Procena plucne i metabolicke funkcije u toku klasicne i laparoskopske holecistektomije kod pacijenta sa ASA I i ASA II skorom

Abstract

This is a prospective study of patients treated at the Center for Urgent Surgery, Clinical Center of Serbia. The patients were divided into two groups; i.e., the controls consisted of 30 subjects, who underwent conventional cholecystectomy, and studied group with 30 patients who had laparoscopic cholecystectomy. The patients were homogenized by ASA score (ASA I and ASA II) and on population basis. Hemodynamic parameters and 4 time-point pulmonary function tests were monitored in both groups. Peritoneal insufflation resulted in significant increase of systemic arterial pressure (23%), mean arterial pressure (23.8%), systemic vascular resistance (65%), pulmonary vascular resistance (90%), and significant reduction of cardiac output (24%) and cardiac index (51%). Pneumoperitoneum caused transient restriction of pulmonary function by reducing the thoracic and lung compliance. Fall of pH concentration, increase of PaCO2 and ET CO2 without any changes of PaO2, SO2, base excess and bicarbonate ions concentrations were the sequelae of CO2 absorption from peritoneal cavity. Postoperative "hypothermi", i.e. lowering of body temperature for 0.3 degrees C was the consequence of sudden gas expansion (Joule-Thompson phenomenon), which implies continuous flow of dry gas under pressure over peritoneal surface. Tissue damage factors (D-dimer, C-reactive protein, Protein C) were significantly lower in laparoscopic group, meaning that such mode of treatment resulted in minor postoperative pain and shorter period of recovery. Laparoscopy is a revolution in surgery. Definite success of any laparoscopic intervention depends on anesthesia as its crucial factor, at the same time meeting the patient's wish and expectations to be free from pain and discharged in no time from hospital.