British Journal of Anaesthesia, Vol 78, Issue 2 128-133, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
E. A. Hirvonen, L. S. Nuutinen and O. Vuolteenaho
In order to determine if there are differences in stress responses, as
reflected in neuroendocrine activation, we have compared data from two
groups of patients undergoing laparoscopic surgery either in the head- up
position for cholecystectomy or in the head-down position for hysterectomy.
Arterial blood samples were obtained for measurement of serum
concentrations of cortisol, catecholamines, renin activity and atrial
natriuretic peptide (measured as N-terminal peptide of proANP), and
haemodynamic data (pulmonary capillary wedge pressure, PCWP) were collected
at the following times: in awake patients, supine at rest (baseline); in
awake patients in the position used during surgery; during laparoscopy; and
2 h after surgery. The same anaesthetic technique and normocapnic
mechanical ventilation were used in both groups. There were no significant
differences between groups in cortisol or adrenaline concentrations, or in
renin activity. There was, however, a three-fold increase in cortisol
towards the recovery period in both groups. Noradrenaline concentrations
increased more in the head- up group suggesting increased sympathetic
nervous activity. In awake patients, plasma NT-proANP concentrations were
significantly higher in the head-down tilt compared with the head-up
position, and NT-proANP correlated well with PCWP. During pneumoperitoneum,
however, NT-proANP concentrations remained low in spite of increased PCWP
suggesting that inflation of the abdomen interferes with venous return. In
conclusion, abdominal surgical laparoscopy in both the head-up and
head-down positions caused marked activation of neuroendocrine responses.
The two surgical positions, however, differed in their effect on the
circulation. In awake patients, head-down tilt was associated with
increased concentrations of plasma NT-proANP, indicating increased venous
return and atrial stretch.
CLINICAL INVESTIGATIONS
Hormonal responses and cardiac filling pressures in head-up or head- down position and pneumoperitoneum in patients undergoing operative laparoscopy
Department of Anaesthesiology, Kuopio University Hospital, SF-70210 Kuopio, Finland; Department of Anesthesiology, Oulu University, SF-90220 Oulu, Finland; Department of Physiology, Oulu University, SF-90220 Oulu, Finland
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