COMPARATIVE EVALUATION OF HAEMODYNAMIC AND CAPNOGRAPHIC CHANGES IN LAPAROSCOPIC CHOLECYSTECTOMY AND OPEN CHOLECYSTECTOMY: PROSPECTIVE, RANDOMIZED CLINICAL STUDY
Journal Title: Journal of Indira Gandhi Institute of Medical Sciences - Year 2019, Vol 5, Issue 1
Abstract
Introduction The overall mortality following open cholecystectomy is very low but is followed by a higher morbidity, especially in elderly patients. After open cholecystectomy, there is post-operative impairment in pulmonary functions, increase in acute phase reactions, severe pain, discomfort, bowel distension, paralytic ileus and prolonged convalescence in the post-operative period. Although laparoscopy was first described at the beginning of 20th century, therapeutic laparoscopic surgical procedures have only recently become well established being somewhat ignored until the late 1960s. In the late 1980s, laparoscopic cholecystectomy was described and has become well established1-2 because of the advantages like greater cosmetic value, less hospital stay and cost-effectiveness. For laparoscopy, creation of pneumoperitoneum and very often changing of patient position are required. The pneumoperitoneum and the patient positions required for laparoscopy induce pathophysiologic changes that complicate anaesthetic management. Many studies have confirmed that CO2 pneumoperitoneum during laparoscopy causes significant haemodynamic changes such as increase in MABP, SVR and decrease in cardiac output. Therefore understanding of pathophysiologic consequences of increased intra-abdominal pressure and Hypercapnia are important for the anaesthesiologists who must ideally prevent or adequately respond to these changes. They must also evaluate and prepare the patient pre-operatively in light of these disturbances.During laparoscopic cholecystectomy pneumoperitoneum is produced to facilitate surgery. The most preferred gas commonly used for producing pneumoperitoneum is carbon-dioxide (CO2). As CO2 is rapidly absorbed in the blood and eliminated through respiration, it enables rapid reversal of clinical signs by treatment, if an open venous channel leads to CO2 embolism.Thus laparoscopic cholecystectomy has some inherent complications due to increase in intra-abdominal pressure, carbon dioxide absorption from the peritoneal cavity and frequent changes of position. These are associated with severe pulmonary, haemodynamic and acid base changes. These haemodynamic effects of laparoscopy in the head-up position is still seen to be well tolerated by healthy persons3 (ASA I, II). But in elderly patients with multiple co-morbid conditions, the paediatric age group, the morbidly obese, pregnant women and the critically ill (ASA III, IV) the risks associated with general anaesthesia can be compounded by the physiologic changes induced by pneumoperitoneum and patient positions. Various studies have demonstrated an increase in heart rate during laparoscopic surgery may be due to absorption of carbon dioxide from peritoneal cavity. Pneumoperitoneum related increased IAP results in activation of the sympathetic system with catecholamine’s release and the renin-angiotensin system with vasopressin release. An increase in intra-abdominal pressure (IAP) with decrease in venous return may also cause a compensatory increase in heart rate. Laparoscopic cholecystectomy
Authors and Affiliations
Arvind Kumar
Keywords
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