MEASUREMENT OF THE VENOUS PRESSURE AND PNEUMOPLETHYSMOGRAPHY OF LOWER EXTREMITY IN LAPAROSCOPIC OPERATION

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  • 腹腔鏡下手術時の気腹操作による下肢静脈圧の変化と空気脈波測定の検討

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Abstract

Deep vein thrombosis is suspected as one of the complications of the laparoscopic operation.<br> We performed venous pressure measurement and pneumo-plethysmography of the lower extremities in 32 patients submitted to laparoscopic procedures in our hospital. Laparotomy patients were served as control group.<br> For the venous pressure measurement, we punctured the dorsal vein with a 22G needle under general anesthesia and connected to a central venous pressure monitor unit.<br> For the pneumo-plethysmography, with the patient in the supine position, the leg was elevated above the heart level. A wide puneumatic tourniquet was placed around the thigh for compression and a narrow touniquet for measurement of venous capacitance (VC), maximum venous outflow (MVO), and recovering time (T) was placed around the calf.<br> The venous pressure which was 8.3±2.3cm H2O before abdominal insufflation rapidly increased to 20.6±4.7cm H2O in 10 minutes, but decreased to 11.4±3.4cm H2O after the insufflation. In the control group venous pressure was between 7.0_??_9.5cm H2O.<br> VC and MVO showed no significant change and the MVO/VC ratio kept at over 80% before, during, and after the operation. T was 4.4±1.2 sec. before operation but increased to 4.9_??_6.2 sec, though not significant and decreased to 4.2±3.1 sec. after operation.<br> During laparoscopic operation, venous pressure of the lower extremities was significantly elevated during the abdominal insufflation period. But using routine insufflation pressure values, the venous return of the lower extremities was not affected.

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