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DOI: 10.1055/s-2005-861195
Prospective Comparison of Cardiopulmonary Events during Minilaparoscopy and Colonoscopy under Conscious Sedation
Publication History
Submitted 27 June 2004
Accepted after Revision 16 November 2004
Publication Date:
20 April 2005 (online)
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Background and Study Aims: Cardiorespiratory parameters were examined throughout diagnostic minilaparoscopy procedures. The same parameters were analyzed during colonoscopy, and the data were compared.
Patients and Methods: Sixty-five consecutive unselected patients undergoing minilaparoscopy (group 1: ASA I, n = 34; group 2: ASA II/III, n = 31) and 61 consecutive unselected patients undergoing colonoscopy (group 3: ASA I, n = 31; group 4: ASA II/III, n = 30) were included. Oxygen saturation (Sao2), heart rate (HR) and mean arterial pressure (RRm) were measured continuously, and 12-lead electrocardiography (ECG) recordings were made at specific times during each procedure.
Results: Minor differences were observed, particularly after premedication, probably due to different dosage regimens and timing in the two examination techniques. After premedication, testing for differences from baseline values showed a minor decrease in Sao2 and RRm in the minilaparoscopy groups in comparison with the colonoscopy groups (median Sao2, group 1: 99.9 % ± 0 vs. group 3 : 100 % -1, P = 0.0078; median RRm, group 1: 99.5 - 4 mm Hg vs. group 3 : 96 -16 mm Hg, P = 0.046, and median RRm, group 2 : 110 + 1 mm Hg vs. group 4 : 101 -13.5 mm Hg, P = 0.0007). HR increased in minilaparoscopy in comparison with colonoscopy (median HR: group 2 : 77 + 4 beats/min vs. group 4 : 75.5 ± 0 beats/min; P = 0.01). Comparison of defined relevant pathological changes in Sao2, RRm, HR, and ECG showed no significant differences.
Discussion: These data indicate that diagnostic minilaparoscopy under conscious sedation is only associated with limited risk in patients with compensated cardiopulmonary diseases. This is probably due to the low insufflation pressure used.
References
- 1 Safran D B, Orlando R . Physiologic effects of pneumoperitoneum. Am J Surg. 1994; 167 281-286
- 2 Puri G D, Singh H. Ventilatory effects of laparoscopy under general anaesthesia. Br J Anaesth. 1992; 68 211-213
- 3 Kashtan J, Green J F, Parsons E Q, Holcroft J W. Hemodynamic effect of increased abdominal pressure. J Surg Res. 1981; 30 249-255
- 4 Helmreich-Becker I, Meyer zum Büschenfelde K H, Lohse A W. Safety and feasibility of a new minimally invasive diagnostic laparoscopy technique. Endoscopy. 1998; 30 756-762
- 5 Thompson A M, Park K G, Kerr F, Munro A. Safety of fibreoptic endoscopy: analysis of cardiorespiratory events. Br J Surg. 1992; 79 1046-1069
- 6 Brown D R, Fishburne J L, Roberson V O, Hulka J F. Ventilatory and blood gas changes during laparoscopy with local anesthesia. Am J Obstet Gynecol. 1976; 124 741-745
- 7 Küstner W, Fischer J, Schmid E, Ritter U. [Effect of laparoscopy on arterial blood gases; in German.] Z Gastroenterol. 1971; 9 346-352
- 8 Baratz R A, Karis J H. Blood gas studies during laparoscopy under general anesthesia. Anesthesiology. 1969; 30 463-464
- 9 Ho H S, Gunther R A, Wolfe B M. Intraperitoneal carbon dioxide insufflation and cardiopulmonary functions: laparoscopic cholecystectomy in pigs. Arch Surg. 1992; 127 928-932
- 10 Westerband A, van de Water J M, Amzallag M. et al . Cardiovascular changes during laparoscopic cholecystectomy. Surg Gynecol Obstet. 1992; 175 535-538
- 11 Joris J L, Chiche J D, Canivet J L. et al . Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998; 32 1389-1396
- 12 O’Leary E, Hibbard K, Tormey W, Cunningham A J. Laparoscopic cholecystectomy: hemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth. 1996; 76 640-644
- 13 Lechner H J. Der Einfluss der Laparoskopie auf das EKG. Z Gastroenterol. 1969; 7 98-101
- 14 Todesco S, Muraca M, Glorioso S, Okoliscsanyi L. Electrocardiogram, arterial and central venous pressure during laparoscopy under local anesthesia. Endoscopy. 1977; 9 82-86
- 15 Schenk K E. Häufigkeit von Extrasystolen bei Endoskopien. Fortschr Med. 1986; 13 271-274
- 16 Safran D, Sgambati S, Orlando R . Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet. 1993; 176 548-554
- 17 Froehlich F, Thorens J, Schwizer W. et al . Sedation and analgesia for colonoscopy: patient tolerance, pain and cardiorespiratory parameters. Gastrointest Endosc. 1997; 45 1-9
- 18 Fennerty M B, Earnest D L, Hudson P B, Sampliner R E. Physiologic changes during colonoscopy. Gastrointest Endosc. 1990; 36 22-25
- 19 Ristikankare M, Julkunen R, Mattila M. et al . Conscious sedation and cardiorespiratory safety during colonoscopy. Gastrointest Endosc. 2000; 52 48-54
U. Denzer, M. D.
First Dept. of Medicine · Johannes Gutenberg University
Langenbeckstrasse 1 · 55131 Mainz · Germany
Fax: +49-6131-175552
Email: denzer@mail.uni-mainz.de