Effect of pneumoperitoneum on stroke volume variability and cardiovascular function during laparoscopic resection of gastrointestinal cancer

CHEN Xiao-xing; DENG Jin-he; ZHAO Wei-xian; ZENG Chao-kun; ZHONG De-yong; LI Yu-ze

Abstract：Objective To observe the effect of pneumoperitoneum on stroke volume variability ( SVV) and cardi-ovascular function in patients undergoing laparoscopic resection of gastrointestinal cancer.Methods Patients scheduled for elective laparoscopic resection of gastrointestinal cancer were enrolled in the study.All patients received total intrave-nous anesthesia with propofol combined with sufentanil, remifentanil and muscle relaxant.Hemodynamic status was moni-tored with Flotrac/Vigileo and heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), SVV, systemic vascular resistance ( SVR) and Narcotrend index( NI) were recorded at the following time points, before induction of anes-thesia , before pneumoperitoneum , initiation of pneumoperitoneum, 10, 20, 50 minutes after pneumoperitoneum, and af-ter the pneumoperitoneum was exsufflated.Duration of surgery, volume of fluid infusion, urine output, volume of intraop-erative bleeding and red blood cell transfusion as well as anesthetics consumption were also recorded.Results Of the 68 patients enrolled, 42 cases needed intravenous infusion of nitroglycerin to control hypertension, although the depth of anes-thesia and NI were maintained at moderate levels during the laparoscopic surgery.SVV tended to decline at early stage of pneumoperitoneum( P<0.05) and returned to the levels similar to before pneumoperitoneum after 30 minutes.CI, MAP and SVR showed continuous elevation compared with those before induction of anesthesia(P<0.05).Conclusions SVV can be used as an indicator to estimate blood volume changes during laparoscopic resection of gastrointestinal cancer with pneumoperitoneum pressure between 12-13 mmHg.However, it seems difficult for anesthesia of propofol combined with sufentanil and remifentanil to prevent sympathetic response and blood pressure increase during pneumoperitoneum.