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Non-Invasive Cardiac Output Monitoring with Electrical Cardiometry During Laparoscopic Cholecystectomy Surgery, a
Khaled Ahmed Yassen1, Walla Aljumaiy2, Imran Alherz3
1Anesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Alahsa 31982, Saudi Arabia.
Insights
Electrical cardiometry (EC) noninvasively monitored hemodynamic changes during laparoscopic surgery. It revealed significant decreases in cardiac output and blood pressure, highlighting individual patient variations crucial for anesthesiologists.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Surgical Monitoring
Background:
- Laparoscopic cholecystectomy involves hemodynamic alterations due to increased intra-abdominal pressure (IAP), autonomic responses, and anesthetics.
- Monitoring cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and mean arterial blood pressure (MABP) is critical during these procedures.
Purpose of the Study:
- To noninvasively measure individual intraoperative hemodynamic responses during laparoscopic cholecystectomy.
- To evaluate the utility of electrical cardiometry (EC) as an adjunct to standard monitoring.
- To assess individual patient variations in hemodynamic responses.
Main Methods:
- Continuous, noninvasive monitoring of CO and associated hemodynamic parameters using electrical cardiometry (EC).
- Measurements taken during and after peritoneal insufflation in 73 patients.
Main Results:
- Increased IAP (13 cmH2O) correlated with overall decreases in CO (-11.29%), MABP (-9.31%), and SVR (-23.16%).
- Significant individual variations were observed, with some patients experiencing drastic drops in CO (-47.14%) and MABP (-61.59%).
- Minimal changes in heart rate (HR) were noted.
Conclusions:
- Electrical cardiometry provides real-time, noninvasive CO monitoring, detecting significant hemodynamic changes missed by conventional methods.
- EC can supplement traditional monitoring, offering anesthesiologists enhanced patient vital information.
- Recognizing individual hemodynamic responses is vital for patient management during laparoscopic procedures.
Abstract:
Background: Increased intra-abdominal pressure (IAP), autonomic reactions, and anesthetics all contribute to hemodynamic alterations during laparoscopic cholecystectomy. This study's objectives are to measure noninvasively the intraoperative individual responses in cardiac and systemic hemodynamics, focusing on cardiac output (CO. L/min), stroke volume (SV, mL/min), systemic vascular resistance (SVR, dyn.s.cm-5), and noninvasive mean arterial blood pressure (MABP, mmHg) during and after peritoneal insufflation (cmH2O). The secondary objective was to evaluate the utility of EC as an adjunct to standard monitoring and to assess the individual differences. Methods: The CO and associated parameters were continuously and noninvasively monitored with the electrical cardiometry (EC, ICON, Osypka, Berlin Germany). Results: Seventy-three patients showed that when the IAP increased to 13 [IQR: 13-14] cmH2O, there was an overall percentage decrease in CO (-11.29%), MABP (-9.31%), and SVR (-23.16%) compared to pre induction with minimal changes in heart rate (HR). Individual variation and extreme reactions among certain patients were noted, with CO falling by -47.14% and MABP by -61.59, respectively, which can have major repercussions. Conclusions: The EC enabled real-time, non-invasive CO monitoring and detected significant cardio-hemodynamic changes that conventional monitors could miss. EC can supplement traditional monitors and give attending anesthesiologists access to more of patients' vital information.
