Filtered signal-averaged P-wave duration during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy: A reflection of pathophysiological cardiac changes

Bickel, Amitai; Marinovski, Michael; Shturman, Alexander; Roguin, Nathan; Waksman, Igor; Eitan, Arie

doi:10.1007/s00464-007-9676-z

Cited by 6 publications

(4 citation statements)

References 46 publications

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“…Patients with ischemic heart disease are prone to develop atrial fibrillation, a condition which could beprecipitated by CO 2 pneumoperitoneum 20 . Most of thestudies addressing cardiovascular effects of CO 2 pneumoperitoneumhave been performed in healthy subjects, whoseem to tolerate pneumoperitoneum without untowardproblem [15,16,21].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy in High Risk Cardiac Patient with DM

Rahman

Shaheen

Munir

et al. 2020

j Bangladesh Soc Anaesthesiologists

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Introduction: Laparoscopic cholecystectomy remains the standardtreatment for cholelithiasis. Everincreasing number of patients with myriad of medical illness is being treated by this technique. However,significant concern prevails among the surgical community regarding its safety in patients with cardiacco-morbidity. Patients with diabetes, significant cardiac dysfunction and multiple co-morbidities wereprospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopiccholecystectomy was performed. Results: Patient demographics, details of peri-operative management and post-operative complicationswere studied.Between July 2014 and January 2018, 32 patients (M:F=24:08) with mean age of 55 years(range 36–78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy.Of these, 24 patients were in NYHA class-II, while 8 belonged to class-III. Left ventricular ejection fraction,as recorded by transthoracic echocardiography, was20–30% in 08 (25%) patients and 30–40% in the rest24(75%). In addition, 21 (71%) patients had regional wall motion abnormalities, 11 (34%) patients hadcardiomyopathy while 09 (39%)patients had prior cardiac interventions. Following laparoscopiccholecystectomy, hypertension (21), tachyarrhythmia(4) and bradycardia (2) were the commonest eventsencountered.Two patients required dopamine in the immediate postoperative period but all other patientsmade an uneventful recovery. Conclusion: With appropriate cardiological support, laparoscopic cholecystectomy may be safely performedin patients with significant cardiac dysfunction. JBSA 2020; 33(2): 78-84

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy in High Risk Cardiac Patient with DM

Rahman

Shaheen

Munir

et al. 2020

j Bangladesh Soc Anaesthesiologists

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“…Neurohumoral response during laparoscopic surgeries can increase systemic vascular resistance, HR and myocardial oxygen consumption 19,20 . Interaction among effects of exogenous CO 2 , raised IAP and reverse Trendelenburg position during LC can thus precipitate myocardial ischemia and dysrhythmias [21][22][23] . LC still remains the therapy of choice even in the sick elderly in order to prevent serious complications of cholelithiasis, but at the cost of a higher rate of morbidities under GA 15,24,25 .…”

Section: Discussionmentioning

confidence: 99%

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Gautam

2018

J. Kathmandu Med. Coll.

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Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia. Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy. Methodology: In this cross-sectional study, fi fty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fi fth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done. Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in fi ve patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days. Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is effi cient for uncomplicated cholelithiasis with minimal modifi cations in surgical technique.

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“…However, pneumoperitoneum induced by CO 2 causes hemodynamic changes, including increased heart rate, mean arterial blood pressure, and systemic vascular pressure. 22,23 The position of patients can also cause hemodynamic changes during laparoscopic cholecystectomy. Maximum hemodynamic changes, including a decline in cardiac index, were observed when CO 2 pneumoperitoneum was induced with patients in a head-up position.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Laparoscopy-assisted Gastrectomy for Patients With Heart Disease

Inokuchi¹,

Kojima²,

Yamada³

et al. 2013

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Laparoscopy-assisted gastrectomy (LG) is an established treatment for early gastric cancer. However, CO2 pneumoperitoneum during laparoscopic surgery can adversely affect cardiac function in the presence of heart disease (HD). We performed LG in 546 patients and conventional open gastrectomy (OG) in 448 patients. Patients with preoperatively diagnosed and treated HD were identified. The clinical outcomes of patients with HD who underwent LG (HD-LG) were compared with those of patients with HD who underwent OG (HD-OG), as well as those of patients with no operative risk who underwent LG (NR-LG). Variables of cardiac function were similar in the HD-LG and HD-OG groups. Postoperative cardiac complications did not differ between the groups (8.3% vs. 13.6%, P = 0.51). The HD-LG group had significantly more cardiac and abdominal complications than the NR-LG group (P = 0.0011 and 0.0070, respectively). LG was tolerated in patients with gastric cancer and mild or moderate HD, similar to OG.

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Filtered signal-averaged P-wave duration during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy: A reflection of pathophysiological cardiac changes

Cited by 6 publications

References 46 publications

Laparoscopic Cholecystectomy in High Risk Cardiac Patient with DM

Laparoscopic Cholecystectomy in High Risk Cardiac Patient with DM

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Clinical Outcomes of Laparoscopy-assisted Gastrectomy for Patients With Heart Disease

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