Key result
Low-pressure laparoscopic cholecystectomy is associated with hemodynamic stability and zero postoperative complications in older adults.
Why the study?
In elderly patients with limited cardiac reserve, pneumoperitoneum during laparoscopic cholecystectomy causes dangerous hemodynamic alterations, and anesthetic implications need analysis.
Observational (n=121)
Hypothesis-generating for low-pressure pneumoperitoneum in elderly cholecystectomy; prospective trials needed before clinical adoption.
BackgroundThe gallbladder stone is 20-40% of geriatric diseases. Inelderly patients with limited cardiac reserve the pneu-moperitoneum determines dangerous alterations of thecardiac output and other hemodynamic variables. Thefrequent co-morbidity in elderly people leads to a severeprognosis in these patients with surgical high mortalityand morbidity rates in open surgery (1) otherwise thelaparoscopic procedure is followed by lower mortalityand morbidity rates (0-0.6% vs 1.4%). (2,3,4). The gra-dual abdominal insufflation to 12 mmHg followed by alimited 10 degree head-up tilt is associated with cardio-vascular stability in elderly ASA III patients (5).The aim of our study was to analyze hemodynamicmodifications during surgical treatment by laparoscopiccolecistectomy and the anesthetic implications.Materials and methods121 patients aged over 65 years old were analyzed whounderwent laparoscopic cholecistectomy . The operationwas conducted with a low pressure of CO2 (8-10mmHg).We observed the hemodynamic trend duringthe anesthesia: blood pressure, heart rate, respiratoryrate, Tidal Volume and end Tidal C0
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Paratore et al. (2010) conducted an observational in Gallbladder stones requiring cholecystectomy (n=121). Laparoscopic cholecystectomy was evaluated on Hemodynamic and blood gas modifications during anesthesia. Laparoscopic cholecystectomy utilizing low-pressure pneumoperitoneum (8-10 mmHg) in patients over 65 years old demonstrated hemodynamic safety with no observed postoperative complications.
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