Abstract
to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.
Highlights
Cholelithiasis is the most common surgical abdominal disease of the elderly, with a prevalence of 21.4% between 60 and years and 27.5% in individuals older than years[1]
This study aims to demonstrate the hemodynamic changes resulting from the pneumoperitoneum in elderly patients submitted to Laparoscopic cholecystectomy (LC) and monitored with transesophageal echocardiography (TEE)
Despite the already recognized advantages of LC in relation to conventional surgery[10], pneumoperitoneum leads to cardiovascular alterations that are well tolerated by healthy individuals, but can be a threat to patients with comorbidities, frequent in the elderly
Summary
Cholelithiasis is the most common surgical abdominal disease of the elderly, with a prevalence of 21.4% between 60 and years and 27.5% in individuals older than years[1]. The increase in life expectancy associated with a higher incidence of cholelithiasis in the elderly has resulted in a greater number of surgeries for the treatment of symptomatic disease in this group[2]. Several studies have evaluated the hemodynamic changes due to pneumoperitoneum, the mechanisms involved in cardiovascular variations have not yet been fully elucidated. Works have been carried out in groups of non-homogeneous patients, under different intra-abdominal pressures and with different positions during surgery[7,8,9]. This study aims to demonstrate the hemodynamic changes resulting from the pneumoperitoneum in elderly patients submitted to LC and monitored with transesophageal echocardiography (TEE)
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