Noninvasive pulse wave analysis for monitoring the cardiovascular effects of CO2 pneumoperitoneum during laparoscopic cholecystectomy

Aims: Peritoneal insufflation results in hemodynamic changes during laparoscopic cholecystectomy. The aim of the present work to test whether non-invasive applanation tonometry is suitable for reflecting these hemodynamic alterations. Patients and methods: 41 patients undergoing laparoscopic cholecystectomies were monitored using SphygmoCor pulse wave analysing system. Peripheral blood pressures (PBP), central aortic blood pressures (CBP), augmentation index (ALX@HR75) and subendocardial viability ration (SVR) were measured at rest (Phase 1), after anesthetic induction (Phase 2), after peritoneal inflation (Phase 3) and after peritoneal deflation. Results: Induction of anesthesia resulted in a statistically significant reduction in both the peripheral blood pressure and central aortic pressures, accompanied by a decrease in augmentation pressure and augmentation index. Peripheral blood pressures did not change markedly along with the peritoneal cavity insufflation, except for the moderate increase in systolic blood pressure. In contrast to this, a marked increase could be observed in central aortic pressure values that was accompanied by increased augementation pressure and augmentation index, indicating a rise in peripheral arterial stiffness. Conclusions: Sphigmocor pulse wave analysis system can be reliably used for detecting and monitoring cardiovascular changes occuring during laparoscopic cholecystectomy.