Hemodynamic Changes During Laparoscopic Cholecystectomy Using Different Intra-Abdominal Pressures
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 3277-3285
AbstractBackground-Biliary diseases, which have been there for a long time, account for a large percentage of digestive system ailments all over the world. Cholelithiasis is the most common of them, producing generalised illness and necessitating surgical intervention for complete recovery. The goal of the study was to examine hemodynamic changes in patients having laparoscopic cholecystectomy with varying intra-abdominal pressures caused by carbon dioxide insufflation.
Methods-The patients were assigned to one of three groups, each of which maintained varying intra-abdominal pressures (8–10 mmHg, 11–13 mmHg, and 14 mmHg and above). Heart rate, non-invasive blood pressure (systolic and mean), and end-tidal carbon dioxide were the baseline parameters examined. All parameters were measured at various intervals, including immediately during CO2 insufflation, 5 minutes, 10 minutes, 20 minutes, and 30 minutes after CO2 insufflation, and every 10 minutes if the surgery lasted longer than 30 minutes, at insufflation, and 10 minutes after CO2 exsufflation.The Pedius Drager Ventilator was used to ventilate the patients, with a tidal volume of 8–10 ml/kg and a respiratory rate of 12–14 breaths/min. Patients were placed in a reverse Trendlenburg position (head up) at 15 degrees during surgery. The obtained results were statistically assessed and analysed. The qualities at the start were determined to be comparable.
Results-The mean and standard deviation of hemodynamic variables were reported. Analysis of Variance and the unpaired student t-testwas used to determine statistical significance between groups (two tailed). The Bonferroni test was used to make inter-group comparisons. A p-value of less than 0.05 was deemed statistically significant. The mean heart rate increased during CO2 insufflation in all three groups (baseline 84.0812.50, 87.9615.73, and 86.9217.00, respectively), and the rise in heart rate continued until exsufflation, after which it decreased, and the heart rates were comparable with the baseline at 10 minutes after exsufflation.The difference in mean heart rate between I and III was statistically significant at 10, 20, and 30 minutes after CO2 insufflation, and at 10 minutes after CO2 exsufflation [p<0.05]. The difference in systolic blood pressure at 10, 20, 30 minutes after CO2 insufflation, at exsufflation, and 10 minutes after exsufflation [p=00.0001] and mean arterial pressure at 5, 10, 20, 30 minutes after CO2 insufflation, at exsufflation, and 10 minutes after exsufflation [p=00.0001] was statistically significant in the inter-group comparison between I and III.The difference in EtCO2 between Group I and Group III, as well as between Group II and Group III, was highly significant statistically immediately after insufflation, and the same trend continued until the end of surgery and even 10 minutes after exsufflation [p=00.001].
Conclusion-The study found that laparoscopic cholecystectomy causes significant intraoperative hemodynamic alterations, with the majority of pathophysiological changes connected to the cardio-vascular system and induced by CO2 insufflation. When compared to low intraabdominal pressure, a high intraabdominal pressure caused by CO2 insufflation is associated with more hemodynamic fluctuations and increased peritoneal CO2 absorption. As a result, low-pressure pneumoperitoneum is feasible for laparoscopic cholecystectomy and minimises the adverse hemodynamic effects of CO2 insufflation
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