CARDIOVASCULAR CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY - A STUDY USING TRANSESOPHAGEAL DOPPLER MONITORING

A transoesophageal Doppler cardiac output monitor was used to study th e cardiovascular changes occurring during laparoscopic cholecystectomy in patients without (group A) or with (group B) a history of cardiova scular disease, i.e. hypertension, ischaemic heart disease or heart fa ilure. Insufflation of the abdomen with carbon dioxide caused signific ant (P<0.01) falls in mean cardiac index (17.9% in group A, 25.1% in g roup B) and mean stroke volume index (15.3% in group A, 21.2% in group B). Simultaneously, there was a significant (P<0.05) increase in mean systolic blood pressure (19.4%) in group A. There were no other diffe rences in the cardiovascular responses of the two groups. There was no correlation between systolic blood pressure and either cardiac index or stroke volume index. No significant complications or morbidity were associated with the use of the transoesophageal Doppler monitor. We c onclude that the cardiovascular changes associated with insufflation a re neither predictable by clinical assessment nor adequately determine d by routine monitoring. We recommend the transoesophageal Doppler mon itor for use in this situation.