Hemodynamic changes during pneumoperitoneum and reverse Trendelenburg position in bariatric surgery: An observational study using noninvasive cardiac output monitoring

Abstract

Background: Patients undergoing bariatric surgeries are at higher perioperative risk due to multiple comorbidities. We studied the hemodynamic changes during pneumoperitoneum and reverse Trendelenburg position in bariatric surgery, using noninvasive cardiac output (CO) monitoring. Methods: In this prospective observational study, 60 patients of the American Society of Anesthesiologists Grade I–II, aged between 18 and 60 years, planned for elective laparoscopic bariatric surgery were included. During the intraoperative period, hemodynamic monitoring was done using an estimated continuous CO (esCCO) monitor. We noted oxygen saturation (SpO2), heart rate, blood pressure (BP), and CO values obtained before induction of general anesthesia and were compared with values obtained after induction, postintubation, after pneumoperitoneum, after reverse Trendelenburg, and every 10 min during the procedure and postextubation. Results: The mean baseline SpO2, pulse rate (PR), systolic BP (SBP), diastolic BP (DBP), and CO was 99.17 ± 1.7, 99.9 ± 1.35 bpm, 136.3 ± 14.5 mm Hg, 83.11 ± 10.5 mm Hg, and 7.59 ± 1.44 L/min, respectively. There was a significant fall in PR, SBP, DBP, and CO after induction of anesthesia and intubation (P = 0.001). After creating pneumoperitoneum and reverse Trendelenburg, the fall in hemodynamic parameters was also significant (P = 0.001). Conclusions: The esCCO noninvasive CO monitor can be used in patients undergoing bariatric surgeries and predict CO during surgery.