Changes in the cardiovascular and respiratory systems during laparoscopic cholecystectomy

The effects of peritoneal insufflation on the cardiovascular and respiratory systems were investigated in eight patients who underwent laparoscopic cholecystectomy. During the operation, intraabdominal pressure was maintained at a constant 12 mm Hg with carbon dioxide. The cardiac index had increased significantly at 20 and 40 min after the start of insufflation (3.6 +/- 0.6, 3.9 +/- 0.8 mL/min, respectively) and after evacuation (4.2 +/- 0.6 mL/min) compared with the control value (3.2 +/- 0.6 mL/min). Mean arterial pressure was significantly increased at 20 min after the start of insufflation (94.6 +/- 11.2 mm Hg) relative to the control value (79.9 +/- 11.1 mm Hg) and remained high after evacuation (101.5 +/- 11.9 mm Hg). Central and femoral venous pressure rose significantly during the operation from baseline values (12 +/- 6 and 4 +/- 4 mm Hg, respectively) to 18 +/- 10 and 11 +/- 6 mm Hg, respectively, at 20 min, and to 18 +/- 10 and 19 +/- 8 mm Hg, respectively, at 40 min after the start of insufflation. These parameters returned to control levels immediately after evacuation. Dynamic lung compliance decreased by 25% as a result of the elevated intraabdominal pressure. These findings demonstrate that some cardiopulmonary changes occur even at an intraabdominal pressure of 12 mm Hg, which up to now has been considered a safe level.