Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position |
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Authors: | O'Leary E; Hubbard K; Tormey W; Cunningham A J |
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Institution: | Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland |
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Abstract: | We have assessed the potential for myocardial ischaemia during laparoscopic
cholecystectomy in 16 otherwise healthy patients. Continuous ambulatory ECG
monitoring was commenced 12 h before operation and continued for 24 h after
operation. The neuroendocrine stress response was assessed by measuring
plasma concentrations of adrenaline and noradrenaline, human growth
hormone, cortisol, renin and aldosterone, and prolactin, at specified times
during surgery. Acute ST segment changes in the ECG occurred in only two
patients. These episodes were independent of creation of pneumoperitoneum
and changes in position. Acute intraoperative increases in MAP were noted
during insufflation of carbon dioxide and reverse Trendelenburg positioning
(P < 0.05). A four-fold increase in plasma concentrations of renin and
aldosterone was noted after pneumoperitoneum and reverse Trendelenburg
positioning (P > 0.05). There was a linear correlation between changes
in plasma renin and aldosterone concentrations and MAP (r = 0.97 and r =
0.85, respectively). Prolactin concentrations increased four-fold after
induction of anaesthesia. Cortisol, HGH, adrenaline and noradrenaline
concentrations increased after deflation of the pneumoperitoneum. The time
profile-concentration changes of increased MAP and renin-aldosterone
suggests a cause-effect relationship. Increased intra-abdominal pressure
and reverse Trendelenburg positioning may reduce cardiac output and renal
blood flow. The early increase in prolactin concentration was probably
secondary to the effect of the opioid fentanyl.
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