Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients

Purpose: To evaluate the haemodynamic and respiratory changes during laparoscopic cholecystectomy in elderly ASA III patients. Methods: This clinical descriptive study included 16 patients aged >75 yr. Anaesthesia was induced with fentanyl and etomidate and maintained with N2O in O-2 (50%), fentanyl and isoflurane as needed. Inspired minute volume was kept constant during anaesthesia. Cardiovascular monitoring included a radial artery catheter and a pulmonary artery catheter for measurement of CO, RVEF and S<(nu)over bar>O-2, and calculation of right ventricular end diastolic volume indexed (RVEDVI). Haemodynamic variables, arterial and venous blood gas analyses were collected before and 10 min after anaesthetic induction, 15, 30 and 60 min after insufflation (IAP = 12 mmHg) followed by a 10 degrees head-up tilt, and after exsufflation. Results: The mean age was 81 +/- 4 yr. The main cardiovascular depression was recorded after anaesthetic induction. Peritoneal insufflation resulted in improvement of cardiovascular function with increases in cardiac index (+19%), heart rate (+21%), MAP (+19%) and S<(nu)over bar>O-2 (+8%), (P < 0.05) which may be the result of a sympathetic stimulation. No change in preload (RVEDVI) and SVR was recorded. Cardiac index was unchanged during pneumoperitoneum. Laparoscopy was associated with an increase in PaCO2 15 min after CO2 insufflation (from 33.9 to 38.3 mmHg, P < 0.05) and a further elevation after 60 min (44,4 mmHg) without any sign of extra peritoneal diffusion. There was no change in the intra-pulmonary shunt and the Pa-ETCO(2) gradient remained stable (mean 7.2 mmHg). Conclusion: We conclude that gradual abdominal insufflation to 12 mmHg followed by a limited 10 degrees head-up tilt is associated with cardiovascular stability in elderly ASA III patients.