Central hemodynamic changes during cholecystectomy in patients with cholelithiasis due to IHD

Aim. To evaluate central hemodynamic changes during laparoscopic cholecystectomy in patients with cholelithiasis and concurrent coronary heart disease.

Materials and Methods. The baseline hemodynamic status of 78 patients with cholelithiasis and chronic calculous cholecystitis was analyzed during their hospitalization for surgical treatment between 2020 and 2023. Dynamic echocardiography was performed on all patients at various stages of laparoscopic cholecystectomy. Among these, 36 patients with cholelithiasis but no concomitant diseases demonstrated a normodynamic (eukinetic) type of blood circulation.

Results. Blood circulation types (normodynamic, hypodynamic, and hyperdynamic) were identified in the 78 patients and were considered when planning preoperative preparation, surgical strategies, and anesthesia approaches. Intraoperative monitoring of central hemodynamics revealed significant changes, especially in patients with concomitant cardiovascular disease and a hypodynamic circulation type. Creation of pneumoperitoneum in all patients was associated with decreased stroke volume, cardiac index, and cardiac output, alongside an increase in systemic vascular resistance (SVR). Therefore, for patients with coronary heart disease and a hypodynamic type of circulation, a gentle pneumoperitoneum regimen at 8-9 mmHg is recommended.

Conclusions. Laparoscopic procedures involving carbon dioxide insufflation into the abdominal cavity result in increased intra-abdominal pressure. To minimize hemodynamic disturbances, it is recommended that laparoscopic cholecystectomy in patients with cholelithiasis and concurrent cardiovascular disease be conducted under a low-pressure pneumoperitoneum regimen (8-9 mmHg).

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