Related Experiment Videos
Cardiovascular changes during laparoscopic cholecystectomy: a study using transoesophageal Doppler monitoring
S Elliott1, P Savill, S Eckersall
1Department of Anaesthetics, Lister Hospital, Stevenage, Hertfordshire, United Kingdom.
Insights
Laparoscopic cholecystectomy causes significant cardiovascular changes, including reduced cardiac output and stroke volume, during abdominal insufflation. Transoesophageal Doppler monitoring is recommended as these changes are unpredictable with standard methods.
Area of Science:
- Cardiovascular Physiology
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy involves abdominal insufflation, potentially affecting cardiovascular dynamics.
- Patients with pre-existing cardiovascular disease may be at higher risk during such procedures.
Purpose of the Study:
- To investigate cardiovascular changes during laparoscopic cholecystectomy.
- To compare responses in patients with and without cardiovascular disease history.
- To evaluate the utility of transoesophageal Doppler monitoring.
Main Methods:
- A transoesophageal Doppler cardiac output monitor was employed.
- Patients were divided into two groups: without (A) and with (B) cardiovascular disease history.
- Cardiovascular parameters were monitored during carbon dioxide insufflation.
Main Results:
- Abdominal insufflation significantly decreased mean cardiac index and stroke volume index in both groups (P < 0.01).
- A significant increase in mean systolic blood pressure was observed in group A (P < 0.05).
- No significant differences in cardiovascular responses were noted between the groups.
Conclusions:
- Cardiovascular changes during laparoscopic insufflation are unpredictable by clinical assessment or routine monitoring.
- Transoesophageal Doppler monitoring is a valuable tool for assessing these hemodynamic shifts.
- The monitor demonstrated no significant complications or morbidity.
Abstract:
A transoesophageal Doppler cardiac output monitor was used to study the cardiovascular changes occurring during laparoscopic cholecystectomy in patients without (group A) or with (group B) a history of cardiovascular disease, i.e. hypertension, ischaemic heart disease or heart failure. Insufflation of the abdomen with carbon dioxide caused significant (P < 0.01) falls in mean cardiac index (17.9% in group A, 25.1% in group B) and mean stroke volume index (15.3% in group A, 21.2% in group B). Simultaneously, there was a significant (P < 0.05) increase in mean systolic blood pressure (19.4%) in group A. There were no other differences in the cardiovascular responses of the two groups. There was no correlation between systolic blood pressure and either cardiac index or stroke volume index. No significant complications or morbidity were associated with the use of the transoesophageal Doppler monitor. We conclude that the cardiovascular changes associated with insufflation are neither predictable by clinical assessment nor adequately determined by routine monitoring. We recommend the transoesophageal Doppler monitor for use in this situation.