Hemodynamic changes during laparoscopic cholecystectomy.
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.
Joris
J L
JL
Department of Anesthesiology, CHU of Liège, Domaine du Sart Tilman, Belgium.
Noirot
D P
DP
Legrand
M J
MJ
Jacquet
N J
NJ
Lamy
M L
ML
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage; D002302:Cardiac Output / Q000502:physiology; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007327:Insufflation; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D012119:Respiration / Q000502:physiology
D002245:Carbon Dioxide; D007530:Isoflurane