RESUMO
Although the technique of laparoscopic cholecystectomy has increasing appeal, physiologic data to support the safety of this procedure are lacking. We studied the cardiovascular changes in 16 patients undergoing laparoscopic cholecystectomy, using impedance cardiography as a noninvasive means of continuous monitoring of cardiac output. Serial measurements of mean arterial pressure (MAP), heart rate (HR), intraperitoneal pressure and expired carbon dioxide tension (PECO2) were also recorded. Results revealed a decrease of 30 percent (p < 0.001) in cardiac index and 5 percent (p = 0.089) in HR, along with increases of 15 percent (p < 0.001) in MAP and of 79 percent (p < 0.001) in the calculated total peripheral resistance index. This elevation in afterload could lead to both an increase in myocardial oxygen consumption and to the potential risk of myocardial ischemia and possibly infarction or congestive heart failure, or both, in patients who are susceptible. The data suggest that patients with a history of cardiac disease should have preoperative cardiac evaluation and be closely monitored during laparoscopic cholecystectomy, as in any other extensive operation.
Assuntos
Colecistectomia Laparoscópica/normas , Hemodinâmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Monitores de Pressão Arterial , Testes Respiratórios , Dióxido de Carbono/análise , Débito Cardíaco , Cardiografia de Impedância , Estudos de Avaliação como Assunto , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória , Consumo de Oxigênio , Fatores de Tempo , Resistência VascularRESUMO
Bradycardia commonly occurs during spinal anesthesia as a result of vagally mediated slowing of sinoatrial (SA) node firing. Peritoneal traction or urinary bladder distension, for example, may serve as a stimulus for SA node inhibition, particularly when thoracic levels of spinal anesthesia interrupt function of the sympathetic limb of the autonomic nervous system. Although atropine dependably reverses such heart rate slowing, we recently encountered, during spinal anesthesia for cystoscopy and retrograde pyelography, bradycardia that was unexpected and refractory to treatment with atropine.
Assuntos
Raquianestesia/efeitos adversos , Bradicardia/etiologia , Ureter/fisiopatologia , Urografia , Idoso , Bradicardia/terapia , Cistoscopia , Humanos , Masculino , ReflexoRESUMO
Intrathoracic intercostal nerve block is a well-described procedure used to provide postoperative pain relief following thoracotomy. The two cases described present possible complications secondary to such blocks and suggest that the routine use of intrathoracic intercostal nerve blocks should be discouraged.