medigraphic.com
ISSN 1665-2576 (Impreso)

2002, Número 3

<< Anterior Siguiente >>

Rev Mex Cir Endoscop 2002; 3 (3)


La patofisiología del pneumoperitoneo. Diez años de estudios en busca de una teoría unificadora

Edgardo BO, Szomstein S, Mailapur RV, Zundel N, Jacobo RR

Idioma: Español
Referencias bibliográficas: 91
Paginas: 101-108
Archivo PDF: 54.52 Kb.


RESUMEN

El amplio uso del pneumoperitoneo en cirugía laparoscópica, y la observación frecuente de presión intraabdominal elevada en pacientes quirúrgicos y víctimas de trauma, expone al cirujano general al problema de la hipertensión intraabdominal en su práctica diaria. Aunque la severidad del problema o sus consecuencias clínicas no siempre es evidente, la presión abdominal es un parámetro importante en la inestabilidad hemodinámica o en la disfunción orgánica. El mecanismo por el cual la PIA afecta los diferentes órganos y sistemas es objeto de numerosas investigaciones. La evidencia que se ha ido acumulando demuestra que más que la presión local en el abdomen, es la presión que se transmite a otros compartimentos distantes, la responsable por mucho de los efectos que se observan. El compartimento intracraneal, protegido por una estructura ósea, es objeto de cambios de presión rápida, sólo compensados parcialmente por los mecanismos autorregulatorios locales. La presión transmitida desde el abdomen hacia el cerebro puede resultar en la liberación de mediadores de estrés y efectores hemodinámicos, como catecolaminas y vasopresina. Los efectos hemodinámicos adversos de la hipertensión intraabdominal pueden ser revertidos disminuyendo la presión abdominal, o cambiando los parámetros que contribuyen al aumento de la PIC, como la posición o el estado hemodinámico (volumen). Bloqueando los mediadores neurohormonales que han sido liberados en respuesta a la elevación de la PIC puede ser el tratamiento que deba investigarse en el futuro.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ. Cardiovascular responses to elevation of intraabdominal hydrostatic pressure. Am J Physiol 1985; 248: R208-R213.

  2. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 1989; 17: 118.

  3. Kashtan J, Green IF, Parsons EQ, Holcroft JW. Hemodynamic effects of increased abdominal pressure. J Surg Res 1981; 30: 249-255.

  4. Meldrum DM, Moore FA, Moore EE et al. Cardiopulmonary hazards of perihepatic packing of major liver injuries. Am J Surg 1995; 170: 537-42.

  5. McLaughlin JG, Scheeres DE, Dean RJ, Bonnell BW. The adverse hemodynamic effects of laparoscopic cholecystectomy. Surg Endosc 1995; 9: 121-124.

  6. Liu Sy, Leighton T, Davis I, Klein S, Lippmann M, Bongard F. Prospective analysis of cardiopulmonary response to laparoscopic cholecystectomy. J Laparoendosc Surg 1991; 1: 241-246.

  7. Hashimoto S, Hashikura Y, Munakata Y et al. Changes in the cardiovascular and respiratory systems during laparoscopic cholecystectomy. J Laparoendosc Surg 1993; 3: 535-539.

  8. Anders A, Mats S, Ola S, Jan D, Hans L. Intestinal perfusion during pneumoperitoneum with carbon dioxide, nitrogen, and nitric oxide during laparoscopic surgery. Eur J Surg 2000; 166: 70-76.

  9. Fitzgerald SD, Andrus CH, Baudendistel LJ, Dahms TE, Kaminski DL. Hypercarbia during carbon dioxide pneumoperitoneum. Am J Surg 1992; 163: 186-190.

  10. Ho HS, Gunther RA, Wolfe BM. Intraperitoneal carbon dioxide insufflation and cardiopulmonary functions. Arch Surg 1992; 127: 928-933.

