Hemodynamic Changes During Laparoscopic Cholecystectomy

TLDR

In 15 ASA I patients undergoing laparoscopic cholecystectomy under isoflurane‑N₂O/O₂ anesthesia, invasive hemodynamic monitoring with a pulmonary artery catheter tracked MAP, CI, and vascular resistances while a CO₂ insufflator maintained 14 mm Hg intraabdominal pressure and the patient was positioned head‑up, with measurements taken before anesthesia, after induction, during tilt, and at 5, 15, 30 min after insufflation and 30 min after exsufflation. Anesthesia and head‑up tilt lowered MAP and CI, pneumoperitoneum increased MAP and vascular resistances while further reducing CI, and the combined effects produced a 50 % drop in CI, with isoflurane’s vasodilatory action partially mitigating these changes, demonstrating significant hemodynamic alterations during lap cholecystectomy.

Abstract

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring including a flow-directed pulmonary artery catheter. During surgery, intraabdominal pressure was maintained automatically at 14 mm Hg by a CO2 insufflator, and minute ventilation was controlled and adjusted to avoid hypercapnia. Hemodynamics were measured before anesthesia, after the induction of anesthesia, after tilting into 10 degrees head-up position, 5 min, 15 min, and 30 min after peritoneal insufflation, and 30 min after exsufflation. Induction of anesthesia decreased significantly mean arterial pressure and cardiac index (CI). Tilting the patient to the head-up position reduced cardiac preload and caused further reduction of CI. Peritoneal insufflation resulted in a significant increase (+/- 35%) of mean arterial pressure, a significant reduction (+/- 20%) of CI, and a significant increase of systemic (+/- 65%) and pulmonary (+/- 90%) vascular resistances. The combined effect of anesthesia, head-up tilt, and peritoneal insufflation produced a 50% decrease in CI. Administration of increasing concentrations of isoflurane, via its vasodilatory activity, may have partially blunted these hemodynamic changes. These results demonstrate that laparoscopy for cholecystectomy in head-up position results in significant hemodynamic changes in healthy patients, particularly at the induction of pneumoperitoneum.