P4.05 Noninvasive Pulse Wave Analysis for Monitoring the Cardiovascular Effects of Pneumoperitoneum During Laparoscopic Cholecystectomy

Abstract

Aim of Study

Due to absorption of carbon dioxide and elevated intraabdominal pressure, pneumoperitoneum during laparoscopic cholecystectomy has potentially harmful intraoperative cardiovascular effects. Our aim was to test the usefulness of a non-invasive method for detecting these hemodynamic parameters.

Methods:

A total of 35 patients, with low anaesthesia risk (ASA 1 and 2) who underwent laparoscopic cholecystectomy were investigated using SphigmoCor arterial wave analyzing system. Conventional pneumoperitoneum was performed, insufflation using carbon dioxid to an intraabdominal pressure of 8–12mmHg. We determined the estimated central aortic pressure, augmentation pressure, augmentation index, ejection duration and subendocardial viability ratio throughout the surgery. These parameters were recorded after induction of anaesthesia and during the inflation period of surgery.

Results:

A significant increase in mean arterial blood pressure (84.5 ± 22.1 vs. 94.0 ± 14.4 mmHg, p = 0,04), aortic pulse pressure (29.5 ± 9.2 vs. 32.7 ± 11.5 mmHg, p = 0.04), augmented pressure (5.9 ± 4.1 vs. 11.0 ± 6.9 mmHg, p < 0.001) and corrigated augmentation index (20.1 ± 13.3 vs. 32.8 ± 12.9, p < 0.001) were recorded after insufflating the abdomen. After deflating the abdomen the measured parameters tended toward normalization.

Conclusions:

The derived parameters suggested an increased mechanical cardiac activity and a raised peripheral vascular resistance along with increases in left ventricular end-systolic wall stress. SphigmoCor arterial wave analysis successfully documented hemodynamic changes occurring during laparoscopic surgery. Our results from this non-invasive technique correspond to data reported previously, using invasive hemodynamic monitoring.