0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Intermittent Sequential Pneumatic Compression in Prevention of Venous Stasis Associated With Pneumoperitoneum During Laparoscopic Cholecystectomy

John A. Millard, MD; Bruce B. Hill, MD, DDS; Philip S. Cook, MD; Michael E. Fenoglio, MD; LeRoy H. Stahlgren, MD
Arch Surg. 1993;128(8):914-919. doi:10.1001/archsurg.1993.01420200088016.
Text Size: A A A
Published online

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° 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° 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.(Arch Surg. 1993;128:914-919)

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();