caa a22 4500 475779975 CHVBK 20180406123641.0 cr unu---uuuuu 170329e20000301xx s 000 0 eng 10.1007/s004640000038 doi (NATIONALLICENCE)springer-10.1007/s004640000038 The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy [Elektronische Daten] [E. A. Hirvonen, E. O. Poikolainen, M. E. Pääkkönen, L. S. Nuutinen] Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies, would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning, anesthesia, and increased intra-abdominal pressure. Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane-fentanyl anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages. Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15-20°) positions, and after the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal pressure at 13-16 mmHg), after deflation of the gas, and in the recovery room. Results: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in heart rate. Carbon dioxide (CO2) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas systemic vascular resistance was decreased in comparison with the baseline. Conclusions: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics during laparoscopic cholecystectomy. Springer-Verlag New York Inc., 2000 Key words: Cholecystectomy — Hemodynamics — Laparoscopy — Pneumoperitoneum — Posture nationallicence Hirvonen E. A. Department of Anesthesiology, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut Poikolainen E. O. Department of Surgery, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut Pääkkönen M. E. Department of Surgery, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut Nuutinen L. S. Department of Anesthesiology, Oulu University Hospital, 90220 Oulu, Finland, Finland aut Surgical Endoscopy Springer-Verlag 14/3(2000-03-01), 272-277 0930-2794 14:3<272 2000 14 464 https://doi.org/10.1007/s004640000038 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000038 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hirvonen E. A. Department of Anesthesiology, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut NATIONALLICENCE 700 1- Poikolainen E. O. Department of Surgery, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut NATIONALLICENCE 700 1- Pääkkönen M. E. Department of Surgery, Kuopio University Hospital, 70211 Kuopio, Finland, Finland aut NATIONALLICENCE 700 1- Nuutinen L. S. Department of Anesthesiology, Oulu University Hospital, 90220 Oulu, Finland, Finland aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/3(2000-03-01), 272-277 0930-2794 14:3<272 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer