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British Journal of Anaesthesia, Vol 78, Issue 3 264-266, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Role of vasopressin in the haemodynamic response to laparoscopic cholecystectomy

A. D. Walder and A. R. Aitkenhead
University Department of Anaesthesia, University Hospital, Queens Medical Centre, Nottingham NG7 2UH

We studied 10 patients undergoing laparoscopic cholecystectomy (group 1) and five control patients (group 2). We measured heart rate, arterial pressure, right atrial pressure (RAP), cardiac index (CI), systemic vascular resistance index (SVRI), intrathoracic pressure (ITP), plasma osmolality, adrenaline, noradrenaline and arginine vasopressin (aVP) concentrations, and serum renin activity (SRA), and calculated the atrial transmural pressure gradient (ATPG). We recorded significant decreases in mean arterial pressure (MAP), SVRI and CI in both groups (P < 0.05) after induction of anaesthesia. MAP and SVRI increased (P < 0.01) while CI decreased further in group 1 patients during the pneumoperitoneum. In group 1 plasma aVP concentration increased after insufflation of the pneumoperitoneum to a level sufficient to cause the recorded haemodynamic changes. ATPG decreased in group 1 patients during the pneumoperitoneum and this is a recognized trigger for aVP release.
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