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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2002 June;68(6):549-54

language: English

Transesophageal Doppler ultrasonography evaluation of hemodynamic changes during videolaparoscopic cholecystectomy

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.

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