THE ADVERSE HEMODYNAMIC-EFFECTS OF LAPAROSCOPIC CHOLECYSTECTOMY

Recent studies suggest that significant physiologic derangements can o ccur during laparoscopic surgery. Eighteen patients admitted for lapar oscopic cholecystectomy were studied. The mean age was 46.7 (range 19- 78). A standard anesthetic technique, reverse Trendelenburg positionin g, and an abdominal insufflation pressure of 15 mmHg with CO2 were use d with all subjects. Central venous pressure (CVP) and arterial pressu res were measured invasively. Stroke volume and cardiac index were cal culated using quantitative transesophageal echocardiography. Baseline measurements were taken after induction. Additional measurements were taken at 15-min intervals throughout the procedure. There was a statis tically significant increase in mean arterial pressure (15.9%), systol ic blood pressure (11.3%), diastolic blood pressure (19.7%), and CVP ( 30.0%) from control baseline values. Significant decreases in stroke v olume (29.5%) and cardiac index (29.5%) occurred within 30 min of the induction of pneumoperitoneum and positioning (P < 0.05, ANOVA). Lapar oscopic cholecystectomy significantly and reversibly decreases cardiac performance. Compromised patients may be at increased risk for compli cations not previously recognized with this procedure.