• M A M Youssef and A saleh Al-Mulhim.
• Department of Anesthesia and ICU, King Fahad Hospital, P.O. Box 1164, Hofuf, Al-Hassa, 31982, Saudi Arabia.
• Surg Endosc. 2007 Sep 1;21(9):1543-8.

BackgroundWith the advent of minimally invasive surgery, laparoscopic cholecystectomy has become the standard treatment for symptomatic gallbladder disease. This study aimed to evaluate the effects of using high- versus low-pressure pneumoperitoneum with different anesthetic techniques on hemodynamics and antidiuretic hormone (ADH) secretion.MethodsFor this prospective study, 60 patients scheduled for elective laparoscopic cholecystectomy were randomly recruited. They were classified into four equal groups: group 1 received general anesthesia with low insufflation pressure (7-9 mmHg); group 2 received general anesthesia with high insufflation pressure (13-15 mmHg); group 3 received general anesthesia in addition to epidural analgesia with low insufflation pressure; and group 4 received general anesthesia in addition to epidural analgesia with high insufflation pressure. Routine intraoperative monitoring was done. The study parameters included heart rate per minute, mean blood pressure (mmHg), and ADH levels (via blood samples) before anesthesia, after induction, 30 and 45 min after abdominal insufflation, and finally, 2 h postoperatively.ResultsThe heart rate showed significant increases after pneumoperitoneum in group 2, as compared with the other three groups. Significant differences in mean blood pressure were observed between the study groups. In groups 1 and 4, mean arterial pressure (MAP) significantly decreased after 15 min, and this decrease persisted until the end of the study. In group 2, MAP significantly increased after 15, 30, 45, and 60 min and after 60 min postoperatively. In group 3, MAP significantly decreased after 30 min, and this decrease persisted 1 h after surgery. There were no significant differences in ADH levels before and after induction of anesthesia among any of the study groups. In groups 1 and 4, no statistically significant changes in ADH levels were observed throughout the study period except a mild increase in ADH levels 30 and 45 min after abdominal insufflation. In group 2, after pneumoperitoneum, there was statistically significant increase in ADH levels from the baseline value of 6.422 +/- 0.551 pmol/l to 7.749 +/- 0.635 pmol/l at 30 min and to 6.457 +/- 0.450 pmol/l at 45 min. In group 3, there was a statistically significant decrease in ADH levels from the baseline value of 6.551 +/- 0.356 pmol/l to 6.125 +/- 0.618 pmol/l at 30 min, to 6.118 +/- 0.491 pmol/l at 45 min, and to 6.169 +/- 0.676 pmol/l at 2 h after abdominal insufflation.ConclusionPneumoperitoneum can affect several homeostatic systems, leading to hemodynamic and hormonal stress responses. The use of general anesthesia plus epidural analgesia with low insufflation pressure, general anesthesia with low insufflation pressure, or general anesthesia plus epidural analgesia with high insufflation pressure is safe and effective in attenuating these responses.

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