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Online ISSN 1827-1596
Donati A., Münch C., Marini B., Orsetti G., Coltrinari R., Pietropaoli P.
From the Institute of Medical and Surgical Emergencies University of Ancona - Ancona
*Resuscitation Azienda Ospedaliera «Lancisi» - Ancona
**Institute of Anesthesiology and Intensive Care University «La Sapienza» - Rome
Background. The aim of this study was to as-sess the changes of hemodynamic and oxyphoretic parameters induced by pneumoperitoneum in a series of patients undergoing laparoscopic cholecystectomy, by using the transesophageal Doppler ultrasonography (TEDU).
Methods. Design: prospective study. Setting: a medico-surgical intensive care unit of an University Hospital. Patients: 11 patients who underwent laparoscopic cholecystectomy because of gallbladder stones. Interventions: a central venous line, a radial artery line were placed before the induction of anesthesia. End expiratory CO2 (EtCO2) was monitored by using a capnometer (Dräger, Germany). Cardiac output (CO) was measured using the transesophageal Doppler system Abbott ODM II (Abbott Critical Care Systems, Ireland), which was positioned in the esophagus after stabilization of anesthesia. Measurements: hemodinamic parameters, including CO, central venous pressure, mean arterial pressure, measurement of EtCO2 and arterial and central venous samples were performed: after reaching a stable anesthesia but before any surgical manipulation (T0); after induction of pneumoperitoneum (T1); 15 min after T1 (T2); 30 min after T1 (T3).
Results. SVR increased significantly at T1 and T2 compared to T0; PaCO2 and PvCO2 at T2 and T3. HR and MAP increased significantly at T1, and CVP significantly at all the times.
Conclusions. Laparoscopic surgery is a mini-invasive technique of increasing success among both surgeons and patients. The widening of candidate patients raises the question of eligibility for individuals with known cardiopulmonary disease. In these patients, only a careful and thorough anesthesiologic monitoring allows the prompt identification and treatment of any relevant hemodynamic and/or ventilatory changes.