Laparoscopic cholecystectomy with reduced abdominal pressure in ASA grade 111 and 1V patients

ABSTRACT

Increased intra-abdominal pressure [IP] and carbon dioxide absorption during laparoscopic cholecystectomy can lead to haemodynamic decompensation and cardiovascular compromise due to impaired venous return and acidosis. We studied effects of increased and reduced IP on cardiac and respiratory functions in 15 patients undergoing laparoscopic cholecystectomy. The effect of reduced IP [T3] from the insufflation pressure [T2] and pre-insufflation pressure [T1] on mean blood pressure [MBP], heart rate [HR], arterial oxygen saturation [SaO2], end tidal carbon dioxide concentration [ETCO2] and mean airway pressure [MAP] were recorded in 15 patients. The patients were operated at lower IP with the help of an anterior abdominal wall lift device. There were no significant changes in SaO2 and HR. MBP increased by up to 69% at T2 and by up to 27% at T3. MAP increased by up to 49% at T2 and by up to 14% at T3. ETCO2 increased by up to 27% at T2 and by up to 12% at T3. All these increases were with reference to T1. It is proposed that by operating under reduced IP, the cardio-respiratory functional changes can be minimised, thus keeping the haemodynamics and respiratory physiology close to their pre-insufflation levels. It is suggested that patients with poor cardio-pulmonary status may benefit if operated under lower IP