title: ["Low-pressure" laparoscopic cholecystectomy in high risk patients (ASA III and IV): our experience].
abstract: The insufflation pressure used for laparoscopic cholecystectomy is usually 12-15 mm Hg, and a pneumoperitoneum with carbon dioxide has a significant effect on both cardiovascular and respiratory function. These effects are transient in young, healthy patients, but may be dangerous in ASA III and IV patients with a poor cardiac reserve. This study was designed to assess the feasibility of performing laparoscopic cholecystectomy at 6.5-8 mm Hg insufflation pressure in "high-risk" patients. Thirteen patients, 10 ASA III and 3 ASA IV, with cholelithiasis, were included in this study The insufflation pressure was 6.5-8 mm Hg, with a 10 degrees anti-Trendelenburg position. The cardiovascular and blood gas variables studied were: mean arterial blood pressure, heart rate, respiratory rate, and end-tidal CO2 pressure. The authors reported no conversions and no intra- or postoperative complications. During insufflation heart rate and mean arterial blood pressure increased minimally if compared with laparoscopic cholecystectomy at 12-15 mm Hg. Pa CO2 increased after insufflation (+5 mm Hg), and the end-tidal CO2 pressure gradient was moderate (3.5 mm Hg) and unchanged during surgery. A low-pressure pneumoperitoneum is feasible for laparoscopic cholecystectomy and minimizes the adverse haemodynamic effects of peritoneal insufflation.
authors.affiliation: Dipartimento di Chirurgia Paride Stefanini, Università La Sapienza di Roma.
authors.forename: Marco
authors.initials: M
authors.lastname: Catani
authors.forename: Renato
authors.initials: R
authors.lastname: Guerricchio
authors.forename: Ritanna
authors.initials: R
authors.lastname: De Milito
authors.forename: Sante
authors.initials: S
authors.lastname: Capitano
authors.forename: Massimo
authors.initials: M
authors.lastname: Chiaretti
authors.forename: Andrea
authors.initials: A
authors.lastname: Guerricchio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Manili
authors.forename: Mario
authors.initials: M
authors.lastname: Simi
mesh_terms: D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012307:Risk Factors