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.
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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)


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