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Canadian Journal of Anesthesia, Vol 44, 467-472, Copyright © 1997 by Canadian Anesthesiologists' Society

ARTICLES

Haemodynamic effects of mechanical peritoneal retraction during laparoscopic cholecystectomy

P Couture, D Boudreault, F Girard, D Girard and R Ratelle
Department of Anaesthesiology, Universite de Montreal, Hopital Notre-Dame, Quebec, Canada. p.couture@sympatico.ca

PURPOSE: Abdominal wall retraction (AWR) was recently proposed as an alternative for CO2 pneumoperitoneum. In this study we evaluated the cardiorespiratory effects of AWR during laparoscopic cholecystectomy. METHODS: Fifteen patients were studied during laparoscopic cholecystectomy using AWR. Monitoring included heart rate (HR), mean arterial pressure (MAP), pulse oxymetry (SpO2), end-tidal CO2 (PETCO2) minute ventilation, and peak inspiratory pressure (PIP). Using transoesophageal echocardiography, the transgastric short axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). These parameters were measured at predetermined periods: 1) five minutes after anaesthetic induction, 2) five minutes after AWR insertion, 3) 15 min after AWR insertion, and 4) after the end of surgery. RESULTS: No change in any measured parameter was observed over time in the AWR group except for an increase in MAP (P } 0.05) after AWR insertion. There were no changes in EDA, ESA and EF during the study, reflecting stable global cardiac function. In addition, no embolic episodes were observed during surgery. CONCLUSION: Our results demonstrate that the use of gasless abdominal distention for laparoscopic cholecystectomy results in a stable haemodynamic profile in healthy patients without cardiac disease, except for a brief increase in MAP after the AWR insertion. The advantages of AWR over conventional pneumoperitoneum should be confirmed in higher risk patients in a prospective, randomized study.


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Copyright © 1997 by the Canadian Anesthesiologists' Society.