Journal of Perioperative Echocardiography

Register      Login

VOLUME 7 , ISSUE 2 ( July-December, 2019 ) > List of Articles

CASE REPORT

Transesophageal Echocardiographic Assessment of Hemodynamic Changes during Laparoscopic Surgeries at High Altitude

Krishna P Gourav, Goverdhan Dutt Puri, Tsering Morup

Keywords : High altitude, Laparoscopic surgeries, Transesophageal echocardiography

Citation Information : Gourav KP, Puri GD, Morup T. Transesophageal Echocardiographic Assessment of Hemodynamic Changes during Laparoscopic Surgeries at High Altitude. J Perioper Echocardiogr 2019; 7 (2):44-47.

DOI: 10.5005/jp-journals-10034-1106

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Anesthesia at high altitudes is challenging due to vast variations in physiology, which are further complicated by the positioning and pneumoperitoneum during laparoscopic surgeries. These changes can be better understood and managed with the help of echocardiography. Here, we demonstrate the effect of laparoscopy on hemodynamics with the help of transesophageal echocardiography (TEE) at high altitudes in three patients. Materials and methods: Three ASA I patients (patient 1, laparoscopic cholecystectomy; patient 2, laparoscopic vaginal hysterectomy; patient 3, laparoscopic hernioplasty with mesh repair) who underwent laparoscopic surgeries at an altitude of 3,500 m were studied. Various parameters were measured by TEE which included left ventricle ejection fraction (EF), left ventricular outflow tract (LVOT) velocity time integral (VTI), cardiac output (CO), E/A, E/eI, tricuspid annular plane systolic excursion (TAPSE), and pulmonary artery acceleration time (PAAT). The mean arterial pressure (MAP), heart rate, SpO2, and end-tidal carbon dioxide were also measured. These parameters were recorded at 10-time points: before induction of anesthesia (T1), before insufflation (T2), after positioning (T3), 5 mm Hg pneumoperitoneum (T4), 10 mm Hg pneumoperitoneum (T5), 14 mm Hg pneumoperitoneum (T6), 10 minutes after 14 mm Hg pneumoperitoneum (T7), 20 minutes after 14 mm Hg pneumoperitoneum (T8), 30 minutes after 14 mm Hg pneumoperitoneum (T9), and 5 minutes after desufflation (T10). Results: We observed a decrease in MAP, LVOT VTI, and CO after pneumoperitoneum when associated with reverse RT position and an increase in MAP, LVOT VTI, and CO when associated with Trendelenburg position. The right ventricular systolic function measured by TAPSE, left ventricular EF, and LV diastolic function remained the same throughout the procedure in all the three patients. Pulmonary artery acceleration time gradually decreased after pneumoperitoneum in all the three patients but stayed in a normal range throughout the procedure. The results of our study are consistent with the previous studies performed at sea level. Conclusion: The present study showed that laparoscopic surgeries may be safely performed in healthy individuals at high altitudes. However, the study was limited by small sample size and done only in healthy subjects.


PDF Share
  1. Rubert CP, Farias FV, Higa RA. Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital. Rev Col Bras Cir 2016;43(1):2–5. DOI: 10.1590/0100-69912016001002.
  2. Atkinson TM, Giraud GD, Togioka BM, et al. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation 2017;135(7):700–710. DOI: 10.1161/CIRCULATIONAHA.116.023262.
  3. Airan M, Appel M, Berci G, et al. Retrospective and prospective multi-institutional laparoscopic cholecystectomy study organized by the society of american gastrointestinal endoscopic surgeons. Surg Endosc 1992;6(4):169–176. DOI: 10.1007/BF02210874.
  4. Cunningham AJ, Turner J, Rosenbaum S, et al. Transoesophageal echocardiographic assessment of haemodynamic function during laparoscopic cholecystectomy. Br J Anaesth 1993;70(6):621–625. DOI: 10.1093/bja/70.6.621.
  5. Dorsay DA, Greene FL, Baysinger CL. Hemodynamic changes during laparoscopic cholecystectomy monitored with transesophageal echocardiography. Surg Endosc 1995;9(2):128–133. ; discussion 133-4.
  6. Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparoscopic cholecystectomy. AnesthAnalg 1993;76(5):1067–1071. DOI: 10.1213/00000539-199305000-00027.
  7. Schiller WR. The trendelenburg position. Surgical requirements. In: Martin JT, ed. Positioning in anesthesia and surgical requirements. Philadelphia: W.B. Saunders; 1987. pp. 112–126.
  8. Lenz RJ, Thomas T, Wilkins G. Cardiovascular changes during laparoscopy: studies of stroke volume and cardiac output using impedance cardiography. Anaesthesia 1976;31(1):4–12. DOI: 10.1111/j.1365-2044.1976.tb11738.x.
  9. Joshi GP, Hein HT, Mascarenhas WL, et al. Continuous transesophageal echo-Doppler assessment of hemodynamic function during laparoscopic cholecystectomy. J Clin Anesth 2005;17(2):117–121. DOI: 10.1016/j.jclinane.2004.06.007.
  10. D’Ugo D, Persiani R, Pennestri F, et al. Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients. Surg Endosc 2000;14(2):120–122. DOI: 10.1007/s004649900080.
  11. Ramos LP, Araújo RB, Castro M, et al. Hemodynamic evaluation of elderly patients during laparoscopic cholecystectomy. Revista do Colégio Brasileiro de Cirurgiões 2018;45(2):e1659. DOI: 10.1590/0100-6991e-20181659.
  12. Murthy TV, Gupta P. Laparoscopic cholecystectomy with pulmonary hypertension: anaesthetic challenges-a case report. Indian J Anaesthe 2008;52(2):217.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.