Experimental studies demonstrated a severe cardiac load of the CO2 pne
umoperitoneum caused by an accelerated after- and a decreased preload.
Patients displaying cardiovascular risks are therefore often rejected
from laparoscopic surgery. Hence, the pathophysiological changes and
the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardi
opulmonary patients (NYHA II-III, n = 15) undergoing laparoscopic chol
ecystectomy are described. The changes in cardiac after- and preload s
eem to be due to the elevated intraabdominal pressure rather than tran
speritoneally resorbed CO2 and are reversible by desufflation. In one
patient conversion to open operation had to be performed because of a
severe drop in cardiac output and right ventricle ejection fraction. M
ixed oxygen saturation was predicting intraoperative worsening in this
case. The described pathophysiological changes may seem to be well to
lerated even in high-risk cardiac patients. Monitoring of hemodynamics
should include an arterial catheter line and blood gas analyses. Phar
macologic interventions or pressureless laparoscopic procedures might
not be necessary as long as laparoscopic cholecystectomy is performed.