Peculiarities of perioperative intensive therapy in patients with an acute calculous cholecystitis

Abstract

Objective. To study perioperative changes in hemodynamics, the oxygen state and metabolism in patients, suffering an acute calculous cholecystitis, and to determine the methods of their correction. Materials and methods. The investigation was based on 131 patients, suffering an acute calculous cholecystitis, to whom laparoscopic cholecystectomy under general anesthesy was performed. The risk value, determined in accordance to classification of American Society of Anesthesiologists, have constituted Class II-ІV. The patients were divided into two groups. The first one have consisted of 63 patients, in whom intensive therapy, directed on support of vital functions, was conducted, while in a second group (68 patients) the data of indirect calorimetry were used additionally. Results. On the stage of the patients staying in reverse position of Trendelenburg, the adjustment of pneumoperitoneum and the operation beginning the lowering of hemodynamics indices, the oxygen state and metabolic disorders have had more pronounced features in patients of the first group, and their restoration was more durable. The second group patients on background of powered infusion therapy and introduction of glucocorticoids were restored more intensively, they woke up more early, the intensive department stay was shorter, emesis and regurgitation have occurred in them in 2.4 times more rarely, and severity of postoperative pain after waking up was lower (р < 0.05). Conclusion. In patients, suffering an acute calculous cholecystitis, laparoscopic cholecystectomy is more secure on background of the hemodynamics, the oxygen state and metabolism corrected.

Keywords

• an acute calculous cholecystitis
• laparoscopic cholecystectomy