased significantly by 6.8 % after insufflation of CO2 (p = 0,001). Mean stroke volume decreased by 26.32 % after insufflation compared with baseline (p = 0,01), and then gradually recovered to baseline by the end of surgery. CO decreased significantly by 33.4 % (up to 4 L/min) after insufflation (p < 0,05) to a level of 7 L/min (p = 0,035) by the end of surgery.
Conclusion. The simultaneous use of carboxypneumoperitoneum and Trendelenburg position in patients with morbid obesity during surgery for gynecologic cancers negatively affects hemodynamic values. Understanding haemodinamic changes in such patients during laparoscopic surgeries can help both surgeons and anesthesiologists to make surgical intervention safer.
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