Utility of Esophageal Doppler and the Hemodynamic Effect of Nicardipine during a Laparoscopic Cholecystectomy

Abstract

Background: We performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during a laparoscopic cholecystectomy. Methods: Forty patients scheduled to undergo a laparoscopic cholecystectomy, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). Results: The mean arterial pressure (MAP) was significantly lower in the Group N patients when compared to the Group C patients 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5)(P ＜ 0.05). There was no significant differences in heart rate (HR) between patients in the two groups. The cardiac output (CO) was significantly increased in the Group N patients when compared to the Group C patients 5 min after the initiation of pneumoperitoneum (T2)(P ＜ 0.05). The peak velocity (PV) was significantly increased in the Group N patients when compared to the Group C patients 5 and 10 min after the initiation of pn eumoperitoneum (T2 and T3)(P ＜ 0.05). The corrected flow time (FTC) was significantly increased in the Group N patients when compared to the Group C patients 5 min after the initiation of pneumoperitoneum (T2)(P ＜ 0.05). Conclusions: We conclude that nicardipine continuous infusion with 0.5-2.0μg/kg/min is effective in attenuating the hemodynamic change after pneumoperitoneum during a laparoscopic cholecystectomy. (Korean J Anesthesiol 2007; 53: 304～10)