Excessive intra-abdominal pressure may cause decreased venous return and hypotension. Since the preliminary laparoscopy did not show any major vascular catastrophe an emergency laparotomy would not be indicated. In most cases, the release of pressure is often sufficient. In cases of a vaso-vagal episode (which may be induced by peritoneal stretching) a dose of atropine may be required.
Pneumoperitoneum- therapeutic
During a laparoscopic procedure, a surgeon will need to create a pneumoperitoneum. This can be achieved by the use of a Verres needle (risk of visceral injury). An alternative is the open ‘Hassan’ style technique. Once access to the abdominal cavity is secured carbon dioxide gas is insufflated to induce a working space. Higher intra-abdominal pressures may compromise venous return and reduce cardiac output. If the blood pressure is seen to drop in this way then the release of air will often improve matters. Should this not be the case then a laparotomy may be necessary to exclude a more significant internal injury.
