The effects of pneumoperitoneum and patient position on the perfusion index and pleth variability index during laparoscopic bariatric surgery

Year 2020, , 54 - 60, 31.05.2020

Reyhan Arslantas Mustafa Kemal Arslantas Gulbin Tore Altun Pelin Corman Dıncer

https://doi.org/10.5472/marumj.711735

Cited By: 1

Abstract

Objective: Limited data are available on the use of the perfusion index (PI) and the pleth variability index (PVI) during laparoscopic
bariatric surgery. We investigated the effects of pneumoperitoneum and the reverse Trendelenburg position on these indices.
Materials and Methods: PI, PVI, heart rate (HR), blood pressure, SpO2 and ventilation parameters were recorded before anaesthesia
induction (T0), 5 min after endotracheal intubation (T1), immediately before surgery, after the patient had been in the reverse
Trendelenburg position for 5 min (T2), after inflating the abdomen with CO2 in reverse Trendelenburg (T3), after the abdomen had
been deflated (T4) and 5 min after extubation (T5).
Results: General anaesthesia induced an increase in the PI (P<.001), and a decrease in the PVI (P=.002). The PI and PVI values were
not affected during T2 or T3. Pneumoperitoneum caused an increase in mean arterial pressure (MAP) and a decrease in HR. PVI and
MAP decreased during T4, but the PI and HR remained unchanged. PVI, HR and MAP increased during T5.
Conclusion: Our data suggest that the reverse Trendelenburg position and pneumoperitoneum did not affect the PI or PVI values,
whereas deflation decreased the PVI in morbidly obese patients under general anaesthesia.

Keywords

Anaesthesia, Morbid obesity, Pleth variability index, Perfusion index, Bariatric surgery

