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[Anesthesia in laparoscopic cholecystectomy with CO2: comparison of the hemodynamic and respiratory behavior using 2
C J Rubio-Martínez1, M Lang-Lenton León, E M Rodríguez-Ponte-Cuadrillero
1Servicio de Anestesiología y Reanimación, Hospital El Sabinal, Las Palmas de Gran Canaria.
Objectives:
To study cardiopulmonary function in 30 ASA I and II patients undergoing laparoscopic cholecystectomy with CO2.
Patients And Methods:
Fifteen patients were given total anesthesia with propofol (group PRO) and 15 inhaled isoflurane (group ISO). In addition to the usual monitoring, we used esophageal Doppler ultrasonogram (ED) to study the hemodynamic status after pneumoperitoneum (NP) at 15 mmHg, after the patient had been placed in anti-Trendelenburg (AT) position, and 10, 20 and 30 minutes after NP (series 1). We also studied response to reduction of NP from 15 mmHg to 12, 10, 8 and 6 mmHg (series 2), repeating this sequence when duration of surgery permitted (series 3).
Results:
In group PRO, cardiac index (CI) decreased 17.96% (NS) after NP and 24.90% (p = 0.015; r = 0.71) after AT. In group ISO, the decreases were 15.86% (p = 0.02; r = 0.69) and 22.34% (p = 0.02; r = 0.80), respectively. Correlated flow time (FTc) and peak velocity (PV) decreased, while the index of total peripheral resistance (TPRI) increased with NP and AT. Recovery of CI was gradual and spontaneous (series 1). The decreases in NP pressure did not produce significant improvement in IC.
Conclusions:
Induction of NP and placement in AT position causes significant decreases in CI as measured by ED in ASA I and II patients, whether they inhale the anesthetic agent or are given total intravenous anesthesia. This effect seems to be related to the increase in afterload, measured in this study by TPRI and the ratio PV/FTc.