Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients.
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.
D'Ugo
D
D
Department of Surgery, Catholic University of Rome, "A Gemelli" Medical School, Largo F. Vito 1, 00168 Rome, Italy.
Persiani
R
R
Pennestri
F
F
Adducci
E
E
Primieri
P
P
Pende
V
V
De Cosmo
G
G
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
D002245:Carbon Dioxide