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[Hemodynamic changes during laparoscopic cholecystectomy under different anesthesia methods]

M Yokoyama1, Y Ohta, M Hirakawa

  • 1Department of Anesthesiology and Resuscitology, Okayama University Medical School.

Masui. the Japanese Journal of Anesthesiology
|February 1, 1996
PubMed
Summary
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Epidural anesthesia provided the most stable hemodynamics during laparoscopic cholecystectomy, unlike inhalation or fentanyl anesthesia. This method minimized cardiovascular changes associated with carbon dioxide insufflation and reverse Trendelenburg positioning.

Area of Science:

  • Anesthesiology
  • Surgical Procedures
  • Cardiovascular Physiology

Background:

  • Laparoscopic cholecystectomy involves carbon dioxide insufflation and reverse Trendelenburg positioning, which can induce significant cardiovascular changes.
  • Anesthesia techniques may influence hemodynamic stability during these procedures.

Purpose of the Study:

  • To compare the cardiovascular effects of different anesthesia methods during laparoscopic cholecystectomy.
  • To determine the most hemodynamically stable anesthesia approach for this surgery.

Main Methods:

  • Twenty-eight patients (ASA I-II) were divided into three anesthesia groups: inhalation (nitrous oxide-oxygen-isoflurane), fentanyl, and epidural (lidocaine infusion).
  • Cardiovascular parameters were monitored, including heart rate, arterial blood pressure, and, in some groups, pulmonary artery pressures and cardiac output via Swan-Ganz catheters.

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Main Results:

  • Inhalation anesthesia led to significant increases in heart rate and arterial blood pressure, which were difficult to control.
  • Fentanyl anesthesia showed a significant decrease in stroke volume post-pneumoperitoneum.
  • Epidural anesthesia demonstrated minimal and non-significant changes in heart rate, blood pressure, and other hemodynamic parameters.

Conclusions:

  • Epidural anesthesia offers superior hemodynamic stability during laparoscopic cholecystectomy compared to inhalation or fentanyl anesthesia.
  • This stability is crucial for managing the physiological stress induced by pneumoperitoneum and patient positioning.