Pneumoperitoneum and PAFCs…

Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, & Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesthesia & Analgesia 1993;76: 1067-1071.

RHH Journal Club. June 20th, 2013. Dr Ramya Sriraman

Full-text article (if available)

Haemodynamic changes reported during gynaecological laparoscopy in earlier studies include an increase in mean arterial blood pressure, a decrease in cardiac output, and an increase in systemic vascular resistance. The authors hypothesized that peritoneal insufflation for laparoscopic cholecystectomy would result in more significant haemodynamic changes.


Study design

Prospective study comparing haemodynamic parameters using invasive (pulmonary artery catheter) monitoring before and after peritoneal insufflation

Single centre

Methods

  • 15 patients
  • Non-obese, 18-70 years, no acute cholecystitis, no cardiorespiratory disease or medications
  • Anaesthetic technique
  • Premedication with hydroxyzine, midazolam, atropine
  • Induction with sufentanil, thiopental, atracurium; maintenance N2O and isoflurane
  • Standard monitors and RIJ PAC
  • Haemodynamic variables measured at 7 different time-points

Intervention

Peritoneal insufflation to maintain IAP at 14 mm Hg by a CO2 insufflator

Control

Patients acted as own controls (control measurements before insufflation)

Validity

Pulmonary artery catheter gold-standard for haemodynamic measurements

Anaesthetist blinded to measurements from PAC

Results

  • MAP increased 35%, CI decreased 20%, SVR increased 65%, PVR increased 90%
  • Deepening of anaesthesia allowed partial correction, but still significantly different from preop values
  • Combined effects of anaesthesia, head-up tilt and increased intra-abdominal pressure produced significant (50%) decrease in cardiac index

Conclusions

  • The results indicate need for caution in patients with impaired cardiac function
  • Need to balance postoperative benefits of laparoscopy vs intraoperative risks in these patients
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