  11. Leighton TA, Liu S, Bongard FS. Comparative cardiopulmonary effects of carbon dioxide versus helium pneumoperitoneum. Surgery 1993; 113: 527-531.

  12. Wittgen C, Andrus C, Fitzgerald S, Baudendistel L, Dahms T, Karminski D. Analysis of hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991; 126: 997-1001.

  13. Thorington JM, Schmidt CF. A study of urinary output and blood pressure changes resulting in experimental ascites. Am J Med Sci 1923; 165: 880-890.

  14. Bradley SE, Bradley GP. The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 1947; 26: 1010-1022.

  15. Celoria G, Steingrub J, Danson JA et al. Oliguria from high intra-abdominal pressure secondary to ovarian mass. Crit Care Med 1987; 15: 78.

  16. Harman PK, Kron IL, McLachlan HD. Elevated intra-abdominal pressure and renal function. Ann Surg 1982; 196: 594-596.

  17. Bloomfield GL, Blocher CR, Fakhry F, Sica DA, Sugerman HJ. Elevated intraabdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 1997; 42: 997-1005.

  18. Caldwell CB, Ricotta JJ. Evaluation of intra-abdominal pressure and renal hemodynamics. Curr prob Surg 1986; 495: 498.

  19. Smith JH, Merrell RC, Raffin TA. Reversal of post-operative anuria by decompressive cetiotomy. Arch Intern Med 1985; 145: 553-554.

  20. Jacques T, Lee R. Improvement of renal function after relief of raised intra-abdominal pressure due to traumatic retroperitoneal haematoma. Anaesth Intens Care 1988; 16: 478-94.

  21. Ivatury RR, Simon RJ. Intraabdominal hypertension: The abdominal compartment syndrome. In: The Textbook of Penetrating Trauma. Williams & Wilkins, 1996, 939-951.

  22. Sugrue M, Jones F Lee A, Buist MD, Deane S, Bauman A, Hillman K. Intraabdominal pressure and gastric intramucosal pH: is there an association? World J Surg 1996; 20: 988-991.

  23. Thaler W, Frey L, Marzoli GP, Messmer K. Assessment of splanchnic tissue oxygenation by gastric tonometry in patients undergoing laparoscopic and open cholecystectomy, Br J Surg 1996; 83: 620-624.

  24. Martin K. Schilling, MD, Claudio Radaelli, MD, Lukas Krahenbuhl, MD, Christoff Signer, MD, Markus W. Buchler MD. Splanchnic microcirculatory changes during CO2 laparoscopy. J Am Coll Surg 1997; 184: 378-382.

  25. Voltz J, Koster S, Weiss M, Schmidt R, Urbaschek R, Melchert F, Albrecht M. Pathophysiology features of a pneumoperitoneum at laparoscopy: a swine model. Am J Obstet Gynecol 1996; 174: 132-140.

  26. M Ben-Haim, RJ Rosenthal. Causes of arterial hypertension and splanchnic ischemia during acute elevations in intra-abdominal pressure with CO2 pneumoperitoneum: a complex central nervous system mediated response. Springer-Verlag 1999.

  27. Eleftheriadis E, Kotzanipassi K, Botsios D, Tzartinoglou E, Farmakis H, Dadoukis H. Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc 1996; 10: 324-326.

  28. El-Kady A, Kleinhaus S, Sammartano R, Boley S. Effects of laparoscopy on mesenteric blood flow. Arch Surg 1978; 113: 867-869.

  29. Benecke P, Schiedeck T, Vatankhah M, Bruck HF. Microcirculatory changes in intraabdominal organs depends on intra-abdominal pressure and operation time. Surg Endosc 1996; 5: 546.

  30. Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992; 33: 45-49.

  31. Paul A, Troidl H, Peters S, Stutmann R. Fatal intestinal ischaemia following laparoscopic cholecystectomy. Br J Surg 1994; 81: 1207.

  32. Richards WO, Scovill W, Shin B. Acute renaI failure associated with increased intra-abdominal Pressure. Ann Surg 1983; 97: 183-187.

