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Higher IPIP safe in laparoscopy of healthy obese.(Gynecology)
CHICAGO -- Higher intraperitoneal insufflation pressures at trocar entry appear to safely establish appropriate pneumoperitoneum in otherwise healthy obese women undergoing laparoscopic surgery, Dr. Basim Abu-Rafea said at the annual meeting of the AAGL (formerly the American Association of Gynecologic Laparoscopists).
Dr. Abu-Rafea and his colleagues at the University of Western Ontario, London, Canada, concluded that setting the intraperitoneal insufflation pressure (IPIP) at 25-30 mm Hg prior to primary trocar insertion eliminates the need to monitor C[O.sub.2] insufflated volume, ensures adequate pneumoperitoneum, and does not appear to be associated with increased hemodynamic risk.
The incidence of adverse events during laparoscopic surgery has been observed to be higher with obesity and increased parity. Research has suggested that IPIPs of 20-30 mm Hg are adequate to lift the abdominal wall. But there are concerns about causing respiratory or cardiovascular suppression or collapse secondary to the high pressures, especially in obese patients.
Dr. Abu-Rafea and his associates conducted a prospective observational cohort study of 100 healthy women who consecutively underwent laparoscopic surgery, primarily for chronic pelvic pain (66) or infertility (23).
The women ranged in age from 19 to 58 years and in weight from 43 kg to 118 kg with body mass indexes of 17-39 kg/[m.sup.2]. Average parity was 1.1, with a range of 0-5.
All were categorized as having American Society of Anesthesiologists (ASA) physical status I or II.
All were given muscle relaxants and general anesthesia, and were in the supine position for the procedures. Pneumoperitoneum was established using a Veress needle.
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Source: HighBeam Research, Higher IPIP safe in laparoscopy of healthy obese.(Gynecology)