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- Title:
Changes in intra-abdominal pressure, hemodynamics, and peak inspiratory pressure during gastroscopy in a porcine model.
- Document type:
- Journal Article
- Author(s):
- von Delius, S; Karagianni, A; Henke, J; Preissel, A; Meining, A; Frimberger, E; Schmid, RM; Huber, W
- Abstract:
- BACKGROUND AND STUDY AIMS: The aim of this experimental study was to assess the effect of gastric insufflation on intra-abdominal pressure (IAP) and associated hemodynamic and respiratory changes during upper gastrointestinal endoscopy. METHODS: Measurements were taken from pigs under general anesthesia with controlled ventilation. Gastroscopy was carried out with continuous insufflation of air by a standard endoscopic light source/insufflator. The cardiac index and global end-diastolic volume index (GEDVI; reflecting preload) were measured by transpulmonary thermodilution. IAP, heart rate, mean arterial pressure (MAP), central venous pressure, systemic vascular resistance index (SVRI; reflecting afterload), peak inspiratory pressure (PIP), and oxygenation (SaO (2)) were also recorded. RESULTS: A total of 266 paired measurements (at the time of transpulmonary thermodilution) were taken from 14 animals. During air insufflation, we observed a significant rise in IAP in all animals up to intermittent values of 22 mm Hg. IAP and PIP correlated well (r = 0.666, P < 0.001), with the latter reaching values as high as 45 mbar in one pig, leading to respiratory compromise. Only marginal changes in heart rate, and a continuous, almost significant rise in MAP (due to a significant increase in SVRI) were recorded. We observed a slight increase in GEDVI, predominantly during the initial phase of air insufflation. The cardiac index showed no substantial changes. There were no episodes of hemodynamic instability, nor a decline in SaO (2). CONCLUSIONS: Air insufflation during gastroscopy resulted in a significant increase in IAP. The main clinically relevant finding was a steady increase in SVRI. Major increments in PIP suggest a role of intra-abdominal hypertension in otherwise unexplained respiratory compromise during upper gastrointestinal endoscopy.
- Journal title abbreviation:
- Endoscopy
- Year:
- 2007
- Journal volume:
- 39
- Journal issue:
- 11
- Pages contribution:
- 962-8
- Language:
- eng
- Fulltext / DOI:
- doi:10.1055/s-2007-966973
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/18008204
- Print-ISSN:
- 0013-726X
- TUM Institution:
- II. Medizinische Klinik und Poliklinik (Gastroenterologie)
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