Effect of pneumoperitoneum and position of patient on femoral vein haemodynamics during laparoscopic surgery

Summary

Femoral vein velocity (FVV) was measured in 15 patients (nine female, six male), with a mean age of 43.6 years (range 21–60), undergoing laparoscopic cholecystectomy. FVV was measured using continuous wave Doppler: 1 day pre-operatively; before, during and after pneumoperitoneum; and 1 day post-operatively. In addition the effects of tilting the patient 10° head up and head down was recorded. Pneumoperitoneum caused a 42% reduction in FW compared to pre-pneumoperitoneum (0.58 vs 1.00, P < 0.05). Following release of pneumoperitoneum there was a rebound of FVV of 15% (1.15 vs 1.00, P < 0.05). Pre- and post-pneumoperitoneum there was a significant reduction in FW with head up compared to head down (pre = 0.97 vs 1.30, P < 0.05; post=1.03 vs 1.17, P < 0.05). During pneumoperitoneum this tended towards significance (0.57 vs 0.71, P = 0.09). Pneumoperitoneum significantly reduces femoral vein blood velocity. Tilting the patient head up further increases this effect. Thrombo-embolic complications following laparoscopic surgery may therefore be increased.

Key Words:

• laparoscopic cholecystectomy
• femoral vein velocity
• pneumoperitoneum
• thrombo-embolism