Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Cardiopulmonary effects of prolonged surgical abdominal retractors application during general anesthesia: a prospective observational comparative study

Efeitos cardiopulmonares da aplicação prolongada de afastadores cirúrgicos abdominais durante anestesia geral: um estudo prospectivo observacional comparativo

Mohamed A. Ghanem, Ahmed S. El-Hefnawy

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Increasing abdominal pressures could affect pulmonary compliance and cardiac performance, a fact based on which the aim of the present study to detect the cardiopulmonary burden of multiple retractors application during supine versus lateral abdominal surgeries. We hypothesized that surgical ring multiple retractors application would affect the pulmonary and cardiac functions during both lateral and supine abdominal surgeries.

Prospective observational comparative study on forty surgical patients subdivided into two groups twenty each, comparing pulmonary compliance and cardiac performance before, during and after retractors application, group (S) supine position cystectomy surgery, and group (L) lateral position nephrectomy surgery under general anesthesia, Composite 1ry outcome; dynamic compliance C-dyn and cardiac index CI and Other outcome variables ICON cardio-meter were also recorded.

C-dyn and C-stat were significantly decreased late during retractor application in lateral compared to supine surgery with significant decrease compared to basal values all over the surgical time. CI was significantly increased after retractor removal in both of the study groups compared to basal values. PAWP was significantly increased in -lateral compared to supine surgery -with significant increase compared to basal value all over the surgical time in both of the study groups. significant increase in DO2I compared to basal value during both supine and lateral positions.

Surgical retraction results in a short-lived significant decreases in lung compliance and cardiac output particularly during the lateral-kidney position than the supine position compliance.


Cardiac output;  Dynamic Compliance;  Static Compliance;  Cancer bladder;  Ring self-retaining retractor



O aumento das pressões abdominais poderia afetar a complacência pulmonar e o desempenho cardíaco, fato a partir do qual o objetivo do presente estudo é detectar a carga cardiopulmonar da aplicação de múltiplos afastadores durante cirurgias abdominais supino versus lateral. Nossa hipótese é que a aplicação de múltiplos afastadores do anel cirúrgico afetaria as funções pulmonar e cardíaca durante as cirurgias abdominais laterais e supinas.


Estudo prospectivo observacional comparativo em quarenta pacientes cirúrgicos subdivididos em dois grupos de vinte cada, comparando a complacência pulmonar e o desempenho cardíaco antes, durante e após a aplicação de afastadores, grupo (S) cirurgia de cistectomia em posição supina e grupo (L) cirurgia de nefrectomia em posição lateral sob anestesia geral, Desfecho primário composto; complacência dinâmica C-dyn e índice cardíaco IC e outras variáveis de resultado ICON cardiômetro também foram registrados.


C-dyn e C-stat diminuíram significativamente durante a aplicação do afastador em lateral em comparação com a cirurgia supina com diminuição significativa em comparação com os valores basais durante todo o tempo cirúrgico. O IC aumentou significativamente após a remoção do afastador em ambos os grupos de estudo em comparação com os valores basais. A PAWP aumentou significativamente na cirurgia lateral em comparação com a cirurgia supina, com aumento significativo em comparação com o valor basal durante todo o tempo cirúrgico em ambos os grupos de estudo. Aumento significativo no DO2I em comparação com o valor basal durante as posições supina e lateral.


A retração cirúrgica resulta em reduções significativas de curta duração na complacência pulmonar e no débito cardíaco, particularmente durante a posição lateral do rim do que na posição supina.


Débito cardíaco; Conformidade Dinâmica; Conformidade Estática; Câncer de bexiga; Afastador de anel autorretentor


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