Esophageal Doppler for hemodynamic monitoring during laparoscopic cholecystectomy

Purpose: To evaluate the use of a 4-mHz continuous wave esophageal Doppler monitor in the hemodynamic management of 48 ASA 1 to 111 patients undergoin g laparoscopic cholecystectomy. Methods: General anesthesia was induced with fentanyl and propofol, maintai ned with N2O/O-2 and muscle relaxation was provided with atracurium. The lu ngs were mechanically ventilated. Non invasive arterial blood pressure, hea rt rate; capnography, arterial blood gas were monitored during CO, pneumope ritoneum Bt 15-mmHg. Using the velocity waveform of descending aortic blood flow, the Doppler device estimated changes in cardiac output and systemic vascular resistances, Results: Peritoneal insufflation resulted in a mean 19% decrease in cardiac output (range - 49 to + 5%; P < 0.05) and a mean 48% increased in systemic vascular resistances (range - 7 to + 101%; P < 0.01). There was no relatio nship between changes in cardiac output and mean arterial pressure or PETCO 2. The esophageal Doppler provided, in two patients, details of hypertensiv e peaks (mean-arterial pressure > 140 mmHg) which responded to administrati on of nicardipine. Conclusion: The Esophageal Doppler provided an easy-to-handle and non invas ive tool to monitor changes in cardiac output during laparoscopic cholecyst ectomy. However, further comparison with a thermodilution cardiac output te chnique is required.