Intermittent sequential pneumatic compression in prevention of venous stasis associated with pneumoperitoneum during laparoscopic cholecystectomy
J. A. Millard, B. B. Hill, P. S. Cook, M. E. Fenoglio and L. H. Stahlgren
Department of Surgery, Saint Joseph Hospital, Denver, Colo.
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 degrees 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 degrees
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.
