Hemodynamic changes during laparoscopic radical cystectomy in urinary bladder cancer

TIAN Li-ping; CHEN Hui-qun; LEI Hong-yi; YE Xiao-ping; ZENG Fan-rong; ZHANG Hong-fei; XU Shi-yuan

Abstract：Objective To comprehensively monitor and analyze the hemodynamic changes during laparoscopic radical cystectomy in urinary bladder cancer.Methods Fifteen ASA classification of Ⅰ~Ⅱadult patients with urinary bladder cancer scheduled for elective laparoscopic radical cystectomy were included in the study .A thermodilution femoral artery catheter was inserted into the right femoral artery under local anesthesia before induction, to monitor hemodynamic parameters including preload, afterload, cardiac function and heart rate ( HR) .Data were collected and analyzed at 7 time points:before induction of anesthesia ( T1 ) , 5 minutes after intubation ( T2 ) , 5 minutes after pneumoperitoneum and change of posture (T3), 1 hour after pneumoperitoneum (T4), 5 minutes after the abdomen was opened (T5), 1 hour after the abdomen was opened (T6) and the end of surgery (T7).Results (1)Compared with T1 and T2 respectively, central venous pressure(CVP) was significantly higher at T3 and T4 (P<0.01), stroke volume variability(SVV) and pulse pressure variability(PPV) were significantly lower at T3 (P<0.05);compared with T2, intrathoracic blood volume index(ITBI) was significantly higher at T3 (P<0.05).(2)Compared with T1, cardiac index(CI) was significantly lower at T2~T6 (P<0.05).(3)Compared with T1, HR and mean arterial pressure(MAP) were significantly lower at T2 (P<0.05);compared with T2, HR was significantly lower at T3 (P<0.05), MAP was significantly higher at T3~T7 (P<0.05).Conclusion Patients undergo dramatic hemodynamic changes during laparoscopic radical cystectomy.ITBI, SVV or PPV may be better indicators than CVP of cardiac preload in this case.