Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients.
OBJECTIVE
To evaluate the haemodynamic and respiratory changes during laparoscopic cholecystectomy in elderly ASA III patients.


METHODS
This clinical descriptive study included 16 patients aged > 75 yr. Anaesthesia was induced with fentanyl and etomidate and maintained with N2O in O2 (50%), fentanyl and isoflurane as needed. Inspired minute volume was kept constant during anaesthesia. Cardiovascular monitoring included a radial artery catheter and a pulmonary artery catheter for measurement of CO, RVEF and SvO2, and calculation of right ventricular end diastolic volume indexed (RVEDVI). Haemodynamic variables, arterial and venous blood gas analyses were collected before and 10 min after anaesthetic induction, 15, 30 and 60 min after insufflation (IAP = 12 mmHg) followed by a 10 degrees head-up tilt, and after exsufflation.


RESULTS
The mean age was 81 +/- 4 yr. The main cardiovascular depression was recorded after anaesthetic induction. Peritoneal insufflation resulted in improvement of cardiovascular function with increases in cardiac index (+19%), heart rate (+21%), MAP (+ 19%) and SvO2 (+8%), (P < 0.05) which may be the result of a sympathetic stimulation. No change in preload (RVEDVI) and SVR was recorded. Cardiac index was unchanged during pneumoperitoneum. Laparoscopy was associated with an increase in PaCO2 15 min after CO2 insufflation (from 33.9 to 38.3 mmHg, P < 0.05) and a further elevation after 60 min (44.4 mmHg) without any sign of extra peritoneal diffusion. There was no change in the intra-pulmonary shunt and the Pa-ETCO2 gradient remained stable (mean 7.2 mmHg).


CONCLUSIONS
We conclude that gradual abdominal insufflation to 12 mmHg followed by a limited 10 degrees head-up tilt is associated with cardiovascular stability in elderly ASA III patients.
Dhoste
K
K
Department of Anaesthesia and Surgical Intensive Care, University Hospital of Poitiers, France.
Lacoste
L
L
Karayan
J
J
Lehuede
M S
MS
Thomas
D
D
Fusciardi
J
J
D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000097:blood; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011659:Pulmonary Gas Exchange; D012119:Respiration
D002245:Carbon Dioxide