title: Changes in the cardiovascular and respiratory systems during laparoscopic cholecystectomy.
abstract: The effects of peritoneal insufflation on the cardiovascular and respiratory systems were investigated in eight patients who underwent laparoscopic cholecystectomy. During the operation, intraabdominal pressure was maintained at a constant 12 mm Hg with carbon dioxide. The cardiac index had increased significantly at 20 and 40 min after the start of insufflation (3.6 +/- 0.6, 3.9 +/- 0.8 mL/min, respectively) and after evacuation (4.2 +/- 0.6 mL/min) compared with the control value (3.2 +/- 0.6 mL/min). Mean arterial pressure was significantly increased at 20 min after the start of insufflation (94.6 +/- 11.2 mm Hg) relative to the control value (79.9 +/- 11.1 mm Hg) and remained high after evacuation (101.5 +/- 11.9 mm Hg). Central and femoral venous pressure rose significantly during the operation from baseline values (12 +/- 6 and 4 +/- 4 mm Hg, respectively) to 18 +/- 10 and 11 +/- 6 mm Hg, respectively, at 20 min, and to 18 +/- 10 and 19 +/- 8 mm Hg, respectively, at 40 min after the start of insufflation. These parameters returned to control levels immediately after evacuation. Dynamic lung compliance decreased by 25% as a result of the elevated intraabdominal pressure. These findings demonstrate that some cardiopulmonary changes occur even at an intraabdominal pressure of 12 mm Hg, which up to now has been considered a safe level.
authors.affiliation: First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Y
authors.initials: Y
authors.lastname: Hashikura
authors.forename: Y
authors.initials: Y
authors.lastname: Munakata
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: K
authors.initials: K
authors.lastname: Hayashi
authors.forename: K
authors.initials: K
authors.lastname: Yanagisawa
authors.forename: M
authors.initials: M
authors.lastname: Numata
mesh_terms: D002245:Carbon Dioxide; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011028:Pneumoperitoneum, Artificial; D012119:Respiration / Q000502:physiology*; D012307:Risk Factors
chemical_list: D002245:Carbon Dioxide