**2. Patients with cardiopulmonary diseases**

Hemodynamic and respiratory effects of the pneumoperitoneum are the most common hazards of surgical intervention in cardiac and pulmonary disease patients. Popken[1] stated

Laparoscopic Cholecystectomy in High Risk Patients 29

resuscitation. Researchers said that even if consciousness is restored, neurologic deficit may remain in hyperglycemic patients. [5] Therefore it is important to maintain an adequate plasma glucose level (120-180 mg/dl) during anesthesia as well as in the pre-operative

Specialists agree that in order to achieve strict plasma glucose control, the plasma glucose level is checked and controlled with hypoglycemic agent such as insulin regularly and frequently which helps prevent acute and chronic complications of DM. They said that stress caused by surgery and anesthesia induces hyperglycemia causing higher blood glucose levels in DM patients who underwent surgery than in patients who did not have

Bedirli et al. [8] gathered the data for their laparoscopic cholecystectomy cases where there are eight hundred sixty-two patients with symptomatic gallbladder stones who underwent laparoscopic cholecystectomy. They took into consideration the age, sex, risk classification of the American Society of Anesthesiologists (ASA), laboratory tests, operative records, morbidity and length of hospital stay for each patient. They noted that almost half of their cholecystectomies which comprised 111 patients were performed as acute surgery due to cholecystitis. There were conversions to open surgery which were required in 16% of the diabetic patients undergoing LC. They concluded that when feasible, LC was a safe

Paajanen et al [9] studied 2,548 consecutive patients (1,581 LC, 967 OC) with symptomatic gallstones who underwent cholecystectomy. They summed up that from 1995 and 2008, they operated 227 patients with diabetes 45 of these patients had type 1 diabetes. They made a comparison with the preoperative data and the operative outcome of the diabetic patients who underwent laparoscopic cholecystectomy and open cholecystectomy. They had observed that more complications occur in the open cholecystectomy group than in the laparoscopic cholecystectomy group. Upon their analysis they stated that comorbidities of diabetes were associated with an elevated risk for complications but obesity or acute surgery was not independently associated with postoperative complications. The authors concluded that laparoscopic cholecystectomy is a safe procedure in diabetic patient as compared to open cholecystectomy where there is a significant reduction in operative risks

period.

surgery. [5]

**3.1 Cases** 

procedure in diabetes.

and complications.

that the advantages of laparoscopic cholecystectomy are more rapid recovery of lung function and a shorter stay in hospital. Catani [4] declared that changes in cardiovascular function due to the insufflation are characterized by an immediate decrease in cardiac index and an increase in mean arterial blood pressure and systemic vascular resistance.
