title: Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients.
abstract: BACKGROUND
  This study aimed by means of transesophageal echocardiography, to evaluate hemodynamic changes induced by pneumoperitoneum in patients with normal cardiac performance.
  
  
  METHODS
  In this study, 11 ASA I-II patients (mean age, 39 years) with normal cardiac performance undergoing laparoscopic cholecystectomy were evaluated. A 5-MHz transesophageal biplane phased-array transducer connected to an echocardiographer was inserted after induction of anesthesia. Data were collected at three different times: before insufflation (T1), 10 min after insufflation (T2), and 5 min after desufflation (T3). At these same times, heart rate, systolic blood pressure, diastolic blood pressure, end-tidal carbon dioxide (CO(2)), and peak airway pressure were recorded. Statistical analysis was performed using one-way and two-way analysis of variance (ANOVA). A p value less than 0.05 was considered significant.
  
  
  RESULTS
  End-systolic and end-diastolic diameters of the left ventricle, contractility, and performance parameters did not change significantly. Conversely, at insufflation, color Doppler area of the mitral backflow increased significantly (p < 0.05) when already present or showed up abruptly (T1: 0.22 +/- 0.28 cm(2); T2: 1.28 +/- 1.02 cm(2); T3: 0.49 +/- 0.53 cm(2)).
  
  
  CONCLUSIONS
  Such an event is not interpreted as a mitral insufficiency. It is possibly the result of a "contrast effect" caused by the absorption of CO(2) microbubbles in the blood.
authors.affiliation: Department of Surgery, Catholic University of Rome, "A Gemelli" Medical School, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: D'Ugo
authors.forename: R
authors.initials: R
authors.lastname: Persiani
authors.forename: F
authors.initials: F
authors.lastname: Pennestri
authors.forename: E
authors.initials: E
authors.lastname: Adducci
authors.forename: P
authors.initials: P
authors.lastname: Primieri
authors.forename: V
authors.initials: V
authors.lastname: Pende
authors.forename: G
authors.initials: G
authors.lastname: De Cosmo
mesh_terms: D000328:Adult; D002245:Carbon Dioxide; D017081:Cholecystectomy, Laparoscopic; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D008863:Microspheres; D011028:Pneumoperitoneum, Artificial; D016277:Ventricular Function, Left
chemical_list: D002245:Carbon Dioxide