Correlación de la medición directa de la presión intraabdominal y la presión programada de insuflación de CO<sub>2</sub> en cirugía laparoscópica

Abstract

Introduction: An intraabdominal pressure less than 14 mmHg is fundamental to avoid hemodynamic alterations during laparoscopic procedures. The monitoring by insuffl ation pressure (InfP) may not be the most reliable. Objective: To compare the InfP values with those measured directly in the abdominal cavity (IAP), and to establish their correlation with hemodynamic variations. Material and methods: During eight laparoscopic procedures, we obtained InfP and IAP measures simultaneously: at baseline and every fi ve minutes until the suspension of the pneumoperitoneum. All procedures were under general anesthesia and deep and/or intense neuromuscular blockage. We analyzed the hemodynamic stability (heart rate, arterial pressure and peripheral oxygen saturation) with the InfP and IAP measures. Results: We analyzed 54 pair measures. The correlation between measures was 0.86 (p < 0.001, R 2 = 0.74). Fifteen measures (27.8%) were equal; in 59.3% IAP > InfP, and in 14.1% IAP < InfP. The variations of IAP 14 mmHg were associated with arterial hypertension and tachycardia, while IAP 11 mmHg were associated with low diastolic arterial pressures and low heart rate (< 60). Conclusions: The monitoring of the intra-abdominal pressure with InfP may not be reliable, so we recommend a direct measurement.