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Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial

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Abstract

Background

Higher intra-abdominal pressure may impair cardiopulmonary functions during laparoscopic surgery. While 12–15 mmHg is generally recommended as a standard pressure, the benefits of lower intra-abdominal pressure are unclear. We thus studied whether the low intra-abdominal pressure compared with the standard pressure improves cardiopulmonary dynamics during laparoscopic surgery.

Methods

Patients were randomized according to the intra-abdominal pressure and neuromuscular blocking levels during laparoscopic colorectal surgery: low pressure (8 mmHg) with deep-block (post-tetanic count 1–2), standard pressure (12 mmHg) with deep-block, and standard pressure with moderate-block (train-of-four count 1–2) groups. During the laparoscopic procedure, we recorded cardiopulmonary variables including cardiac index, pulmonary compliance, and surgical conditions. We also assessed postoperative pain intensity and recovery time of bowel movement. The primary outcome was the cardiac index 30 min after onset of laparoscopy.

Results

Patients were included in the low pressure with deep-block (n = 44), standard pressure with deep-block (n = 44), and standard pressure with moderate-block (n = 43) groups. The mean (SD) of cardiac index 30 min after laparoscopy was 2.7 (0.7), 2.7 (0.9), and 2.6 (1.0) L min−1 m−2 in each group (P = 0.715). The pulmonary compliance was higher but the surgical condition was poorer in the low intra-abdominal pressure than the standard pressure (both P < 0.001). Other variables were comparable between groups.

Conclusion

We observed few cardiopulmonary benefits but poor surgical conditions in the low intra-abdominal pressure during laparoscopy. Considering cardiopulmonary dynamics and surgical conditions, the standard intra-abdominal pressure may be preferable to the low pressure for laparoscopic surgery.

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Acknowledgements

We thank the Medical Research Collaborating Centre for their advices about the statistical analyses.

Funding

This study was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corporation. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corporation.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Youn Joung Cho, Hyesun Paik, Woo Young Jo, Yunseok Jeon, Kook Hyun Lee & Jeong-Hwa Seo

  2. Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea

    Seung-Yong Jeong & Ji Won Park

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  1. Youn Joung Cho
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Correspondence to Jeong-Hwa Seo.

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Disclosures

Kook Hyun Lee and Jeong-Hwa Seo received a research grant from Merck Sharp & Dohme Corporation (Grant No. 51350). Youn Joung Cho, Hyesun Paik, Seung-Yong Jeong, Ji Won Park, Woo Young Jo, and Yunseok Jeon have no conflicts of interest or financial ties to disclose.

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Cho, Y.J., Paik, H., Jeong, SY. et al. Lower intra-abdominal pressure has no cardiopulmonary benefits during laparoscopic colorectal surgery: a double-blind, randomized controlled trial. Surg Endosc 32, 4533–4542 (2018). https://doi.org/10.1007/s00464-018-6204-2

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