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Clinical Trial
. 2016 Aug 11;16(1):62.
doi: 10.1186/s12871-016-0226-x.

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

Hüseyin Ulaş Pınar  1 , Rafi Doğan  2 , Ümmü Mine Konuk  2 , Egemen Çifci  3 , Enes Duman  3 , Erdal Karagülle  4 , Emin Türk  4 , Ömer Karaca  2
Affiliations
Clinical Trial

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

Hüseyin Ulaş Pınar et al. BMC Anesthesiol. .

Abstract

Background: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery.

Methods: This study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration.

Results: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001).

Conclusions: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts.

Trial registration: Date of registration 21/07/2016, ISRCTN Registry ( No: ISRCTN15164056 , registered retrospectively).

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Figures

Fig. 1
Fig. 1
Images from a patient’s IJV and SCV measurements by time point T2 and T3. a IJV image and measurements at T2. b IJV image and measurements at T3. c SCV image and measurements at T2. d SCV image and measurements at T3
Fig. 2
Fig. 2
End-inspiratory and endexpiratory measurements of CSAs of IJV, SCV. a End-inspiratory CSA measurements of IJV (cm2) T1. b End-expiratory CSA measurements of IJV (cm2). c End-inspiratory CSA measurements of SCV (cm2). d End-expiratory CSA measurements of SCV (cm2). * Statistical significant increase when compared to T2 value. ** Statistical significant decrease when compared to T4 value
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