  33. Harris AP, Koehler RC, Gleason CA, Jones MD Jr, Traystman RJ. Cerebral and peripheral circulatory responses to intracranial hypertension in fetal sheep. Circ Res 1989; 64: 991-1000.

  34. Sugerman HJ, Felton WL, Sismanis A et al. Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity. Neurology 1995; 45: 1655-1659.

  35. Bloomfield GL, Dalton JM, Sugerman HJ et al. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 1995; 39: 1168-1170.

  36. Fuji Y, Tanaka H Tsurukoa S et al. Middle cerebral arterial blood flow velocity increases during laparoscopic cholecystectomy. Anesth Analg 1994; 78: 80-83.

  37. Josephs LG, Este McDonald JR, Birkett DH, Hirsch EF. Diagnostic laparoscopy increases intracranial pressures. Trauma 1994; 36: 815-819.

  38. Rosenthal RJ, Hiatt JA, Phillips EH et al. Intracranial pressure: Effects of pneumoperitoneum in a large animal model. Surg Endosc 1997; 11: 376-380.

  39. Rosenthal RJ, Friedman RL, Khan MA, Martz J, Thiagarajah S, Cohen D, Shi Q, Nussbaum M. Reasons for intracranial hypertension and hemodynamic instability during acute elevation of intraabdominal pressure: observations in a large animal model. J Gastrointest Surg 1998; 2: 415-425.

  40. Mullane JF, Gliedman ML. Elevation of the pressure in the abdominal inferior vena cava as a cause of a hepatorenal syndrome. Surgery 1966; 59: 1135-1146.

  41. Rubinson RM, Vasko JS, Doppman L et al. Inferior vena caval obstruction from increased intra-abdominal pressure. Arch Surg 1967; 94: 766-770.

  42. Doppman J, Rubinson RM, Rockoff SD et al. Mechanism of obstruction of the infradiaphragmatic portion of the inferior vena cava in the presence of increased intra-abdominal pressure. Invest Radiol 1966; 1: 37-53.

  43. Rosenthal RJ, Friedman RL, Khan MA, Chidambaram A, Martz J, Shi Q, Nussbaum M. Effects of hyperventilation and hypoventilation on PaCO2 and intracranial pressure during acute elevations of intra-abdominal pressure with CO2 pneumoperitoneum: large animal observations. J Am Coll Surg 1998; 87: 32-39.

  44. Ratjen F, Trost A, Welker J et al. The effects of rapid thoracic compression on intracranial pressure in newborn lambs. Pediatr Res 1995; 38: 664-667.

  45. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. A proposed relationship between increased intraabdominal, intrathoracic and intracranial pressure. Crit Care Med 1997; 25: 496-503.

  46. Hargreaves DM. Hypercapnia and raised cerebrospinal fluid pressure. Anesthesia 1990; 45: 7-12.

  47. Westlake B, Nitze EK, Kaye M. Raised intracranial pressure in emphysema. Br Med J 1954; I: 302-304.

  48. Guyton AC. Nervous regulation of the circulation and rapid control of arterial pressure. In: Guyton AC, ed. Physiology, 8th ed. Philadelphia: WB Saunders, 1991; pp 202-203.

  49. Newton DAG, Bone I. Papilloedema and optic atrophy in chronic hypercapnia. Br J Dis Chest 1979; 73: 399-404.

  50. Jones B. The effects of patient repositioning on intracranial pressue. Aust Adv Nurs 1994; 12: 32-39.

  51. Schneider GH, von Helden GH, Franke R et al. Influence of body position on juglar venous saturation, intracranial pressure and cerebral perfusion pressure. Acta Neurochir 1993; 59: 107-112.

  52. O’Leary E. Hubbard K, Tormey W, Cunningham AJ. Laparoscopic cholecystectomy: hemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth 1996; 76: 640-644.

