Abstract
This review analyzes the literature dealing with cardiopulmonary function during and pulmonary function following laparoscopic cholecystectomy in order to describe the patterns of changes in these functions and the mechanisms involved as well as to identify areas of concern and lacunae in our knowledge. Information was obtained from a Medline literature search and the annual meeting supplements of Anesthesiology, Anesth Analg, Br J Anaesth, and Can J Anaesth. The principal findings were that changes in cardiovascular Junction due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance. In the next few minutes there is partial restoration of cardiac index and resistance but blood pressure and heart rate do not change. The pattern is the result of the interaction between increased abdominal pressure, neurohumoral responses and absorbed CO2. Pulmonary junction changes are characterized by reduced compliance without large alterations in PaO2, but tissue oxygenation can be adversely affected due to reduced O2 delivery. A major difficulty in maintaining normocarbia is due to the abdominal distention reducing pulmonary compliance and to CO2 absorption. End tidal CO2 tension is not a reliable index of PaCO2, particularly in ASA III–IV patients. The pattern of lung function following LC is characterized by a transient reduction in lung volumes and capacities with a restrictive breathing pattern and the loss of the abdominal contribution to breathing. Atelectasis also occurs. These changes are qualitatively similar to but of a lesser magnitude than those following “open” abdominal operations. It is concluded that the changes in cardiopulmonary function during laparoscopic upper abdominal surgery lead us to suggest judicious invasive monitoring and careful interpretation in ASA III–IV patients. Lung function following extensive procedures in sick patients has not been reported.
Résumé
Ce survol analyse la littérature portant sur la fonction cardiopulmonaire pendant et la fonction pulmonaire après la cholecystectomie laparoscopique dans le but d’en décrire le profil des changements et les mécanismes engagés, et identifier les domaines d’intérêt particuliers et les lacunes de nos connaissances. Les renseignements ont été compilés à partir des données de Medline et des suppléments d’Anesthesiology, Anesth Analg, Br J Anaesth, et Can J Anaesth. Les répercussions cardio-vasculaires causées par l’insufflation sont caractérisées par une chute immediate de l’index cardiaque et une augmentation de la pression artérielle moyenne et de la résistance vasculaire ont constitué les constatations les plus importantes. Dans les minutes qui suivent, l’index cardiaque et la résistance se rétablissent partiellement, mais la pression artérielle et la fréquence cardiaque ne changent pas. Cet état résulte de l’interaction entre l’augmentation de la pression abdominale, les réponses neuro-humorales et le CO2 absorbé. Les changements de la fonction pulmonaire sont caractérisés par une baisse de la compliance sans modifications significatives de la PaO2, mais l’oxygénation des tissus peut être désavantagée par la baisse du transport de l’O2. Le maintien de la CO2 téléexpiratoire représente un problème majeur à cause de la distension l’abdominale qui réduit la compliance pulmonaire et par la réabsorption du CO2. Le CO2 téléexpiratoire évalue mal la PaCO2 spécialement chez les patients ASA III et IV. L’état de la fonction pulmonaire est caractérisé par une réduction transitoire des volumes et des capacités pulmonaires avec un profil restrictif et une perte de la contribution abdominale à la respiration. Il existe aussi de l’atélectasie. Ces changements sont identiques à ceux qui suivent la cholécystectomie traditionnelle mais à un moindre degré. Les répercussions sur la fonction cardio-pulmonaire pendant la chirurgie laparoscopique haute nous incitent à suggérer un monitorage effractif pertinent interprété avec perspicacité chez les patients ASA III et IV. On n’a pas fait d’observation sur la fonction pulmonaire de patients tarés après des interventions complexes.
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Wahba, R.W.M., Béïque, F. & Kleiman, S.J. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth 42, 51–63 (1995). https://doi.org/10.1007/BF03010572
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DOI: https://doi.org/10.1007/BF03010572