Effect of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy

doi:10.16139/j.1007-9610.2019.01.015

Abstract

Abstract: Objective To investigate the effects of carbon dioxide pneumoperitoneum and patients position on hemodynamic during laparoscopic cholecystectomy. Methods A total of 57 patients (24 male,33 female) aged (59.42+12.97) years with American Society of Anesthesiologists score Ⅰ-Ⅱ undergoing laparoscopic cholecystectomy were enrolled in this study. Continuous non-invasive arterial pressure monitoring system(CNAP) was used. Hemodynamic indexes including heart rate (HR), arterial systolic blood pressure (SAP), arterial diastolic pressure (DAP), mean arterial pressure (MAP), cardiac output (CO), stroke volume (SV), peripheral vascular resistance (SVR) and pulse pressure variation degree (PPV) were recorded by CNAP after entering operating room(T0), at 5 min after endotracheal intubation(T1), after artificial pneumoperitoneum(T2), on the left side of the head high 20 degree position which is re-Trendelenburg position (rT position) (T3) and 15 minutes after establishment of pneumoperitoneum (T4). Results SAP was significantly lower at T1 compared with at T0, restored to basal level at T2 and T3, and was higher at T3 compared with at T1 and T2 (P<0.05). DAP was significantly higher at T2 than at T1, and higher at T3 compared with at T0, T1, T2 and T4 (P<0.05). MAP at T3 was the highest when compared with those at other time points (P<0.05). CO decreased at from T2 to T4 compared at T0 and T1 (P<0.05). SV was significantly lower at T2 compared with at T0, and lower at T3 compared with at both T0 and T1(P<0.05). SVR was significantly higher at T2 and T4 than at both T0 and T1, and higher at T3 than at from T0 to T2 (P<0.05). PPV was higher at T2 and T4 than at both T0 and T1, higher at T3 than at T0, T1 and T4 (P<0.05). HR showed no obvious change in 5 time points. Conclusions Carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy may decrease CO and SV, and elevate SVR and PPV, but has no effect on blood pressure. Carbon dioxide pneumoperitoneum combined with rT position would elevate SVR further so there is obvious changes in blood pressure.

Key words: Laparoscopic cholecystectomy, Carbon dioxide pneumoperitoneum, Position, Hemodynamics

CLC Number:

R657.4

LUO Ying, QIAN Jiemin, CHEN Xiaowei, MA Haiyan, XU Ping, LIU Linna, NI Qiang. Effect of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2019, 24(01): 70-74.

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