Changes in the Cardiovascular and Respiratory Systems During Laparoscopic Cholecystectomy

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Abstract
The effects of peritoneal insufflation on the cardiovascular and respiratory systems were investigated in eight patients who underwent laparoscopic cholecystectomy. During the operation, intraabdominal pressure was maintained at a constant 12 mm Hg with carbon dioxide. The cardiac index had increased significantly at 20 and 40 min after the start of insufflation (3.6 ± 0.6, 3.9 ± 0.8 mL/min, respectively) and after evacuation (4.2 ± 0.6 mL/min) compared with the control value (3.2 ± 0.6 mL/min). Mean arterial pressure was significantly increased at 20 min after the start of insufflation (94.6 ± 11.2 mm Hg) relative to the control value (79.9 ± 11.1 mm Hg) and remained high after evacuation (101.5 ± 11.9 mm Hg). Central and femoral venous pressure rose significantly during the operation from baseline values (12 ± 6 and 4 ± 4 mm Hg, respectively) to 18 ± 10 and 11 ± 6 mm Hg, respectively, at 20 min, and to 18 ± 10 and 19 ± 8 mm Hg, respectively, at 40 min after the start of insufflation. These parameters returned to control levels immediately after evacuation. Dynamic lung compliance decreased by 25% as a result of the elevated intraabdominal pressure. These findings demonstrate that some cardiopulmonary changes occur even at an intraabdominal pressure of 12 mm Hg, which up to now has been considered a safe level.