**2.1 Cases**

Popken et al [1] published a study regarding patients with cardiopulmonary impairment where they used laparoscopic cholecystectomy in 19 high-risk patients (ASA IV) and 465 patients with a lower operative risk (ASA I-III). The authors state that out of 484 patients, there were 5 percent who suffered intraoperative cardiopulmonary complications. There were three who belonged to the high-risk group (15.8%) and 21 to the lower risk groups (4.5%). There were general postoperative complications that occurred in 14 cases (2.9%). The authors noted that the number of days spent in hospital was 4.96 to 7.6 in average days in the high-risk group versus 2.23 to 4.8 days in groups ASA I-III. They concluded that highrisk patients shows a raise perioperative rate of complications in laparoscopic cholecystectomy but they also stated that it is not basically a contraindication for this operative method.

Tillman et al. [2] also investigated their laparoscopic cholecystectomy cases in 17 patients with severe cardiac dysfunction. They reported that there were three of the 17 patients who required administration of nitroglycerin to maintain the MAP and SVR within the accepted limits while one also required administration of dobutamine to maintain CI. There was no myocardial morbidity or mortality in the perioperative period according to their report. They concluded that laparoscopic cholecystectomy in patients with severe cardiac dysfunction results in significant hemodynamic changes.
