Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy.

OBJECTIVE: to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. METHODS: we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. RESULTS: although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. CONCLUSION: laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.

Comportamento cardiovascular de idosos submetidos a colecistectomia laparoscópica / Cardiovascular behavior of elderly patients undergoing laparoscopic cholecystectomy

Introdução: Existe uma alta prevalência de disfunção diastólica na população com mais de 60 anos. A cirurgia laparoscópica pode gerar alterações hemodinâmicas importantes. O comportamento da função diastólica da população idosa frente a essas alterações é desconhecido. Método: Para estudar as variáveis hemodinâmicas e avaliar a função diastólica pela ecocardiografia transesofágica durante as cirurgias de colecistectomia laparoscópica em pacientes com mais de 60 anos, os dados foram coletados e analisados em três momentos distintos: antes, durante e após o pneumoperitônio. Comparações entre grupos de comorbidades e medicamentos para obter correlações com possíveis fatores de proteção ou agravantes. Resultados: Houve notória prevalência de algum grau de disfunção diastólica na amostra estudada. A pressão de insuflação de CO2 de 13 mmHg resultou em elevação da pressão arterial diastólica e menor diâmetro da veia cava inferior, sem grandes alterações da função diastólica em pacientes idosos em geral. ECG alterado anterior relacionado com enchimento do ventrículo esquerdo prejudicado durante o pneumoperitônio. O uso de bloqueadores dos canais de cálcio, inibidores da enzima de conversão da angiotensina e antagonistas do receptor AT2 mostrou potencial proteção contra o aumento da pressão arterial induzido pelo pneumoperitônio. Conclusão: A laparoscopia é geralmente segura em idosos, mas pode prejudicar a função diastólica em situações específicas. Esses pacientes requerem cuidados perioperatórios diferenciados pelos maiores riscos e particularidades

Background: There is a high prevalence of diastolic dysfunction in the population over 60 years of age. Laparoscopic surgery can generate important hemodynamic changes. The behavior of elderly population diastolic function in face of these changes is unknown. Method: To study hemodynamic variables and assess diastolic function by transesophageal echocardiography during laparoscopic cholecystectomy surgeries in patients over 60 years old, data were collected and analyzed at three different times: before, during and after pneumoperitoneum. Comparisons between groups of comorbidities and medications to obtain correlations with possible protective or aggravating factors. Results: There was a notorious prevalence of some degree of diastolic dysfunction in the studied sample. A CO2 insufflation pressure of 13 mmHg resulted in raises in diastolic blood pressure and smaller inferior vena cava diameter, without great alterations regarding diastolic function in elderly patients in general. Previous altered ECG related with impaired left ventricle filling during pneumoperitoneum. The use of calcium channel blockers, angiotensin converting enzyme inhibitors and AT2 receptor antagonists showed potential protection against the pneumoperitoneum-induced increase in blood pressure. Conclusion: Laparoscopy is generally safe in elderly, but can impair diastolic function in specific situations. These patients require differentiated perioperative care due to their greater risks and particularities