IS LAPAROSCOPIC CHOLECYSTECTOMY THE APPRO PRIATE TECHNIQUE FOR CARDIOPULMONARY HIGH-RISK PATIENTS

There is considerable debate whether or not the laparoscopic technique for cholecystectomy supersedes conventional procedures in patients wi th pre-existing cardiopulmonary disease. Hemodynamic stress and CO2 ab sorption from the peritoneum can have a negative effect on intraoperat ive safety. On the other hand, a more rapid recovery of lung function and a shorter stay in hospital are the obvious advantages. 74 patients were investigated in our study: 54 with a low cardiopulmonary risk (g roup 1, ASA classes I or II) and 20 high risk patients belonging to AS A class III (group 2). Series of blood-gas samples were drawn from an arterial catheter and the respiratory parameters and blood gas values measured before and at the end of the CO2-insufflation period were com pared. No dangerous rise in paCO2 or decrease in pH occurred with the ventilation method used in this study (Ti: Te = 1 : 1, PEEP = 5 mbar, Rf = 10/min modification of the tidal-volume according to the measured paCO2 and ventilation with an O2/air mixture). No significant changes in arterial O2 saturation compared with-baseline values occurred and values remained within the physiological range. We conclude that exces sive intraoperative paCO2 increase can be avoided by modification of t he ventilation procedure and that laparoscopic cholecystectomy is an a dvantageous technique in the patient with cardiopulmonary disease.