Document Detail

Laparoscopy in high-risk cardiac patients.
MedLine Citation:
PMID:  8322127     Owner:  NLM     Status:  MEDLINE    
Fifteen patients with severe cardiac disease (American Society of Anesthesiologists III or IV) underwent laparoscopy using radial artery and pulmonary artery catheters to determine intraoperative hemodynamic changes. Cardiac output (CO), mean arterial blood pressure (MAP), central venous pressure, heart rate, systemic vascular resistance (SVR) and mixed venous oxygen saturation (SVO2) were recorded before anesthetic induction, after induction, but before peritoneal insufflation, after insufflation and after release of pneumoperitoneum. Peritoneal insufflation led to significant elevations in MAP and SVR and reduction in CO. For seven patients, a decrease in SVO2 after peritoneal insufflation was predictive of significant worsening of hemodynamic parameters, suggesting inadequate cardiac reserve. In all patients, hemodynamic parameters returned toward baseline once pneumoperitoneum was released. There were no perioperative cardiac complications. While it is evident that laparoscopy presents serious hemodynamic stress, it can be performed safely in high-risk patients, using aggressive intraoperative monitoring.
D Safran; S Sgambati; R Orlando
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery, gynecology & obstetrics     Volume:  176     ISSN:  0039-6087     ISO Abbreviation:  Surg Gynecol Obstet     Publication Date:  1993 Jun 
Date Detail:
Created Date:  1993-08-03     Completed Date:  1993-08-03     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0101370     Medline TA:  Surg Gynecol Obstet     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  548-54     Citation Subset:  AIM; IM    
Department of Surgery, Hartford Hospital, Connecticut 06115.
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MeSH Terms
Aged, 80 and over
Cholecystectomy, Laparoscopic* / adverse effects
Heart Diseases* / physiopathology
Middle Aged
Monitoring, Intraoperative
Pneumoperitoneum, Artificial
Risk Factors

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