INDIRECT MEASUREMENT OF INTRA-ABDOMINAL PRESSURE IN ELDERLY PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY: CLINICAL SIGNIFICANCE AND PROGNOSTIC VALUE

Abstract

Intra-abdominal hypertension remains a frequent and clinically significant complication in elderly patients after laparoscopic cholecystectomy. The study comparatively evaluated dynamics of intra-abdominal pressure (IAP) measured indirectly via bladder in the early postoperative period depending on the anesthesia technique.

Eighty patients aged 60–74 years (ASA II–III) were divided into two groups: total intravenous anesthesia (TIVA, n=40) and combined multimodal anesthesia with epidural component (CMA, n=40). Measurements were performed before surgery, 30 min after desufflation, 6 h, 24 h and 48 h postoperatively.

The CMA group demonstrated significantly faster and more complete normalization of IAP: median values at 30 min, 6 h, 24 h and 48 h were 9.1; 7.8; 6.5 and 6.2 mmHg respectively (vs 11.8; 10.4; 8.9 and 7.6 mmHg in TIVA group, p<0.001–0.002). Time to reach IAP ≤8 mmHg was approximately 18 hours in CMA vs 38 hours in TIVA.

The obtained results indicate that prolonged epidural analgesia should be considered the method of choice for postoperative pain management in elderly patients after laparoscopic cholecystectomy in order to minimize the duration and severity of postoperative intra-abdominal hypertension.