Measuring intraabdominal pressure in the operating room
Intra-abdominal
pressure monitoring is commonly done in the operating room during
laparoscopic surgery.
Typically the patient’s abdomen is inflated with gas to a
predetermined pressure and maintained at that pressure during the
case. Though well tolerated by most patients, this pressure
elevation may cause hemodynamic compromise and tissue hypoxia.[1-4]
Given our
current understanding of the pathophysiology of abdominal
compartment syndrome, there are other indications for
intra-abdominal pressure monitoring in the operating theatre.
One obvious indication is to obtain baseline IAP data on
morbidly obese patients. This provides the clinician insight into
the level of IAP that this patient has lived with and adapted to for
a prolonged time. If the patient then becomes critically ill during
the post-operative period, this baseline pressure will provide
insights into when the IAP is becoming elevated.[5-7] Another use of
IAP monitoring in the operating theatre is monitoring of IAP at the
time of abdominal wall closure after any major laparotomy or when
repairing an infant’s abdominal wall defect.[4, 8-12] If the
intra-abdominal pressure increases dramatically during abdominal
wall closure, the surgeon should consider a staged closure to allow
time for any edema to resolve. This planned closure has been
implemented by several of the referenced authors with resulting
reductions in complications in these patients. Finally, surgical
procedures done in the prone position can result in elevated IAP
that may lead to hemodynamic instability during the case and has
been reported to lead to ischemic bowel in prolonged spinal surgical
cases.[13, 14]
Intra-abdominal pressure monitoring during this situation will
assist the anesthesiologist in evaluating the multiple causes of
hemodynamic compromise in such cases.
References:
1.
Baroncini, S., et al.,
Anaesthesia for laparoscopic surgery in paediatrics. Minerva
Anestesiol, 2002. 68(5): p. 406-13.
2.
Chiu, A.W., et al.,
Effects of intra-abdominal pressure on renal tissue perfusion during
laparoscopy. J Endourol, 1994.
8(2): p. 99-103.
3.
Schwarte, L.A., et al.,
Moderate increase in intraabdominal pressure attenuates gastric
mucosal oxygen saturation in patients undergoing laparoscopy.
Anesthesiology, 2004. 100(5): p. 1081-7.
4.
Malhotra, S.K. and D. Nakra,
Detection of impending
abdominal compartment syndrome. Anaesthesia, 2004.
59(11): p. 1146-7.
5.
Sanchez, N.C., et al.,
What is normal intra-abdominal pressure? Am Surg, 2001.
67(3): p. 243-8.
6.
Nguyen, N.T., et al.,
Evaluation of intra-abdominal pressure after laparoscopic and open
gastric bypass. Obes Surg, 2001.
11(1): p. 40-5.
7.
Wilson, A., et al.,
Intra-abdominal pressure and the morbidly obese patients: the effect
of body mass index. J Trauma, 2010.
69(1): p. 78-83.
8.
Jona, J.Z., The 'gentle
touch' technique in the treatment of gastroschisis. J Pediatr
Surg, 2003. 38(7): p. 1036-8.
9.
Kidd, J.N., Jr., et al.,
Evolution of staged versus
primary closure of gastroschisis. Ann Surg, 2003.
237(6): p. 759-64;
discussion 764-5.
10.
Olesevich, M., et al.,
Gastroschisis revisited: role of intraoperative measurement of
abdominal pressure. J Pediatr Surg, 2005.
40(5): p. 789-92.
11.
Batacchi, S., et al.,
Vacuum-assisted closure device enhances recovery of critically ill
patients following emergency surgical procedures. Crit Care,
2009. 13(6): p. R194.
12.
Mentula, P. and A. Leppaniemi,
Prophylactic open abdomen in
patients with postoperative intra-abdominal hypertension. Crit
Care, 2010. 14(1): p.
111.
13.
Ball, C.G., et al.,
Intra-abdominal hypertension, prone ventilation, and abdominal
suspension. J Trauma, 2010.
68(4): p. 1017.
14.
Hering, R., et al., The
effects of prone positioning on intraabdominal pressure and
cardiovascular and renal function in patients with acute lung
injury. Anesth Analg, 2001.
92(5): p. 1226-31.