• The cardiovascular responses to manipulation of the abdominal viscera were studied in 68 patients undergoing laparotomy. The anesthesia most frequently used was nitrous oxide in combination with ether and other agents, and continuous recordings were made of the pressure in the brachial artery, the electrocardiogram, electroencephalogram, and intrathoracic pressure. The common response, obtained in 55 patients, was arterial hypotension with or without bradycardia. No one area or maneuver could be depended on to elicit this response. It was not explained by purely mechanical factors such as occlusion of veins. It appeared to be a reflex response to the stimulation of localized receptors, which must be assumed to be more frequent in the upper part of the abdomen and on the parietal, rather than the visceral, peritoneum.
Rocco AG, Vandam LD. CHANGES IN CIRCULATION CONSEQUENT TO MANIPULATION DURING ABDOMINAL SURGERY. JAMA. 1957;164(1):14–18. doi:10.1001/jama.1957.02980010016004
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