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Hemodynamic response to thoracoscopy and thoracotomy.

S Trca¹, Z Krska, O Kittnar

¹First Surgical Department, First Faculty of Medicine and General Teaching Hospital, Charles University, Prague, Czech Republic.

Physiological Research

|August 18, 2009

Summary

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Area of Science:

Cardiovascular Physiology
Thoracic Surgery

Background:

Pleural cavity operations impact pulmonary circulation and overall hemodynamics.
Patient positioning and artificial pneumothorax influence these circulatory changes.
Hemodynamic effects of thoracoscopy, an advanced thoracic surgery approach, remain largely unknown.

Purpose of the Study:

To compare the hemodynamic responses between open (thoracotomy) and closed (thoracoscopy) surgical approaches.
To identify specific hemodynamic changes associated with each surgical technique.

Main Methods:

Monitored 38 patients undergoing thoracic surgery from anesthesia induction to completion.
Measured hemodynamic parameters including blood pressure, O2 saturation, pulmonary artery pressures, wedge pressure, central venous pressure, cardiac output, and total peripheral resistance.

Main Results:

No significant difference in overall hemodynamic response was observed between thoracotomy and thoracoscopy groups.
Significant hemodynamic changes occurred during both procedures, particularly after patient repositioning (hip position) and pneumothorax establishment.
Patient repositioning led to decreased systolic and diastolic blood pressure, MAP, SaO2, and systolic pulmonary artery pressure.
Pneumothorax establishment resulted in cardiac output restoration and decreased total peripheral resistance.

Conclusions:

Thoracoscopy elicits hemodynamic changes comparable to those of thoracotomy.
Patient positioning and pneumothorax are critical factors influencing hemodynamics during thoracic surgery, irrespective of the surgical approach.