Hemodynamic Response to
Laparoscopic Cholecystectomy – Impacts of Increased Afterload
and Ischemic Dysfunction of the Left Ventricle
V. DANZIG1, Z. KRŠKA2, R.
DEMEŠ2, Z. DANZIGOVÁ3, A. LINHART4,
O. KITTNAR5
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
Summary
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
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