Hemodynamic Changes During Laparoscopic Cholecystectomy

Abstract

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring including a flow-directed pulmonary artery catheter. During surgery, intraabdominal pressure was maintained automatically at 14 mm Hg by a CO2 insufflator, and minute ventilation was controlled and adjusted to avoid hypercapnia. Hemodynamics were measured before anesthesia, after the induction of anesthesia, after tilting into 10 degrees head-up position, 5 min, 15 min, and 30 min after peritoneal insufflation, and 30 min after exsufflation. Induction of anesthesia decreased significantly mean arterial pressure and cardiac index (CI). Tilting the patient to the head-up position reduced cardiac preload and caused further reduction of CI. Peritoneal insufflation resulted in a significant increase (+/- 35%) of mean arterial pressure, a significant reduction (+/- 20%) of CI, and a significant increase of systemic (+/- 65%) and pulmonary (+/- 90%) vascular resistances. The combined effect of anesthesia, head-up tilt, and peritoneal insufflation produced a 50% decrease in CI. Administration of increasing concentrations of isoflurane, via its vasodilatory activity, may have partially blunted these hemodynamic changes. These results demonstrate that laparoscopy for cholecystectomy in head-up position results in significant hemodynamic changes in healthy patients, particularly at the induction of pneumoperitoneum.

Hemodynamics during laparoscopic extra- and intraperitoneal insufflation

“…Clinical studies during intraperitoneal insufflation with carbon dioxide showed that arterial blood pressure increases and cardiac output decreases [8,13]. Few data exist on the hemodynamic effects of laparoscopy in an extraperitoneally created cavity.…”

Effect of Premedication With Intravenous Clonidine on Haemodynamic Changes in Laparoscopic Cholecystectomy: A Randomised Study

“…Traditionally, they have been used as antihypertensive drugs, but doses based on sedative, anxiolytic, analgesic properties are being developed. (13,14,15) We studied 100 adult patients with similar Demographic profiles like Age, Height, Weight, BMI, Sex, ASA physical status I and II and scheduled for elective laparoscopic cholecystectomy under general anaesthesia.…”

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

“…As a generalisation, pneumoperitoneum orchestrates a neurohormonal stress response which LVEF: left ventricular ejection fraction increases systemic vascular resistance, mean arterial blood pressure and heart rate [13][14][15]. These factors increase the afterload and myocardial oxygen consumption which are poorly tolerated by patients with cardiac dysfunction [16].…”

“…Patients with ischemic heart disease are prone to develop atrial fibrillation, a condition which could be precipitated by CO 2 pneumoperitoneum [19]. Most of the studies addressing cardiovascular effects of CO 2 pneumoperitoneum have been performed in healthy subjects, who seem to tolerate pneumoperitoneum without untoward problem [14,15,20]. Similar issues have not been studied under the setting of randomized trial in patients with cardiac co-morbidities [21].…”