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Abstract
Summary
Laparoscopic cholecystectomy is gaining wide acceptance as the procedure of choice by most patients and surgeons mainly because of the markedly more rapid recovery compared with the open procedures.
The aim of the present work was to evaluate stress response to carbon dioxide pneumoperitoneum and haemodynamic changes in laparoscopic cholecystectomy.
The study was carried out on 40 adult patients of both sexes. They were subdivided into two groups. (each one included 20 patients).
In G I, Elective open cholecystectomy was done.
In G II, Elective laparoscopic cholecystectomy was done
Heart rate increased significantly after induction of anesthesia in both groups. In G II, it increased significantly at start of peritoneal insufflation, 15, 30, 45, and 60 minutes after that and immediately after recovery. There was a significant increase in heart rate in G II in comparison to G I at start of insufflation and 15 minutes after that.
Mean arterial pressure increased significantly after induction of anesthesia in both groups. In G II, It increased significantly 15, 30, 45 and 60 minutes after start of insufflation. Comparing both groups, MAP was significantly increased during the insufflation period. MAP and HR returned to the preoperative values after desufflation.
Serum Na and K concentrations did not change significantly in either group during the whole period of the study. Comparison of both groups revealed that serum K concentration was significantly higher in G II than
G I at 60 minutes intraoperatively and at the end of operation.
PaCO2 decreased significantly in G I at start of surgery, 30 and 60 minutes after that and at the end of operation. This was associated with a significant increase in pH with no change in serum bicarbonate, base excess, PaO2 or oxygen saturation. In G II, there was a significant decrease in PaCO2 with a significant increase in pH at start of peritoneal insufflation with no change in serum bicarbonate or base excess. 30 minutes after start of insufflation, there was an insignificant change in PaCO2 associated with significant decreases in pH, HCO3- and BE. Sixty minutes after start of insufflation and at the end of operation, PaCO2 increased significantly with a significant decrease in pH, HCO3- and BE.
Comparing both groups, PaCO2 increased significantly while pH, HCO3- and BE decreased significantly in G II in comparison to G I 30 and 60 minutes after start of insufflation and at the end of operation. There were insignificant changes in PaO2 and oxygen saturation during the whole period of the study in both groups.
Serum cortisol levels increased significantly in a progressive manner in both groups until the end of operations. Comparing both groups, no significant differences were noted during the whole period of the study.
C-Reactive protein levels were significantly lower in G II than in G I on the 1st, 3rd and 5th postoperative days respectively.