  53. Williams A, Coyne SM. Effects of neck position on intracranial pressure. Am J Crit Care 1993; 2: 68-71.

  54. Hariri RJ, Firlick AD, Shepard SR et al. Traumatic injury, hemorrhagic shock and fluid resuscitation: Effects on intracranial pressure and brain compliance. J Neurosurg 1993; 79: 421-427.

  55. Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. Effects of increased intraabdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J Trauma 1996; 40: 936-43.

  56. Sullivan HG, Miller JD, Becker DP. The Physiological basis of intracranial pressure change with progressive epidural brain compression. J Neurosurg 1977; 47: 532-534.

  57. Cushing H. Some experimental and clinical observations concerning states of increased intracranial tension. Johns Hopkins Med J 1901; 12: 290-293.

  58. Brown FK. Cardiovascular effects of acutely raised intracranial pressure. Am J Physiol 1956; 185: 510-514.

  59. Ducker TB, Simmons RL, Anderson RW et al. Hemodynamic cardiovascular response to raised intracranial pressure. Med Ann DC 1969; 37: 523-526.

  60. Hoff JT, Reis DJ. Localization of regions mediating the Cushing response in CNS of cats. Arch Neurol 1970; 23: 228-240.

  61. Doba N, Reis DJ. Localization within the brainstem of a receptive area mediating the pressor response to increased intracranial pressure (the Cushing response). Brain Res 1972; 47: 487-491.

  62. Reis DJ, Ruggiero DA, Morrison SF. The Cl area of the rostral ventrolateral medulla oblongata. A critical brainstem region for control of resting and reflex integration of arterial pressure. Am J Hypertens 1989; 2: 363-374.

  63. Deuss U, Dietrich J, Kaulen D, Frey K, Spangenberger W, Allolio B, Matuszczak M, Troidl H, Winkelmann W. The stress response to laparoscopic cholecystectomy: investigation of endocrine parameters. Endoscopy 1994; 26: 235-238.

  64. Cooper GM, Scoggins AM, Ward ID, Murphy D. Laparoscopy-a stressful procedure. Anaesthesiology 1982; 37: 266-269Æ.

  65. Mansour MA, Stiegmann GV, Yamamoto M, Berguer R. Neuroendocrine stress response after minimally invasive surgery in pigs. Surg Endosc 1992; 6: 294-297.

  66. Odeberg S, Ljungqvist O, Svenberg T, Sollevi A. Lack of neurohumoral response to pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 1997; 12: 1217-23

  67. Milheiro A, Sousa FC, Mnaso EC, Leitao F. Metabolic responses to cholecystectomy: open vs laparoscopic approach. J Laparoendosc Surg 1994; 4: 311-317.

  68. Schauer PR, Sirinek KR. The laparoscopic approach reduces the endocrine response to elective cholecystectomy. The Am Surg 1995; 61: 106-111.

  69. Ortega AE, Peters JH, Incarbone R, Estrada L, Ehsan A, Kwan Y, Spencer CJ, Moore-Jeffries E, Kuchta K, Nicoloff JT. A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996; 183: 249-256.

  70. Donald RA, Perry EG, Wittert GA, Chapman M, Livesey JH, Ellis MJ, Evans MJ, Yandle T, Espiner EA. The plasma ACTH, AVP, CRH and catecholamine responses to conventional and laparoscopic cholecystectomy. Clin Endocrinol 1993; 38: 609-15.

  71. Melville RJ, Frizis HI, Forsling ML et al. (The stimulus of vasopressin release during laparoscopy. Surg Gynecol Obstet 1985; 161: 253-256.

  72. Le Roith D, Bark H, Nyksa M et al. The effect of abdominal pressure on plasma antidiuretic hormone levels in the dog. J Surg Res 1982; 32: 65-69.

  73. Herruzo JA, Castellano G, Larrodera L, Morillas JD, Sanchez DM, Provencio R, Munoz-Yague MT. Plasma arginine vasopressin concentration during laparoscopy. Hepatogastroenterol 1989; 36: 499-503.

