Diaphragmatic activity after laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is presumed to induce a reduction in diaphtagmatic activity. Indirect Indices of diaphragmatic function based on tidal changes in pressures and cross-section area measurements can be u nreliable in the postoperative phase. The present study evaluates diaphragm atic activity by directly recording diaphragmatic EMG (EMG(dia)) data, alon g with indirect indices. Methods: Thirteen adult patients (American Society of Anesthesiologists phy sical status I or II) undergoing laparoscopic cholecystectomy were examined preoperatively for inspiratory tidal changes in gastric (Pgas-insp) and es ophageal (Peso-insp) pressures, and tidal changes in ribcage (V-thor) and a bdominal (V-abd) cross-section areas and then again at 1, 6, and 24 h posto peratively combined with EMG(dia) recordings. Variations in inspiratory gas tric (Delta Pgas-insp) and Inspiratory transdiaphragmatic (Delta Pdi-insp) pressures were derived from the above. Results: Laparoscopic cholecystectomy induced a significant reduction in me an Delta Pgas-insp, mean Delta Pdi-insp, and mean V-abd Indicating a reduct ion of diaphragmatic activity postoperatively. Delta Pdi-insp decreased fro m 11.8 +/- 4.0 cm H2O preoperatively to 5.7 +/- 5.7 cm H2O at 1 h and 6.6 /- 5.1 cm H2O at 6 h postoperatively (mean +/- SD; P < 0.05). V-abd decreas ed from 327.0 +/- 113.0 mi preoperatively to 174.0 +/- 65.0 mi at I h and 1 75.0 +/- 98.0 ml at 6 h postoperatively (mean +/- SD; P < 0.05), These valu es had partially recovered at 24 h. Conclusion: The direct and indirect Indices of diaphragmatic activity taken together confirm the presence of reduction in diaphragmatic activity after laparoscopic cholecystectomy followed by its partial recovery at 24 h.