Disease relevance of Pneumoperitoneum

• CONCLUSIONS: Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum [1].
• RESULTS: In the euvolemic group, prolonged CO2 pneumoperitoneum caused decreased renal blood flow, oliguria, and impaired creatinine clearance [2].
• Free intra-abdominal gas associated with octreotide use: intestinal perforation or benign pneumoperitoneum associated with underlying systemic sclerosis [3]?
• Three preterm infants exposed antenatally to indomethacin developed a characteristic syndrome consisting of edema and hydrops with a bleeding disorder at birth, oliguric renal failure during the first 3 postnatal days, and acute pneumoperitoneum resulting from localized ileal perforation(s) at the end of the first week of life [4].
• Carbon dioxide pneumoperitoneum is associated with increased liver metastases in a rat model [5].

Psychiatry related information on Pneumoperitoneum

• To investigate the effects of pneumoperitoneum on the peritoneal defense mechanism induced by streptozocin infusion during laparoscopic surgery in diabetic rats and to show the importance of regulation of diabetes for peritoneal defense mechanisms [6].

High impact information on Pneumoperitoneum

• Plasma vasopressin levels increased significantly during pneumoperitoneum, as did intrathoracic and atrial pressures; the atrial transmural pressure gradient declined [7].
• However, no changes in plasma levels of norepinephrine, aldosterone, and renin activity were observed during pneumoperitoneum [7].
• Abdominal distention during pneumoperitoneum results in a marked increase in plasma arginine vasopressin levels, which has been ascribed to an increase in intrathoracic pressure [7].
• OBJECTIVE: To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese [1].
• Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement [8].

Chemical compound and disease context of Pneumoperitoneum

• Vasopressin response to pneumoperitoneum: mechanical or nociceptive stimulation [9]?
• Carbon dioxide for obstetric pneumoperitoneum [10].
• CONCLUSION: Carbon dioxide pneumoperitoneum was associated with increased preload and afterload in patients undergoing laparoscopic cholecystecomy [11].
• Local anesthetic (0.5% bupivacaine with epinephrine) or placebo solutions were given as follows: immediately after the creation of a pneumoperitoneum (blocking before surgery), and at the end of the operation (blocking after surgery) [12].
• Neonatal pneumoperitoneum without significant adventitious pulmonary air: use of metrizamide to rule out perforation of the bowel [13].

Biological context of Pneumoperitoneum

• OBJECTIVE: To evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO2 pneumoperitoneum [2].
• BACKGROUND: The purpose of this study is to determine alterations of acid-base balance originated by pneumoperitoneum with CO2 [14].
• RESULTS: I.V. and i.p. lidocaine inhibited increases in mean systemic vascular resistance induced by the pneumoperitoneum [2109 (SD 935) and 2282 (895), respectively, vs 3013 (1067) dyne s(-1) cm(-5) in the control group] [15].
• The effect of CO2 pneumoperitoneum on free radicals and lipid peroxidation is pressure-dependent in rats [16].
• Comparison of immunologic and physiologic effects of CO2 pneumoperitoneum at room and body temperatures [17].

Anatomical context of Pneumoperitoneum

• After placement of a pulmonary artery catheter, carotid arterial line, Foley catheter, and renal artery ultrasonic flow probe, CO2 pneumoperitoneum (15 mmHg) was maintained for 4 hours [2].
• Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control [18].
• METHODS: For this study, 120 Sprague-Dawley rats underwent anesthesia only (Control), 10 mmHg pneumoperitoneum (PP), or abdominal wall lift (AWL) [19].
• CONCLUSION: The morphologic integrity of the peritoneum is temporarily disturbed by a CO2 pneumoperitoneum [20].
• In groups II, III and IV, pneumoperitoneum was maintained for 60 min without flow, with a continuous low flow (1 ml/min) and a continuous high flow (10 ml/min) through the abdominal cavities of the mice using non-humidified CO2, respectively [21].

Gene context of Pneumoperitoneum

• CONCLUSION(S): The data confirm that CO2 pneumoperitoneum is a cofactor in adhesion formation and demonstrate that VEGFR-1 plays a role in pneumoperitoneum-enhanced adhesions, which is consistent with a role of placental growth factor, VEGF-A, and VEGF-B in pneumoperitoneum-enhanced adhesions [22].
• PAI-1 concentration increased after 60 minutes of pneumoperitoneum whereas tPA concentration did not change [23].
• RESULTS: The expression of P-cadherin mRNA was significantly increased at 48 h (p = 0.007) and returned to the control level by 72 h after CO(2) pneumoperitoneum [24].
• RESULT(S): In both HIF-1alpha and HIF-2alpha wild-type mice, pneumoperitoneum enhanced adhesion formation [25].
• The aim of this study was to evaluate the effects of enalaprilat (Vasotec) administration on renal function during CO2 pneumoperitoneum, given that this drug, which is an angiotensin-converting enzyme inhibitor, by inhibiting the renin-angiotensin-aldosterone system, alters hormone-induced changes during pneumoperitoneum [26].

Analytical, diagnostic and therapeutic context of Pneumoperitoneum

• In the cell seeding model, peritoneal tumor growth was greater after laparotomy in comparison to CO2 pneumoperitoneum (p < 0.02) [27].
• Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes [1].
• Calibrated pneumoperitoneal venting to prevent N2O accumulation in the CO2 pneumoperitoneum during laparoscopy with inhaled anesthesia: an experimental study in pigs [28].
• Insufflation group mice underwent CO2 pneumoperitoneum (4-6 mmHg) for 20 minutes [29].
• Hence, the pathophysiological changes and the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardiopulmonary patients (NYHA II-III, n = 15) undergoing laparoscopic cholecystectomy are described [30].

References