TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF HEMODYNAMIC FUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY

We have measured cardiovascular changes associated with insufflation o f carbon dioxide and the reverse Trendelenburg position during laparos copic cholecystectomy, using transoesophageal echocardiography in 13 h ealthy patients. End-tidal carbon dioxide values increased after insuf flation of carbon dioxide, with values significantly (P < 0.05) increa sed after lateral tilt positioning. Creation of a pneumoperitoneum was associated with increases (P < 0.05) in left ventricular end-systolic wall stress, concomitant with increases (P < 0.01) in peak airway pre ssure and systemic arterial pressure. In addition, left ventricular en d-diastolic area decreased (P < 0.05) after reverse Trendelenburg posi tioning. Left ventricular ejection fraction was maintained throughout the study.