Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study.
BACKGROUND
Carbon dioxide (CO2) pneumoperitoneum effects are still controversial. The aim of this study was to investigate cardiopulmonary changes in patients subjected to different surgical procedures for cholecystectomy.


METHODS
In this study, 15 patients were assigned randomly to three groups according to the surgical procedure to be used: open cholecystectomy (OC), CO2 pneumoperitoneum cholecystectomy (PP), and laparoscopic gasless cholecystectomy (abdominal wall lifting [AWL]), respectively. A pulmonary artery catheter was used for hemodynamic monitoring in all patients. A subcutaneous multiplanar device (Laparo Tenser) was used for abdominal wall lifting. To avoid misinterpretation of results, conventional anesthesia was performed with all parameters, and the position of the patients held fixed throughout surgery. The following parameters were analyzed: mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), central venous pressure (CVP), systemic vascular resistances index (SVRI), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), pulmonary vascular resistances index (PVRI), peak inspiratory pressure (PIP), end-tidal CO2 pressure (ETCO)2, CO2 arterial pressure (PaCO2), and arterial pH.


RESULTS
All the operations were completed successfully. The Laparo Tenser allowed good exposition of the surgical field. A slight impairment of the cardiopulmonary functions, with reduction of SVRI, MAP, and CI and elevation of pulmonary pressures and vascular resistance, followed induction of anesthesia. However, these effects tended to normalize in the OC and AWL groups over time. In contrast, CO2 insufflation produced a complex hemodynamic and pulmonary syndrome resulting in increased right- and left side filling pressures, significant cardiac index reduction, derangement of the respiratory mechanics, and respiratory acidosis. All of these effects normalized after desufflation.


CONCLUSIONS
Cardiopulmonary adverse effects of general anesthesia were significant but transitory and normalized during surgery. Carbon dioxide pneumoperitoneum caused a significant impairment in cardiopulmonary functions. In high-risk patients, gasless laparoscopy may be preferred for reliability and absence of cardiopulmonary alterations.
Galizia
G
G
Department of Surgical Sciences, General and Hepato-Biliary Surgery Unit, Second University of Naples School of Medicine, c/o II Policlinico, Ed. 17, Via S. Pansini, 5, 80131 Naples, Italy. gennaro.galizia@unina2.it
Prizio
G
G
Lieto
E
E
Castellano
P
P
Pelosio
L
L
Imperatore
V
V
Ferrara
A
A
Pignatelli
C
C
D000009:Abdominal Muscles; D000328:Adult; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000379:methods; D001794:Blood Pressure; D015992:Body Mass Index; D002245:Carbon Dioxide / Q000008:administration & dosage; D002496:Central Venous Pressure; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011651:Pulmonary Artery / Q000502:physiology; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D013525:Surgical Instruments; D014655:Vascular Resistance
D002245:Carbon Dioxide