Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients

Abstract

Background: This study aimed by means of transesophageal echocardiography, to evaluate hemodynamic changes induced by pneumoperitoneum in patients with normal cardiac performance.

Methods: In this study, 11 ASA I–II patients (mean age, 39 years) with normal cardiac performance undergoing laparoscopic cholecystectomy were evaluated. A 5-MHz transesophageal biplane phased-array transducer connected to an echocardiographer was inserted after induction of anesthesia. Data were collected at three different times: before insufflation (T1), 10 min after insufflation (T2), and 5 min after desufflation (T3). At these same times, heart rate, systolic blood pressure, diastolic blood pressure, end-tidal carbon dioxide (CO₂), and peak airway pressure were recorded. Statistical analysis was performed using one-way and two-way analysis of variance (ANOVA). A p value less than 0.05 was considered significant.

Results: End-systolic and end-diastolic diameters of the left ventricle, contractility, and performance parameters did not change significantly. Conversely, at insufflation, color Doppler area of the mitral backflow increased significantly (p < 0.05) when already present or showed up abruptly (T1: 0.22 ± 0.28 cm²; T2: 1.28 ± 1.02 cm²; T3: 0.49 ± 0.53 cm²).

Conclusions: Such an event is not interpreted as a mitral insufficiency. It is possibly the result of a ``contrast effect’’ caused by the absorption of CO₂ microbubbles in the blood.