Transoesophageal acoustic quantification for evaluation of cardiac function during laparoscopic surgery

Pneumoperitoneum may be poorly tolerated in patients with marginal cardiopu lmonary function. Transoesophageal echocardiography is a relatively non-inv asive technique that can track changes in left ventricular cavity area usin g acoustic quantification and has been found to provide a reliable, realtim e estimation of left ventricular function. We evaluated mid-papillary fract ional area change during pneumoperitoneum in 17 healthy adult patients (gro up 1) and 17 with hypertension and/or ischaemic heart disease (group 2) und ergoing laparoscopic cholecystectomy. Peritoneal insufflation led to signif icant (p < 0.01) decreases in fractional area change and an increase in mea n blood pressure. There was no significant change in heart rate. Patients w ith cardiovascular disease who had a > 30% decrease in fractional area chan ge following carbon dioxide insufflation (group 2B) were given an intraveno us infusion of glyceryl trinitrate. In groups 1 and 2A, fractional area cha nge improved slightly with head-up tilt and continued to improve over the c ourse of surgery. Glyceryl trinitrate led to a significant increase in frac tional area change and a decrease in mean blood pressure back to baseline v alues. We conclude that peritoneal insufflation of carbon dioxide results i n a significant increase in cardiac workload that is well tolerated in pati ents with no cardiovascular disease. Coexisting cardiovascular disease can result in even more pronounced impairment of cardiac function, which may no t be predictable by clinical assessment or adequately determined by routine monitoring. We recommend the use of transoesophageal acoustic quantificati on as a monitor in these patients and the administration of glyceryl trinit rate to ameliorate myocardial stress.