The effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy

Background: The purpose of this study was to prospectively examine the comb ined effects of pneumoperitoneum and the reverse Trendelenberg position on cardiac hemodynamics during laparoscopic cholecystectomy. Methods: Thirty-nine patients undergoing laparoscopic cholecystectomy as pe rformed by a single surgeon were en rolled in the study. Hemodynamic data w ere collected continuously using a transthoracic bioimpedance monitor. All patients were subjected to insufflation pressures of 15 mmHg. Data were exa mined using mixed analysis of variance (ANOVA). Results: Cardiac index fell 11% with induction of anesthesia (p < 0.05), wi th stroke volume decreasing 7.2% (p < 0.05). Insufflation caused significan t decreases in stroke volume (SV) left ventricular end diastolic volume (LV EDV) but not cardiac index (CI). Placing the patients in the reverse Trende lenberg position caused no significant changes in these parameters. There w ere no significant differences between ASA (American Society of Anesthesiol ogists) classes I and IT patients when compared to ASA III patients. Conclusions: Patients undergoing laparoscopic cholecystectomy experience si gnificant hemodynamic depression. The effect of general anesthesia is the m ost profound. Insufflation of the abdomen caused more mild hemodynamic effe cts in our study. The addition of a reverse Trendelenberg position did not alter the patient's hemodynamic status.