[Hemodynamic changes during laparoscopic cholecystectomy].

Abstract

The authors investigated in 24 patients with ASA I or II who were subjected to elective laparoscopic cholecystectomy haemodynamic parameters (CI, SI, HR, MAP, SVRI, EF and LCWI), assessed by transthoracic electric bioimpendance. They used a BoMED NCCOM3 apparatus and evaluated data from the period before induction of anaesthesia (considered as control data), after induction of anaesthesia, immediately after insufflation of CO2 into the peritoneum, 30 minutes after insufflation and after desufflation. Insufflation of CO2 into the peritoneum caused a statistically significant drop of CI (p < 0.05), reduction of HR (p < 0.05), a drop of EF (p < 0.05), reduction of LCWI (p < 0.05) and a statistically significant rise of SVRI (p < 0.001). Thirty minutes after insufflation another significant drop of CI occurred and also for the first time of SI (p < 0.05 and p < 0.05 resp.); the mean values of HR and MAP did not differ significantly from control values, SVRI remained elevated (p < 0.05) and EF was permanently reduced (p < 0.05). After desufflation all haemodynamic values with the exception of EF did not differ significantly from control values. The reduced EF (p < 0.05), however, reached as to its absolute value the lower borderline of the physiological range. Based on these results, the authors assume that in patients with a compromised cardiovascular apparatus circulatory complications could develop. In these patients laparoscopic cholecystectomy should be indicated after due consideration.