Hemodynamic and respiratory changes during laparoscopic cholecystectomy with high and reduced intraabdominal pressure

Laparoscopic cholecystectomy (lapchole) is a safe procedure. Most of the complications are operation related. The complications related to increased intraabdominal pressure (IAP) are well recognized, but not emphasized enough. The changes in physiological parameters at different IAPs were studied to evaluate the usefulness of reduced IAP in minimizing these changes. Thirty consecutive patients consisting of 16 ASA III, 2 ASA IV, and the rest ASA I and II, underwent lapchole under high and reduced IAP. The mean arterial pressure (MAP), heart rate (HR), arterial oxygen saturation (SaO2), airway pressure (AWP), and end-tidal carbon dioxide (ETCO2) were recorded before insufflating carbon dioxide (T1), with IAP of 14 mm Hg (T2) and IAP of 6 mm Hg or less (T3). At T2, MAP increased by 41.15%, AWP by 44.3%, and ETCO2 by 20.5% as compared to T1 (p < 0.001). HR and SaO2 showed no significant changes. At T3 there was an increase in MAP by 24.94%, in AWP by 10%, and ETCO2 by 10.6% with no significant changes in HR and SaO2. Thus, operating under reduced IAP may be beneficial to the patients with decreased cardiopulmonary reserve, especially while undergoing long surgical procedures.