Hemodynamic changes during laparoscopic cholecystectomy in patients with severe cardiac disease

Study Objective: To evaluate the hemodynamic changes and need for pharmacologic interventions during laparoscopic cholecystectomy in patients with severe cardiac dysfunction. Design: Prospective open study. Setting: University hospital. Patients: 17 ASA physical status III and IV patients with severe cardiac dysfunction undergoing elective laparoscopic cholecystectomy. Interventions: A standardized general anesthetic and surgical technique was used for all patients. In addition to routine monitoring, invasive hemodynamic monitoring included radial and pulmonary artery (PA) cannulation. Measurements and Main Results: Hemodynamic parameters were recorded prior to induction of anesthesia, 5 minutes after induction of anesthesia but prior to incision, 5 minutes after carbon dioxide (CO₂) insufflation and head-up tilt, every 10 minutes after change of position, after deflation of the abdomen and return to supine position, and 10 minutes after attaining supine position. Need for any pharmacologic interventions [to maintain mean arterial pressure (MAP) < 100 mmHg and/or systemic vascular resistance (SVR) <2,000 dynes·sec/cm^-5, and/or cardiac index (CI) > 1.5 L/min/m² and the incidence of any myocardial morbidity and mortality was noted. CI decreased significantly (p < 0.05) following insufflation and remained low until exsufflation. MAP, SVR, and PA occlusion pressure increased significantly (p < 0.05) after CO₂ insufflation. Three of the patients required administration of nitroglycerin to maintain the MAP arid SVR within the accepted limits, one of whom also required administration of dobutamine to maintain CI. There was no myocardial morbidity or mortality in the perioperative period. Conclusion: Laparoscopic cholecystectomy in patients with severe cardiac dysfunction results in significant hemodynamic changes.