ALTERATIONS OF CARDIOVASCULAR PERFORMANCE DURING LAPAROSCOPIC COLECTOMY - A COMBINED HEMODYNAMIC AND ECHOCARDIOGRAPHIC ANALYSIS

We investigated cardiovascular performance in 12 patients (mean age 66 +/- 12 yr) with significant coexisting cardiopulmonary disease (hyper tension, coronary artery disease, chronic obstructive pulmonary diseas e) during laparoscopic colectomy under general anesthesia. Hemodynamic monitors included arterial and pulmonary artery catheters in combinat ion with transesophageal echocardiography. Hemodynamic and echocardiog raphic data were obtained at five epochs: baseline (after induction of anesthesia), insufflation (after pneumoperitoneum, supine position), Trendelenburg 5 (5 min after placement into Trendelenburg's position), Trendelenburg 20 (at 20 min in Trendelenburg's position), and end (af ter release of the pneumoperitoneum, supine position). Hemodynamic res ponses to peritoneal insufflation resulted in significant increases in systemic vascular resistance (SVR) as well as endsystolic area (ESA) and significant decreases in cardiac index (CI) and ejection fraction area (EF(a)) compared with baseline. Trendelenburg's positioning augme nted ventricular preload and performance, resulting in significant inc reases in pulmonary capillary wedge pressure, CI, end-diastolic area, and EF(a) compared with insufflation. At the final epoch, end, a hyper dynamic state occurred as evidenced by a significantly decreased ESA a nd SVR while heart rate, CI, and EF(a) increased significantly compare d to baseline and insufflation. In an elderly population with signific ant coexisting cardiopulmonary disease, intraoperative maneuvers requi red for laparoscopic colectomy resulted in previously undescribed alte rations of cardiovascular performance, which persisted after release o f the pneumoperitoneum.