Impact of Capnoperitoneum on Cardiac Output and Total Peripheral Resistance in Hypertensive Patients During Laparoscopic Surgery: A Prospective Observational Study

Abstract

Background: Laparoscopic surgery induces significant hemodynamic changes due to pneumoperitoneum. The cardiovascular response in hypertensive patients may differ from normotensive individuals. Objective: To evaluate changes in cardiac output and total peripheral resistance in hypertensive patients during capnoperitoneum under general anesthesia and compare these changes with normotensive controls. Methods: This prospective observational study included 70 patients (35 hypertensive, 35 normotensive) undergoing elective laparoscopic surgery. Dynamic cardiac functions were monitored using bio-reactance-based non-invasive cardiac output monitoring. Parameters were recorded at predetermined intervals from pre-induction through recovery. Results: Hypertensive patients showed higher baseline TPR (1743.06 ± 293.39 vs 1507.86 ± 320.67, p=0.0021) and lower cardiac output (4.41 ± 0.42 vs 4.73 ± 0.76 L/min, p=0.0317). During pneumoperitoneum, TPR increased maximally by 58.7% in hypertensive patients compared to 24.5% in normotensive patients. Maximum cardiac output decrease was 15.5% at 15 minutes in hypertensive patients versus 11.8% at 5 minutes in normotensive patients. Amlodipine monotherapy (88.5% of hypertensive patients) showed more stable hemodynamic profiles compared to combination therapy. Perioperative complications were minimal in both groups. Conclusion: Hypertensive patients demonstrate more pronounced hemodynamic changes during laparoscopic surgery, with delayed recovery patterns. However, with appropriate monitoring and management, laparoscopic procedures can be safely performed in wellcontrolled hypertensive patients.