Haemodynamic changes during laparoscopic cholecystectomy in the high-risk patient.

Although laparoscopic cholecystectomy (LC) has become the standard surgical procedure for the treatment of gall stones, the question has still to be answered whether it is safe for critically ill patients with cardiac disease. 20 ASA-class III/IV patients were monitored during LC by means of a Swan-Ganz catheter. Commencement of anaesthesia led to a significant decrease of mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index. Increasing intra-abdominal pressure by insufflation of CO2 and surgical stimuli during gall bladder dissection induced an increase of pulmonary arterial occlusion pressure mean pulmonary artery pressure and central venous pressure (p = 0.05). Mean arterial pressure, cardiac index, stroke volume index and left ventricular stroke work index remained below pre-induction values (p < 0.05). In 13 patients with high filling pressures the administration of nitroglycerine improved all parameters. In the post-anaesthetic care unit all parameters had returned towards baseline. In conclusion, LC may lead to temporary myocardial insufficiency. Nevertheless, LC seems to be safe provided that pathological alterations are recognised and treated.