title: Hemodynamic changes during laparoscopic cholecystectomy in patients with severe cardiac disease.
abstract: OBJECTIVE
  To evaluate the hemodynamic changes and need for pharmacologic interventions during laparoscopic cholecystectomy in patients with severe cardiac dysfunction.
  
  
  METHODS
  Prospective open study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  17 ASA physical status III and IV patients with severe cardiac dysfunction undergoing elective laparoscopic cholecystectomy.
  
  
  METHODS
  A standardized general anesthetic and surgical technique was used for all patients. In addition to routine monitoring, invasive hemodynamic monitoring included radial and pulmonary artery (PA) cannulation.
  
  
  RESULTS
  Hemodynamic parameters were recorded prior to induction of anesthesia, 5 minutes after induction of anesthesia but prior to incision, 5 minutes after carbon dioxide (CO2) insufflation and head-up tilt, every 10 minutes after change of position, after deflation of the abdomen and return to supine position, and 10 minutes after attaining supine position. Need for any pharmacologic interventions [to maintain mean arterial pressure (MAP) < 100 mmHg and/or systemic vascular resistance (SVR) < 2,000 dynes sec/cm-5, and/or cardiac index (CI) > 1.5 L/min/m2] and the incidence of any myocardial morbidity and mortality was noted. CI decreased significantly (p < 0.05) following insufflation and remained low until exsufflation. MAP, SVR, and PA occlusion pressure increased significantly (p < 0.05) after CO2 insufflation. Three of the 17 patients required administration of nitroglycerin to maintain the MAP and SVR within the accepted limits, one of whom also required administration of dobutamine to maintain CI. There was no myocardial morbidity or mortality in the perioperative period.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy in patients with severe cardiac dysfunction results in significant hemodynamic changes.
authors.affiliation: Department of Anesthesiology, Baylor University Medical Center at Dallas 75235-9068, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Hein
authors.forename: G P
authors.initials: GP
authors.lastname: Joshi
authors.forename: M A
authors.initials: MA
authors.lastname: Ramsay
authors.forename: L G
authors.initials: LG
authors.lastname: Fox
authors.forename: B J
authors.initials: BJ
authors.lastname: Gawey
authors.forename: C L
authors.initials: CL
authors.lastname: Hellman
authors.forename: J C
authors.initials: JC
authors.lastname: Arnold
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D001794:Blood Pressure / Q000502:physiology; D002763:Cholecystectomy; D006331:Heart Diseases / Q000150:complications* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D014655:Vascular Resistance / Q000502:physiology