The hemodynamic and respiratory alterations associated with laparoscopic cholecystectomy
Dr. Gauri M Panjabi, Dr. Tarak K Modi
Background: Laparoscopic cholecystectomy requires pneumoperitoneum and reverse trendelenburg’s position which causes different changes in physiology, ventilatory and hemodynamic changes. Both the mechanical (pressure related) and co2 absorption-related effect of carbon dioxide pneumoperitoneum impact the cardio vascular system. Aims of Study: The aim of this study was to examine the combined effects of pneumoperitoneum and the reverse trendelenburg position on physiological alterations during laparoscopic cholecystectomy particularly Hemodynamic changes and Ventilatory changes Materials and Methods: Study was done in 30 adult ASA I/II patients during laparoscopic cholecystectomy. All patients were premedicated with inj. Emset 4mg, inj Glycopyrolate 0.2mg and inj Fentanyl 2ug/kg iv. Patient was induced with thiopental sodium 5-7 mg/kg and succinylcholine 2 mg/kg intravenously and intubated with appropriate size of cuff tube. General anesthesia was maintained with Oxygen (50%), Nitrous oxide (50%), Sevoflurane and intermittent inj. Atracurium. Patient was ventilated with low flow anesthesia using closed circuit. Hemodynamic and ventilatory changes were measured before anesthesia, after the induction of anesthesia, after head-up position, 5, 15 and 30 min after pneumoperitoneum. Results: Heart rate did not change significantly after induction, head up position and 30 minutes after pneumoperitoneum. However MAP was decreased after head up position and elevated progressively after pneumoperitoneum. No significant changes in spo2 noted during surgery but etco2, Peak inspiratory pressure and Plateau airway pressure rises significantly. Conclusions: Laparoscopic cholecystectomy causes significant hemodynamic and respiratory changes even in healthy patients due to mechanical effect of pneumoperitoneum and hypercarbia due to co2 insufflation. To conclude with, Anesthesiologists should pay attention and do careful monitoring of cardiovascular and pulmonary function to prevent cardio-pulmonary complications during laparoscopic cholecystectomy.