Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis.

Abstract

We investigated cardiovascular performance in 12 patients (mean age 66 +/- 12 yr) with significant coexisting cardiopulmonary disease (hypertension, coronary artery disease, chronic obstructive pulmonary disease) during laparoscopic colectomy under general anesthesia. Hemodynamic monitors included arterial and pulmonary artery catheters in combination with transesophageal echocardiography. Hemodynamic and echocardiographic data were obtained at five epochs: baseline (after induction of anesthesia), insufflation (after pneumoperitoneum, supine position), Trendelenburg 5 (5 min after placement into Trendelenburg's position), Trendelenburg 20 (at 20 min in Trendelenburg's position), and end (after release of the pneumoperitoneum, supine position). Hemodynamic responses to peritoneal insufflation resulted in significant increases in systemic vascular resistance (SVR) as well as endsystolic area (ESA) and significant decreases in cardiac index (CI) and ejection fraction area (EFa) compared with baseline. Trendelenburg's positioning augmented ventricular preload and performance, resulting in significant increases in pulmonary capillary wedge pressure, CI, end-diastolic area, and EFa compared with insufflation. At the final epoch, end, a hyperdynamic state occurred as evidenced by a significantly decreased ESA and SVR while heart rate, CI, and EFa increased significantly compared to baseline and insufflation. In an elderly population with significant coexisting cardiopulmonary disease, intraoperative maneuvers required for laparoscopic colectomy resulted in previously undescribed alterations of cardiovascular performance, which persisted after release of the pneumoperitoneum.