Perioperative Cardiac Morbidity After Laparoscopic Cholecystectomy

ixty patients scheduled for laparoscopic cholecystectomyunder general anaesthesia were included in this study. They weredivided into three equal groups acording to the type of the patient.Group I included 20 patients young and healthy, group II included 20geriatric patients free from a history of myocardial ischaemia andgroup III included 20 geriatric patients with a history of myocardialischaemia.Routine pre-anaesthetic work-up included history, physicalexamination and routine full laboratory investigations were done.Patients with a history of recent pulmonary disease, abnormal physicalfinding or who smoked were excluded from the study. Other criteriafor exclusion were hypertension and diabetes.The following parameters were recorded pre-operatively; age,weight, respiratory rate, pulse rate and arterial blood pressure.The patients were premedicated with atropine sulphate 0.01mg/kg-1 i.m 20 minutes before operation. On arrival to the operationroom, patients were anaesthetized with fentanil 1-2 μg/kg-1 5-10minutes before induction of anaesthesia, sleeping dose of thiopentonesodium 3-4 mg/kg-1 and tracheal intubation was facilitated withsuccinyle choline 1 mg/kg-1 and maintained with oxygen andhalothane 0.5-1%. Pipecuronium was used for maintenance ofanaesthesia. Ventilation was controlled with ventilator setting(respiratory rate 12 breath/min.). Tidal volume 8 ml/kg-1 affordingnormocapnia (end tidal Cot between 30-40 mmHg). Intraoperativefluid management was also standardized and consisted of 10 ml/kg-1intravenous bolus of lacted Ringer’s solution before induction ofanaesthesia followed by 6 ml/kg-1111 infusion of the same solution.Pneumoperitoneum was established in the horizontal position and thepatients were positioned in reverse trendelenburg position. At the endof operation, neuromuscular blocked was revrsed by neostigminemethyle bromide (50 μg/kg-1) mixed with atropine sulphate (0.01mg/kg-1) i.v.