Changes in renal blood flow in elderly versus young and middle age patients during laparoscopic cholecystectomy / 中华麻醉学杂志

ABSTRACT

ObjectiveTo compare the changes in renal blood flow in elderly and adult patients during laparoscopic cholecystectomy.MethodsSixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr,weighing 48-78 kg,undergoing elective laparoscopic cholecystectomy were enrolled in this study.The patients were divided into 2 groups according to the age ( n =30) group Ⅰ young and middle-age (18-60 yr) and group Ⅱ elderly (61-75 yr).Anesthesia was induced with midazolam,fentanyl,propofol and vecuromium and maintained with infusion of propofol and remifentanil,isoflurane inhalation and intermittent iv boluses of vecuromium.The patients were intubated and mechanically ventilated.PETCO2 was maintained at 30-40 mm Hg.The probe of transesophageal echocardiography (TEE) was inserted into esophagus after tracheal intubation.The internal diameter and time integral of left renal artery were measured by TEE before pneumoperitoneum (baseline) and at 1,5,10,15,20 and 30 min of pneumoperitoneum and 1,5 min after deflation.The blood flow of left renal artery (LRAF) was calculated.The maximal derease in LRAF during pneumoperitoneum was analyzed.ResultsThe internal diameter and time integral of left renal artery and LRAF were significantly decreased during peumoperitoneum and at 1 min after deflation in both groups ( P ＜ 0.05).LRAF before peumoperitoneum was significantly lower,and the time point of LRAF maximum decrease during pneumoperitoneum was later in group Ⅱ than in group Ⅰ ( P ＜ 0.05).ConclusionThe renal blood flow is temporary decreased during laparoscopic cholecystectomy both in young and middle age and elderly patients.The time point of LRAF maximum decrease in elderly patients is later than that in adult patients.