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• W2032159575 abstract "S417 INTRODUCTION: This study was undertaken to assess the peroperative haemodynamic and ventilatory effects of laparoscopic cholecystectomy in patients with pre-existing medical diseases (ASA physical status III) compared to healthy patients. METHODS: The study was conducted on 30 patients scheduled for laparoscopic cholecystectomy. They were allocated into two equal groups: Group I (15 healthy patients, ASA class I-II) and Group II (15 patients with pre-existing medical diseases, ASA class III). All patients were premedicated with I.M midazolam and atropine. Anesthesia was induced using intravenous fentanyl, thiopentone, succinylcholine and was maintained with 50% nitrous oxide in oxygen, and halothane 0.5% with incremental bolus doses of fentanyl and muscular relaxation with vecuronium. CO2 was insufflated intermittently when needed, to maintain an intra-abdominal pressure at 12-15 mm Hg. Monitoring of SBP, HR, SPO2, end-tidal CO2 and blood gases was carefully done. RESULTS: Changes of haemodynamic variables (MAP, HR), in both groups of the present study, were statistically significant compared to pre-induction values, yet were within the clinically acceptable range. Regarding the ventilatory changes in both groups, the mean end tidal and arterial carbon dioxide tension increased significantly with insufflation reaching a maximum level at T8 (60 minutes after insufflation). In both groups, CO2 insufflation resulted in increased mean end tidal CO2, arterial CO2 tension, peak airway pressures, and a simultaneous decrease in the mean values of PaO2 and percentage of O2 saturation. These changes were more accentuated with sudden increase in intra-abdominal pressures and were more pronounced in Group II. The Pa-ETCO2 gradient showed a significant increase in Group II (range of 5.94-9.68 mmHg). The adverse cardiopulmonary effects of CO2 pneumoperitoneum in Group II were more marked (arrhythmias, episodes of hypertension, hypoxia) and required meticulous medical intervention. Two patients in Group II were nursed postoperatively in the ICU with a chest T-tube for 24 hours until their general condition stabilized. One other patient was discarded from the study due to conversion to open cholecystectomy, following the development of respiratory acidosis and failure of all attempts at correction. CONCLUSION: Whereas cardiopulmonary changes during laparoscopic cholecystectomy are not hazardous in the healthy patient, special care, judicious invasive monitoring and careful interpretation are mandatory in all patients with pre-existing medical diseases (ASA class III)." @default.
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• W2032159575 title "HAEMODYNAMIC AND VENTILATORY CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY IN MEDICALLY-COMPROMISED PATIENTS" @default.
• W2032159575 doi "https://doi.org/10.1097/00000539-199902001-00414" @default.
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