  74. Husain MK, Manger WM, Rock TW. Vasopressin release due to manual restraint in the rat: role of body compression with other stressful stimuli. Endocrinology 1979; 10:641-644.

  75. Punnonen R, Vinamaki O. Vasopressin release during laparoscopy. Lancet 1982; 1:175-176.

  76. Demers LM. Pituitary function. In: Burtis CA, Ashwood ER (eds) Tietz textbook of clinical chemistry 3rd ed., WB Saunders Company, Philadelphia, pp. 1999; 1470-92.

  77. Targarona EM, Pons MJ, Balague C, Esper JJ, Moral A, Martinez j, Gaya J, Filella X, Rivera F, Ballestra A, Trias M. Acute phase is the only significantly reduced component of the injury response after laparoscopic cholecystectomy. World J Surg 1996; 20: 528-534.

  78. Safran D, Sgambati S, Orlando R. Laparoscopy in high risk cardiac patients. Surg Gynecol Obstet 1993; 176: 548-554.

  79. Nogueira JM, Cangro CB, Fink JC, Schweitzer E, Wiland A, Klassen DK, Gardner J, Flowers J, Jacobs S, Cho E, Philosophe B, Bartlett ST, Weir MR. A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 1999; 67: 722-8.

  80. Widergen JT, Bartistella FD. The open abdomen treatment for intra-abdominal compartment syndrome. J Trauma 1994; 37: 158.

  81. Saggi BH, Bloomfield GL, Sugerman HJ, Blocher CR, Hull JP, Marmarou AP, Bullock MR. Treatment of intracranial hypertension using non surgical abdominal decompression. J Trauma 1999; 46: 646-651Æ.

  82. Koivusalo AM, Kellokumpu I, Scheinin M, Tikkanen I, Makisalo H, Lindgren L. A comparison of gasless mechanical and conventional carbon dioxide pneumoperitoneum methods for laparoscopic cholecystectomy. Anesth Analg 1998; 86: 153-8.

  83. Lindgren L, Koivusalo AM, Kellokumpu I. Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy. Br J Anaesth 1995; 75: 567-572.

  84. Eisenhauer DM, Saunders CJ, Ho HS, Wolfe BM. Hemodynamic effects of argon pneumoperitoneum. Surg Endosc 1994; 8: 315-321.

  85. Andrus CH. Invited commentary: Hemodynamic effects of argon pneumoperitoneum. Surg Endosc 1994; 8: 322-323.

  86. Bongard FS, Pianim NA, Leighton TA, Dubecz S, Davis IP, Lippmann M, Klein S, Liu S. Helium insufflation for laparoscopic operation. Surg Gynecol Obstet 1993; 177: 140-146.

  87. Rademaker BMP, Bannenberg JJG, Kalkman CJ, Meyer DW. Effects of pneumoperitoneum with helium on hemodynamics and oxygen transport: a comparison with carbon dioxide. J Laparoendosc Surg 1995; 5: 15-22.

  88. Phillips RS, Goldberg RI, Watson PW, Marshall JR, Barkin JS. Mechanism of improved patient tolerance to nitrous oxide in diagnostic laparoscopy. Am J Gastroenterol 1987; 82: 143-144.

  89. El-Minawi MF, Wahbi O, El-Bagouri IS, Sharawi M, El-Mallah SY. Physiologic changes during CO2 and N2O pneumoperitoneum in diagnostic laparoscopy. A comparative study. J Reprod Med 1981; 26: 338-46.

  90. Joris JL, Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol 1998; 32: 1389-96

  91. Thibonnier M, Kilani A, Rahman M, DiBlasi TP, Warner K, Smith MC, Leenhardt AF, Brouard R. Effects of nonpeptide V(1) vasopressin receptor antagonist SR49059 in hypertensive patients. Hypertension 1999; 34: 1293-300.




2020     |     www.medigraphic.com