HEMODYNAMIC AND VENTILATORY CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY ASA-III PATIENTS

Purpose: To evaluate the haemodynamic and respiratory changes during l aparoscopic cholecystectomy in elderly ASA III patients. Methods: This clinical descriptive study included 16 patients aged >75 yr. Anaesthe sia was induced with fentanyl and etomidate and maintained with N2O in O-2 (50%), fentanyl and isoflurane as needed. Inspired minute volume was kept constant during anaesthesia. Cardiovascular monitoring includ ed a radial artery catheter and a pulmonary artery catheter for measur ement of CO, RVEF and S<(nu)over bar>O-2, and calculation of right ven tricular end diastolic volume indexed (RVEDVI). Haemodynamic variables , arterial and venous blood gas analyses were collected before and 10 min after anaesthetic induction, 15, 30 and 60 min after insufflation (IAP = 12 mmHg) followed by a 10 degrees head-up tilt, and after exsuf flation. Results: The mean age was 81 +/- 4 yr. The main cardiovascula r depression was recorded after anaesthetic induction. Peritoneal insu fflation resulted in improvement of cardiovascular function with incre ases in cardiac index (+19%), heart rate (+21%), MAP (+19%) and S<(nu) over bar>O-2 (+8%), (P < 0.05) which may be the result of a sympatheti c stimulation. No change in preload (RVEDVI) and SVR was recorded. Car diac index was unchanged during pneumoperitoneum. Laparoscopy was asso ciated with an increase in PaCO2 15 min after CO2 insufflation (from 3 3.9 to 38.3 mmHg, P < 0.05) and a further elevation after 60 min (44,4 mmHg) without any sign of extra peritoneal diffusion. There was no ch ange in the intra-pulmonary shunt and the Pa-ETCO(2) gradient remained stable (mean 7.2 mmHg). Conclusion: We conclude that gradual abdomina l insufflation to 12 mmHg followed by a limited 10 degrees head-up til t is associated with cardiovascular stability in elderly ASA III patie nts.