What are the hemodynamic effects?
- Intraabdominal hypertension greater than 15 mm Hg can result in significant changes in central hemodynamics and even more pronounced changes in splanchnic circulation.
- Mean arterial blood pressure and systemic peripheral resistance are increased (up to 35% and 160%, respectively) at operative levels of pneumoperitoneum (12 to 15 mm Hg), presumably as a result of sympathetic vasoconstriction from hypercarbia.
- Cardiac index may increase 20%.
- As intraabdominal pressure increases more than 20 mm Hg, cardiac output falls and abdominal venous compliance decreases, reaching a point at which effective Trendelenburg position and higher pneumoperitoneum can combine in patients with preexisting cardiopulmonary disease to produced potential hemodynamic compromise.
