| The hemodynamic effects of a reversed Trendelenburg in elderly patients with increased cardiac risk during laparoscopic cholecystectomy. |
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Kyo Sang Kim, Si Min Yi, Jong Hun Jun, Mi Ae Cheong, Min Seok Koo |
1Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Korea. kimks@hanyang.ac.kr
2National Medical Center, Seoul, Korea. |
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| Abstract |
BACKGROUND
We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n = 30; age 70.8 +/- 4.9 years, mean +/- SD) and compared the results with elderly patients at normal risk (ASA class II; n = 30; age 69.2 +/- 4.1 years) during laparoscopic cholecystectomy. METHODS: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20degrees) and a left lateral tilt (15degrees) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. RESULTS: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P < 0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P < 0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes.
CONCLUSIONS
Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring. |
| Key Words:
Cardiac diseases; Elderly; Esophageal Doppler monitor; Hemodynamic; Laparoscopic cholecystectomy; Reversed Trendelenburg position |
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