Document Detail


Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study.
MedLine Citation:
PMID:  11353965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Carbon dioxide (CO2) pneumoperitoneum effects are still controversial. The aim of this study was to investigate cardiopulmonary changes in patients subjected to different surgical procedures for cholecystectomy. METHODS: In this study, 15 patients were assigned randomly to three groups according to the surgical procedure to be used: open cholecystectomy (OC), CO2 pneumoperitoneum cholecystectomy (PP), and laparoscopic gasless cholecystectomy (abdominal wall lifting [AWL]), respectively. A pulmonary artery catheter was used for hemodynamic monitoring in all patients. A subcutaneous multiplanar device (Laparo Tenser) was used for abdominal wall lifting. To avoid misinterpretation of results, conventional anesthesia was performed with all parameters, and the position of the patients held fixed throughout surgery. The following parameters were analyzed: mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), central venous pressure (CVP), systemic vascular resistances index (SVRI), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), pulmonary vascular resistances index (PVRI), peak inspiratory pressure (PIP), end-tidal CO2 pressure (ETCO)2, CO2 arterial pressure (PaCO2), and arterial pH. RESULTS: All the operations were completed successfully. The Laparo Tenser allowed good exposition of the surgical field. A slight impairment of the cardiopulmonary functions, with reduction of SVRI, MAP, and CI and elevation of pulmonary pressures and vascular resistance, followed induction of anesthesia. However, these effects tended to normalize in the OC and AWL groups over time. In contrast, CO2 insufflation produced a complex hemodynamic and pulmonary syndrome resulting in increased right- and left side filling pressures, significant cardiac index reduction, derangement of the respiratory mechanics, and respiratory acidosis. All of these effects normalized after desufflation. CONCLUSIONS: Cardiopulmonary adverse effects of general anesthesia were significant but transitory and normalized during surgery. Carbon dioxide pneumoperitoneum caused a significant impairment in cardiopulmonary functions. In high-risk patients, gasless laparoscopy may be preferred for reliability and absence of cardiopulmonary alterations.
Authors:
G Galizia; G Prizio; E Lieto; P Castellano; L Pelosio; V Imperatore; A Ferrara; C Pignatelli
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial     Date:  2000-12-21
Journal Detail:
Title:  Surgical endoscopy     Volume:  15     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-16     Completed Date:  2001-09-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  477-83     Citation Subset:  IM    
Affiliation:
Department of Surgical Sciences, General and Hepato-Biliary Surgery Unit, Second University of Naples School of Medicine, c/o II Policlinico, Ed. 17, Via S. Pansini, 5, 80131 Naples, Italy. gennaro.galizia@unina2.it
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MeSH Terms
Descriptor/Qualifier:
Abdominal Muscles*
Adult
Analysis of Variance
Anesthesia, General / methods
Blood Pressure
Body Mass Index
Carbon Dioxide / administration & dosage
Central Venous Pressure
Cholecystectomy / adverse effects*,  methods
Cholecystectomy, Laparoscopic / adverse effects,  methods
Female
Heart Rate
Hemodynamics / physiology*
Humans
Lung / physiology*
Male
Middle Aged
Pneumoperitoneum, Artificial / adverse effects*,  methods
Pulmonary Artery / physiology
Pulmonary Wedge Pressure
Stroke Volume
Surgical Instruments
Vascular Resistance
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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