The Hemodynamic Changes Before And After Pneumoperitoneum Laparoscopic Cholecystectomy

Objective:To observe the impact of pneumoperitoneum on hemodynamics during laparascopic cholecystectomy.Metheds:Eighteen patients(ASAâ… -â…¡) scheduled for laparoscopic cholecystectomy were included in this study.A radial artery catheter was inserted before anesthesia and connected to an arterial pressure-based cardiac output(APCO) measurement device (Flotrac^TM/Vigileo^TM,Edwards Lifescience).Routine perioperative monitor was also connected with patients.Patients were induced with dexamethasone 10mg,fentanyl 0.1-0.2mg,lidocaine 1mg/kg,rocuronium bromide 0.6-0.8mg/kg,propofol TCI target concentration 4ug/kg and remifentanil TCI target concentration 3ng/ml.Anesthesia was maintained with propofol TCI target concentration 2.5ug/kg,remifentanil TCI target concentration 3ng/ml and fentanyl 5ug/kg in total.If MAP or HR continuous increased(＞1.2basic value) and last more than 5 minutes,change the target concentration of remifentanil,the maximum≤4ng/ml.Hemodynamic parameters(HR,MAP,SBP,DBP,APCO) were measured at different times before and after anesthesia induction,before and after CO₂ inflation,before and after CO₂ deflation.Results:Compared with the period before peritoneal insufflation,After CO₂ insufflating 1 minute,HR,DBP increased,APCI decreased(P＜0.05).After peritoneal insufflation 5 minutes,SBP,MAP and APCI increased,DBP elevated further.MAP, SBP,DBP,APCI and HR were similar with the values that recorded after peritoneal insufflation 5 minutes and satble until exsufflation.Compared with the period pneumoperitoneum lasting,HR and DBP decreased,APCI increased(P＜0.05) after exsufflation 1 minute.When pneumoperitoneum had been removed 5 minutes,HR and APCI returned to the level before peritoneal insufflation;MAP and DBP decreased (P＜0.05),but still higher than the level before peritoneal insufflation. Conclussion:Peritoneal insufflation affected the hemodynamics significantly during laparoscopic cholecystectomy.When Peritoneal insufflation started,cardiac ouput reduced,APCI dereased,HR and DBP increased.When the pneumoperitoneum had last 5 minutes,APCI increased and returned to the level before Peritoneal insufflation; HR,SBP,DBP and MAP incresed and stay at a high level until exsufflation.Then these hemodynamic varies almost unchanged until pneumoperitoneum removed.After exsufflation,cardiac output increased significantly,as a result,APCI elevated.When pneumoperitomeun had been removed 5 minutes,these hemodynamic parameters returned to the level before Peritoneal insufflation.