Hemodynamic and pulmonary changes during and after laparoscopic cholecystectomy. A comparison with traditional surgery.

Background: The cardiopulmonary changes experienced by patients who undergo laparoscopic cholecystectomy (LC) and the prognostic value of patient characteristics are not well understood.

Methods: Cardiorespiratory changes were investigated in 120 patients undergoing LC or open cholecystectomy (OC). The results and their relation to patient variables were statistically evaluated.

Results: The most significant cardiorespiratory changes were (A-a)PO2 increase during OC; decrease of pH and compliance and increase of peak airway pressure during LC; impairment of arterial blood gas mean values and respiratory muscle strength; atelectasis and pneumonia (five cases) after OC; and lamellar atelectasis (two cases) after LC. Significant adverse prognostic factors related to intra- and postoperative LC cardiorespiratory changes were ASA class greater than I, FEF75-85% < 900 ml, and PaO2 < 10.4 kPa (PPV, 71.4% and 46.6%, respectively).

Conclusions: LC carries no significant cardiorespiratory changes provided that intraoperative monitoring of hemodynamics and respiratory parameters is done for the study of blood gas values in all patients at risk.