HEMODYNAMIC-CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH SEVERE CARDIAC DISEASE

Study Objective: To evaluate the hemodynamic changes and need for phar macologic interventions during laparoscopic cholecystectomy in patient s with severe cardiac dysfunction. Design: Prospective open study. Set ting: University hospital. Patients: 17 ASA physical status III and IV Patients with severe cardiac dysfunction undergoing elective laparosc opic cholecystectomy. Interventions: A standardized general anesthetic and surgical technique was used for all patients. In addition to rout ine monitoring, invasive hemodynamic monitoring included radial and pu lmonary artery (PA) cannulation. Measurements and Main Results: Hemody namic parameters were recorded prior to induction of anesthesia, 5 min utes after induction of anesthesia but prior to incision, 5 minutes af ter carbon dioxide (CO2) insufflation and head-up tilt, every 10 minut es after change of position, after deflation of the abdomen and return to supine position, and 10 minutes after attaining supine position. N eed for any pharmacologic interventions [to maintain mean arterial pre ssure (MAP) < 100 mmHg and/or systemic vascular resistance (SVR) < 2,0 00 dynes.sec/cm(-5), and/or cardiac index (CI) > 1.5 L/min/m(2)] and t he incidence of any myocardial morbidity and mortality was noted. CI d ecreased significantly (p < 0.05) following insufflation and remained low until exsufflation. MAP, SVR, SVR, and PA occlusion pressure incre ased significantly (p < 0. 05) after CO2 insufflation. Three of the 17 patients required administration of nitroglycerin to maintain the MAP and SVR within the accepted limits, one of whom also required adminis tration of dobutamine to maintain CI. There was no myocardial morbidit y or mortality in the perioperative period. Conclusion: Laparoscopic c holecystectomy in patients with severe cardiac dysfunction results in significant hemodynamic changes. (C) 1997 by Elsevier Science Inc.