The effects of pneumoperitoneum and patient position on the perfusion index and pleth variability index during laparoscopic bariatric surgery
Objective: Limited data are available on the use of the perfusion index (PI) and the pleth variability index (PVI) during laparoscopicbariatric 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 anaesthesiainduction (T0), 5 min after endotracheal intubation (T1), immediately before surgery, after the patient had been in the reverseTrendelenburg position for 5 min (T2), after inflating the abdomen with CO2 in reverse Trendelenburg (T3), after the abdomen hadbeen 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 werenot affected during T2 or T3. Pneumoperitoneum caused an increase in mean arterial pressure (MAP) and a decrease in HR. PVI andMAP 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.
___
- [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