TY - JOUR
T1 - Pulmonary function and stress response after laparoscopic cholecystectomy
T2 - Comparison with subcostal incision and influence of thoracic epidural analgesia
AU - Rademaker, B. M.
AU - Ringers, J.
AU - Odoom, J. A.
AU - De Wit, L. T.
AU - Kalkman, C. J.
AU - Oosting, J.
PY - 1992
Y1 - 1992
N2 - Laparoscopic cholecystectomy (LPC) is increasingly used to treat symptomatic cholelithiasis. We compared the effects of cholecystectomy by subcostal incision to those of LPC on lung function and endocrine metabolic response. The effects of thoracic epidural analgesia for LPC were studied as well. Thirty patients undergoing elective cholecystectomy under general anesthesia were allocated to three study groups: group I, cholecystectomy by subcostal incision; group II, LPC; group III, LPC and epidural analgesia with 0.5% bupivacaine with epinephrine, followed by continuous epidural infusion of 6 mL of 0.5% bupivacaine. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 s were measured with the patients in a half-sitting position. In all groups, sustained decreases in FVC, forced expiratory volume in 1 s, and peak expiratory flow were observed up to 24 h after surgery. Reduction of FVC was significantly more in group I compared with groups II and III (P < 0.05). The FVC in group I decreased from 3.8 ± 0.42 (SD) to 1.1 ± 0.27 L (P < 0.01), in group II from 3.6 ± 1.46 to 2.1 ± 0.94 L (P < 0.05), and in group III from 3.8 ± 0.92 to 2.8 ± 0.90 L (P < 0.05). In all groups, plasma glucose and cortisol increased after surgery compared with baseline levels (P < 0.05). At 240 min after surgery, a small but significant decrease of cortisol was measured in group III (P < 0.05). Patients in groups I and II received significantly more fentanyl during surgery and nicomorphine postoperatively compared with patients in group III (P < 0.05). In group III, epidural analgesia decreased visual analogue pain scores (P < 0.05), but there was no difference in pain scores between groups I and II. In conclusion, the endocrine metabolic response is not abolished after LPC. Thoracic epidural analgesia decreased postoperative pain and possibly attenuated the metabolic endocrine response, but it did not improve lung function after LPC. Nevertheless, pulmonary function is significantly better after LPC than after cholecystectomy via subcostal incision.
AB - Laparoscopic cholecystectomy (LPC) is increasingly used to treat symptomatic cholelithiasis. We compared the effects of cholecystectomy by subcostal incision to those of LPC on lung function and endocrine metabolic response. The effects of thoracic epidural analgesia for LPC were studied as well. Thirty patients undergoing elective cholecystectomy under general anesthesia were allocated to three study groups: group I, cholecystectomy by subcostal incision; group II, LPC; group III, LPC and epidural analgesia with 0.5% bupivacaine with epinephrine, followed by continuous epidural infusion of 6 mL of 0.5% bupivacaine. Forced vital capacity (FVC), peak expiratory flow, and forced expiratory volume in 1 s were measured with the patients in a half-sitting position. In all groups, sustained decreases in FVC, forced expiratory volume in 1 s, and peak expiratory flow were observed up to 24 h after surgery. Reduction of FVC was significantly more in group I compared with groups II and III (P < 0.05). The FVC in group I decreased from 3.8 ± 0.42 (SD) to 1.1 ± 0.27 L (P < 0.01), in group II from 3.6 ± 1.46 to 2.1 ± 0.94 L (P < 0.05), and in group III from 3.8 ± 0.92 to 2.8 ± 0.90 L (P < 0.05). In all groups, plasma glucose and cortisol increased after surgery compared with baseline levels (P < 0.05). At 240 min after surgery, a small but significant decrease of cortisol was measured in group III (P < 0.05). Patients in groups I and II received significantly more fentanyl during surgery and nicomorphine postoperatively compared with patients in group III (P < 0.05). In group III, epidural analgesia decreased visual analogue pain scores (P < 0.05), but there was no difference in pain scores between groups I and II. In conclusion, the endocrine metabolic response is not abolished after LPC. Thoracic epidural analgesia decreased postoperative pain and possibly attenuated the metabolic endocrine response, but it did not improve lung function after LPC. Nevertheless, pulmonary function is significantly better after LPC than after cholecystectomy via subcostal incision.
UR - http://www.scopus.com/inward/record.url?scp=0026784829&partnerID=8YFLogxK
M3 - Article
C2 - 1387297
AN - SCOPUS:0026784829
SN - 0003-2999
VL - 75
SP - 381
EP - 385
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 3
ER -