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[Anesthetic management for laparoscopic cholecystectomy in a patient with dilated cardiomyopathy]
1Department of Anesthesiology, Faculty of Medicine, University of Tokyo.
Insights
Laparoscopic cholecystectomy under low pneumoperitoneum pressure is safe for patients with dilated cardiomyopathy and mild cardiac dysfunction. This approach minimizes hemodynamic changes during the procedure.
Area of Science:
- Cardiology
- Anesthesiology
- Surgical Innovation
Background:
- Dilated cardiomyopathy presents unique challenges for surgical anesthesia.
- Pre-operative evaluation is crucial for risk stratification in patients undergoing elective surgery.
Observation:
- A 55-year-old female with diagnosed dilated cardiomyopathy underwent laparoscopic cholecystectomy.
- Echocardiography revealed mild left ventricular hypokinesis, indicating slightly reduced cardiac function.
- Hemodynamic monitoring showed transient increases in heart rate and blood pressure during induction and pneumoperitoneum, with subsequent stability.
Findings:
- Laparoscopic cholecystectomy was successfully performed under general anesthesia with low pneumoperitoneum pressure.
- Anesthesia involved diazepam, fentanyl, thiopental sodium, vecuronium, isoflurane-nitrous oxide-oxygen, and intraoperative dopamine infusion.
- The patient experienced no significant hemodynamic instability throughout the procedure.
Implications:
- Low-pressure pneumoperitoneum facilitates safe laparoscopic cholecystectomy in select patients with dilated cardiomyopathy.
- This technique is appropriate for patients without heart failure or with only mild cardiac function impairment.
- Careful anesthetic management and monitoring are essential for optimizing outcomes in these patients.
Abstract:
A 55-year-old female with dilated cardiomyopathy was scheduled for laparoscopic cholecystectomy under general anesthesia. Pre-operative tests revealed abnormal ECG and hypokinesis of left ventricular wall motion on echocardiography. A detailed medical examination resulted in the diagnosis of dilated cardiomyopathy, although there was a very mild decrease in cardiac function. We determined that laparoscopic cholecystectomy could be safely carried out under general anesthesia if pneumoperitoneum pressure was kept low. Anesthesia was induced with diazepam 3.75 mg, fentanyl 75 micrograms, thiopental sodium 25 mg and vecuronium 6 mg. Anesthesia was maintained with isoflurane-nitrous oxide-oxygen. From the induction to the end of the operation, dopamine was infused. Increased heart rate and blood pressure were noted for a short time at the induction and at the time of first pneumoperitoneum. Thereafter, no considerable hemodynamic changes occurred. We therefore consider that laparoscopic cholecystectomy under low pressure pneumoperitoneum is appropriate for dilated cardiomyopathy when there is no accompanying heart failure or when only mildly decreased cardiac function exists, such as in this case.
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