Haemodynamic monitoring during diagnostic gynaecological laparoscopy

Abstract

Haemodynamic changes during laparoscopy result from the effects of pneumoperitoneum and patient position. There is a decrease in cardiac output with an increase in arterial pressure and systemic and pulmonary vascular resistance. This work described an endo-oesophageal probe equipped with ultrasonic transducers, a Doppler ultrasound velocimeter and an 'M' mode ultrasound scanner imaging system to measure aortic blood flow (ABF), the systolic, diastolic and mean arterial pressures (SAP, DAP, MAP) and heart rate (HR), stroke volume (SV), total vascular resistance (TSVRa). The patients studied were undergoing gynaecological laparoscopy. We noted haemodynamic changes, first at the beginning of anaesthesia, after Trendeleburg positioning, and at the end of peritoneal insufflation of 4 L of CO2. We compared the measurements in two groups of 30 females under general anaesthesia: (a) induction with propofol 2.5 mg, atracurium 0.06 mg kg−1, with propofol 6 mg kg h−1 and fentanyl 0.002 mg kg−1 and atracurium 0.04 mg kg−1 for maintenance; (b) induction with thiopentone 4 mg kg−1, Myorelaxin and maintenance with O2/N2O (1:1) and halothane 0.6 vol.%, fentanyl 0.002 mg kg−1 and pancuronium 0.04 mg kg−1. ABF in the second group decreased from 3.8 to 2.75 L min−1. TSVRa increased from 1846 to 2050. In the first group ABF decreased from 3.69 to 2.53 L min−1 and TSVRa increased from 1504 to 1730. We conclude that this technique is useful during laparoscopy for dynamic monitoring and also offers a sensitive and early method for detecting gas embolism.