Haemodynamic effects of pneumoperitoneum during laparoscopic cholecystectomy: A prospective comparative study using bioimpedance cardiography

Abstract

The haemodynamic effects of increased intra-abdominal pressure during laparoscopic cholecystectomy in 22 patients were compared with those in 11 patients undergoing open cholecystectomy; bioimpedance cardiography was used for monitoring at predetermined time intervals. In the laparoscopy group stroke volume, cardiac and ejection velocity indices were significantly decreased and the total peripheral resistance index was significantly increased during the insufflation period when compared with preinsufflation and corresponding values in the group undergoing open operation. Routine intraoperative parameters such as heart rate and blood pressure did not show any significant change or indicate alterations in cardiovascular performance during laparoscopic procedures. Continuous non-invasive cardiovascular monitoring by bioimpedance cardiography may be useful in patients with limited cardiac function.

Pathophysiological and clinical aspects of the CO2 pneumoperitoneum (CO2-PP)

“…The elevated catecholamine levels returned to baseline values only after desufflation [11,13]. The observed changes in cardiac afterload, which are also described by Koksoy et al [9], are therefore not only due to direct effects of the elevated IAP on the vascular system but also to increased catecholamine levels augmenting systemic vascular resistance.…”

“…A reason for this might be that, so far, the majority of laparoscopic operations have been performed in young and healthy patients not allowing a substantial, invasive hemodynamic monitoring because of ethical and moral problems [1,8,9,14]. Only a few studies have been done to evaluate the indications and perioperative risks of laparoscopic surgery in high-risk cardiac patients.…”

Hemodynamic and pulmonary changes during and after laparoscopic cholecystectomy A comparison with traditional surgery

“…A thorough understanding of these changes is imperative. It is also necessary both to determine the minimum preoperative risk factors and to design a system for monitoring and maintaining a satisfactory intraoperative course for all patients [1,14,24,25]. CO 2 insufflation and rT position are the main problems, followed by abdominal distention, potential hypercarbia, and acidosis [2,3,23,25].…”

Cardiac function during laparoscopic vs open gastric bypass

“…Several investigators have reported depressed cardiac function during short laparoscopic operations such as laparoscopic cholecystectomy [1,7,10,12]. In addition, others have observed that a 15 mmHg pneumoperitoneum appears to be the threshold for a decrease in cardiac output [2,3,6,11].…”

“…Pneumoperitoneum is associated with systemic absorption of CO 2 that can lead to hypercarbia and acidosis [5]. In addition, increased intraabdominal pressure and reverse Trendelenburg position during the laparoscopic operation may impede venous return and decrease cardiac function [1,7,10].…”