Physiol. Res. 54: 377-385, 2005

Hemodynamic Response to Laparoscopic Cholecystectomy – Impacts of Increased Afterload and Ischemic Dysfunction of the Left Ventricle


1Second Department of Internal Medicine and Department of Nephrology, 2First Department of Surgery, 3Fourth Department of Internal Medicine and Gastroenterology, 4Second Department of Internal Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University and 5Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Received May 14, 2004
Accepted September 24, 2004
On-line available December 9, 2004

The authors describe the results of intra-operative hemodynamic monitoring during laparoscopic cholecystectomy in patients with ischemic left ventricular dysfunction and with significant aortic stenosis. The results in the groups composed of 13 and 12 patients were compared with the findings in 10 young, non-obese, non-smokers without significant cardiovascular history and with normal findings during resting transthoracic echocardiography. Monitoring itself was conducted using transesophageal echocardiography 1) after the induction of anesthesia, 2) after the induction of capnoperitoneum, and 3) after setting the operative anti-Trendelenburg position. The measurements were performed at least in triplicate and the results were processed using ANOVA test. Significant differences were identified in the time course patterns of heart rate, mean arterial pressure, dual product (pressure-rate-product), and cardiac output. In terms of pathophysiology, we believe that the most important achievement was the identification of different time course patterns of individual parameters in the respective groups. The results in the group of patients with aortic stenosis were based particularly on the different time course of the mean arterial pressure, while the results in patients with ischemic disease were more dependent on the time course of the heart rate. Very ineteresting is a drop of peripheral vascular resistance after positioning of these patients which could be explained only partially by a beta-blocking or ACEI medication. In clinical terms, the most important finding was probably that no complications occurred in the entire group of 35 patients, of which 25 suffered from severe organic cardiopathies.

Key words
Laparoscopic cholecystectomy • Hemodynamic response in cardiac patients • Transesophageal echocardiography

© 2005 by the Institute of Physiology, Czech Academy of Sciences