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- Title
Acute congestive heart failure after laparoscopic cholecystectomy: a case report.
- Authors
Giaquinto D; Swigar K; Johnson MD
- Abstract
Compared with open procedures, laparoscopic surgery is safe with a low incidence of complications. In rare circumstances, however, intraoperative complications such as acute pulmonary edema have been reported. The patient described herein is a 59-year-old woman with obesity, gastroesophageal reflux disease, and chronic obstructive pulmonary disease who developed acute congestive heart failure (CHI) and cardiomegaly immediately following laparoscopic cholecystectomy. She required emergent reintubation, diuresis, and admission to the intensive care unit for postoperative mechanical ventilation.Potential causes of pulmonary edema associated with laparoscopic surgery (extreme Trendelenburg position, venous carbon dioxide embolism, absorption of crystalloid irrigation fluid, cardiopulmonary disease, adverse drug reactions, negative pressure [postobstructive pulmonary edema]) were considered. A process of exclusion revealed that the hemodynamic changes induced by insuflation with an intro-abdominal pressure of 20 mm Hg were the most likely causes of the CHF Suggestions to prevent occurrence of CHF are tight control of hemodynamics with use of invasive monitoring in high-risk patients and gentle, slow insufflation of the abdomen to an intro-abdominal pressure of 15 mm Hg or less. Intraoperative and/or postoperative CHF should be treated with diuretics, intravenous nitroglycerin, arterial vasodilators, and/or inotropic agents as needed.
- Publication
AANA Journal, 2003, Vol 71, Issue 1, p17
- ISSN
0094-6354
- Publication type
Journal Article