References

• [1] Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9:88. doi:10.1186/1471-2458-9-88
• [2] Montravers P, Augustin P, Zappella N, et al. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med 2015;34:45–52. doi:10.1016/j.accpm.2014.06.002
• [3] Schürner AM, Manzini G, Bueter M, Schadde E, Beck- Schimmer B, Schläpfer M. Perioperative surgery – and anaesthesia-related risks of laparoscopic Roux-en-Y gastric bypass – a single centre, retrospective data analysis. BMC Anesthesiol 2018;18:190. doi:10.1186/s12871.018.0654-x
• [4] Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep 2016;5:424-34. doi:10.1007/s13679.016.0235-6
• [5] Watson X, Cecconi M. Haemodynamic monitoring in the peri-operative period: the past, the present and the future. Anaesthesia 2017;72 Suppl 1:7-15. doi:10.1111/anae.13737
• [6] Deng QW, Tan WC, Zhao BC, Wen SH, Shen JT, Xu M. Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis. Crit Care 2018;22:298. doi:10.1186/s13054.018.2251-2
• [7] Demirel İ, Bolat E, Altun AY, Özdemir M, Beştaş A. Efficacy of goal-directed fluid therapy via pleth variability index during laparoscopic roux-en-y gastric bypass surgery in morbidly obese patients. Obes Surg 2018;28:358-63. doi:10.1007/ s11695.017.2840-1
• [8] Tapar H, Karaman S, Dogru S, et al. The effect of patient positions on perfusion index. BMC Anesthesiol 2018;18:111. doi:10.1186/s12871.018.0571-z
• [9] Arslantas R, Arslantas MK, Tore Altun G, Corman Dincer P. The effect of patient position and pleth variability index in patients undergoing laparoscopic cholecystectomy. GKDA Derg 2019;25:190-7. doi: 10.5222/GKDAD.2019.80958
• [10] Wajima Z, Shiga T, Imanaga K. Does pneumoperitoneum affect perfusion index and pleth variability index in patients receiving combined epidural and general anesthesia? Biosci Trends 2018;11:667-74. doi:10.5582/bst.2017.01253
• [11] Monnet X, Guérin L, Jozwiak M, et al. Pleth variability index is a weak predictor of fluid responsiveness in patients receiving norepinephrine. Br J Anaesth 2013;110:207-13. doi:10.1093/ bja/aes373
• [12] Høiseth LØ, Hoff IE, Hagen OA, Landsverk SA, Kirkebøen KA. Dynamic variables and fluid responsiveness in patients for aortic stenosis surgery. Acta Anaesthesiol Scand 2014;58:826- 34. doi:10.1111/aas.12328
• [13] Siswojo AS, Wong DMY, Phan TD, Kluger R. Pleth variability index predicts fluid responsiveness in mechanically ventilated adults during general anesthesia for noncardiac surgery. J Cardiothorac Vasc Anesth [Internet]. 2014;28:1505-9. doi:10.1053/j.jvca.2014.04.010
• [14] Mizuno J, Morita Y, Kakinuma A, Sawamura S. 2012. General anaesthesia induction using general anaesthetic agents and opioid analgesics increases Perfusion Index (PI) and decreases Pleth Variability Index (PVI): Observational clinical study. Sri Lankana J Anaesthesiol 2012; 20:7-12. doi:10.4038/slja. v20i1.3664
• [15] Chu H, Wang Y, Sun Y, Wang G. Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis. J Clin Monit Comput 2016;30:265-74. doi:10.1007/s10877.015.9742-3
• [16] Perel A. The value of dynamic preload variables during spontaneous ventilation. Curr Opin Crit Care 2017;23:310-7. doi:10.1097/MCC.000.000.0000000430
• [17] Knight DJW, Mahajan RP. Patient positioning in anaesthesia. Contin Educ Anaesth Crit Care Pain. British Journal of Anaesthesia 2004;4:160-3. doi:10.1093/bjaceaccp/mkh044
• [18] Bapteste L, Carrillon R, Javelier S, et al. Pulse pressure variations and plethysmographic variability index measured at ear are able to predict fluid responsiveness in the sitting position for neurosurgery. J Neurosurg Anesthesiol 2019;10.1097/ANA.000.000.0000000587. doi:10.1097/ ANA.000.000.0000000587
• [19] Koivusalo AM, Lindgren L. Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2000;44:834-41. doi:10.1034/j.1399- 6576.2000.440709.x
• [20] Díaz F, Erranz B, Donoso A, Salomon T, Cruces P. Influence of tidal volume on pulse pressure variation and stroke volume variation during experimental intra-abdominal hypertension. BMC Anesthesiol 2015;15:127. doi:10.1186/s12871.015.0105-x
• [21] Jacques D, Bendjelid K, Duperret S, Colling J, Piriou V, Viale JP. Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure: an experimental study. Crit Care 2011;15:R33. doi:10.1186/cc9980
• [22] Høiseth LØ, Hoff IE, Myre K, Landsverk SA, Kirkebøen KA. Dynamic variables of fluid responsiveness during pneumoperitoneum and laparoscopic surgery. Acta Anaesthesiol Scand 2012;56:777-86. doi:10.1111/j.1399- 6576.2011.02641.x
• [23] Liu F, Zhu S, Ji Q, Li W, Liu J. The impact of intra-abdominal pressure on the stroke volume variation and plethysmographic variability index in patients undergoing laparoscopic cholecystectomy. Biosci Trends. 2015;9:129-33. doi:10.5582/ bst.2015.01029
• [24] Alpert MA, Omran J, Bostick BP. Effects of obesity on cardiovascular hemodynamics, cardiac morphology, and ventricular function. Curr Obes Rep 2016;5:424-34. doi:10.1007/s13679.016.0235-6
• [25] Cobb WS, Burns JM, Kercher KW, Matthews BD, James Norton H, Todd Heniford B. Normal intraabdominal pressure in healthy adults. J Surg Res 2005;129:231-5. doi:10.1016/j. jss.2005.06.015