scholarly journals Unusually High Intra-abdominal Opening Pressure Confirmed by Simultaneous Gastric Pressure Measurement during Laparoscopy

2012 ◽  
Vol 6 (1) ◽  
pp. 12-15
Author(s):  
Richard Matulewicz ◽  
Antonio R. Gargiulo ◽  
Stephen H. Loring ◽  
Massimo Ferrigno
Keyword(s):  
Respiratory Mechanics ◽  
Obese Woman ◽  
Veress Needle ◽  
Abdominal Pressure ◽  
Needle Placement ◽  
Opening Pressure ◽  
Robot Assisted ◽  
Gastric Pressure ◽  
High Degree ◽  
Viable Method

A 28 year-old obese woman was scheduled for robot-assisted bilateral tubal re-anastomosis under general anesthesia and neuromuscular blockade. As part of a respiratory mechanics study, gastric pressure (Pga) was measured. At the beginning of the operation, the surgeon repeatedly inserted a Veress needle consistently measuring an unusually high opening pressure of 15 mmHg, at a time when Pga was 12.5 mmHg. Based on the elevated Pga values, we inferred that the high opening pressure was a valid intra-peritoneal pressure, rather than a sign of incorrect needle placement; therefore, the surgeon proceeded with uneventful insufflation of the peritoneal cavity. This patient exhibited an unusually high opening intra-abdominal pressure that likely reflected her high degree of central obesity. Simultaneous Pga determination proved valuable in confirming intra-peritoneal location of the tip of Veress needle and may be a viable method of corroborating high opening pressures despite safe needle positions in laparoscopic cases.

Responses of feline gastroesophageal junction to changes in abdominal pressure

1987 ◽  
Vol 253 (3) ◽  
pp. G315-G322 ◽  
Author(s):  
J. T. Boyle ◽  
S. M. Altschuler ◽  
T. E. Nixon ◽  
A. I. Pack ◽  
S. Cohen
Keyword(s):  
Gastroesophageal Junction ◽  
Gastric Distension ◽  
Abdominal Pressure ◽  
Electromyographic Activity ◽  
Abdominal Compression ◽  
Balloon Distension ◽  
Gastric Pressure ◽  
High Pressure Zone ◽  
Antireflux Barrier ◽  
Sustained Inhibition

The responses of the lower esophageal sphincter (LES), stomach, and diaphragm and their contribution to changes in the high-pressure zone (HPZ) at the gastroesophageal junction were determined during extrinsic abdominal compression or intragastric balloon distension in anesthetized cats. Abdominal compression consistently induced an increase in intraluminal end-expiratory LES and gastric pressure (P less than 0.01). Changes in LES pressure significantly exceeded the changes in gastric pressure (P less than 0.01). In contrast, the LES response during gastric distension was variable in the group of animals despite a consistent volume-dependent increase in gastric pressure. Mean LES pressure for the group was unchanged, although 33% of individual animals exhibited a decrease in LES pressure during gastric distension. Both abdominal stimuli induced sustained inhibition of crural (P less than 0.01), but not costal, diaphragmatic electromyographic activity. Vagotomy affected the LES but not the gastric or diaphragmatic responses to both stimuli. In the group of animals, the combined effect of the changes in the three measured variables on the HPZ resulted in maintenance of the antireflux barrier during abdominal compression but a significant decrease in the barrier during gastric distension.

EFFECT OF INTRA-ABDOMINAL PRESSURE ON RESPIRATORY MECHANICS

2007 ◽  
Vol 62 (sup1) ◽  
pp. 78-88 ◽  
Author(s):  
P. Pelosi ◽  
M. Quintel ◽  
M.L.N.G. Malbrain
Keyword(s):  
Respiratory Mechanics ◽  
Abdominal Pressure

scholarly journals A targeting method for robot-assisted percutaneous needle placement under fluoroscopy guidance

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Zhonghao Han ◽  
Keyi Yu ◽  
Lei Hu ◽  
Weishi Li ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Needle Placement ◽  
Robot Assisted ◽  
Fluoroscopy Guidance

scholarly journals Airway Closure during Surgical Pneumoperitoneum in Obese Patients

2019 ◽  
Vol 131 (1) ◽  
pp. 58-73 ◽  
Author(s):  
Domenico Luca Grieco ◽  
Gian Marco Anzellotti ◽  
Andrea Russo ◽  
Filippo Bongiovanni ◽  
Barbara Costantini ◽  
...  
Keyword(s):  
Lung Volume ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Control Group ◽  
Obese Patients ◽  
Airway Closure ◽  
Alveolar Pressure ◽  
Opening Pressure ◽  
Airway Opening ◽  
Pressure Controlled

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundAirway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.MethodsWithin the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.ResultsEleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H2O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H2O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H2O [15 to 19] vs. 27 cm H2O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.ConclusionsIn obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

scholarly journals A targeting method for robot-assisted percutaneous needle placement under fluoroscopy guidance

2019 ◽  
Vol 24 (sup1) ◽  
pp. 44-52 ◽  
Author(s):  
Zhonghao Han ◽  
Keyi Yu ◽  
Lei Hu ◽  
Weishi Li ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Needle Placement ◽  
Robot Assisted ◽  
Fluoroscopy Guidance

Regional differences in abdominal pressure swings in dogs

1984 ◽  
Vol 57 (6) ◽  
pp. 1682-1687 ◽  
Author(s):  
M. Decramer ◽  
A. De Troyer ◽  
S. Kelly ◽  
L. Zocchi ◽  
P. T. Macklem
Keyword(s):  
Regional Differences ◽  
Abdominal Muscle ◽  
Abdominal Pressure ◽  
Bilateral Stimulation ◽  
Quiet Breathing ◽  
Gastric Pressure ◽  
Anesthetized Dogs ◽  
Small Change ◽  
Crural Diaphragm ◽  
Stimulation Of

The pressure swings under the costal (Pcos) and crural diaphragms (Pcru) and between the intestinal loops (Pint) were compared with the swings in gastric pressure (Pga) in 13 supine anesthetized dogs. Pcos, Pcru, and Pint were measured with air-filled latex balloons in eight dogs and saline-filled catheters in five. Pga was measured with an air-filled balloon in all dogs. During quiet breathing differences were often present, the directions of which were variable from animal to animal. During mechanical ventilation, all pressures increased, but both Pcos and Pcru increased more than Pga, whereas only a small change was observed in Pint. During bilateral stimulation of the costal diaphragm, Pcos invariably increased more than Pga and Pint, whereas almost no change was observed in Pcru. During bilateral stimulation of the crural diaphragm, Pcru invariably increased more than Pga, Pint, and Pcos. During abdominal muscle stimulation as during external abdominal compression, Pint always increased more than Pcos and Pcru. During lower rib cage compression, Pga, Pcos, and Pcru increased more than Pint. During sternocleidomastoid stimulation, all pressure swings were negative, but the change in Pint was always smaller than in Pcos, Pcru, or Pga. Inhomogeneities observed with balloons and saline-filled catheters were similar. After the abdomen was filled with 2 liters of saline all pressure swings became much more homogeneous.

scholarly journals Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

2001 ◽  
Vol 56 (4) ◽  
pp. 123-130 ◽  
Author(s):  
Roberto de Cleva ◽  
Fabiano Pinheiro da Silva ◽  
Bruno Zilberstein ◽  
David J B Machado
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Incisional Hernia ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Obese Woman ◽  
Incisional Hernia Repair ◽  
Abdominal Pressure ◽  
Urinary Flow ◽  
Abdominal Compartment

We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

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