We studied the haemodynamic changes induced by pneumoperitoneum (PP) in elderly patients with increased cardiac risk (ASA class III; n = 10; age 72.3 ± 8.8 years, mean±SD, P < 0.05; group 2) and compared the results with patients at normal risk (ASA class I, II; n = 12; age 55.6 ± 11.8 years; group 1). Thermodilution measurements were performed after induction of general anaesthesia (T1), after onset of PP (T2, intraabdominal pressure 14 mmHg) and after additional 15° head-up tilt (T3). In both groups PP, as compared with T1, induced a significant increase in mean arterial pressure (MAP, mmHg, group 1:77 ± 14 to 96 ± 18, P < 0.05/group 2:75 ± 10 to 102 ± 18, P < 0.01), mean pulmonary artery pressure (MPAP, mmHg: 15 ± 5 to 22 ± 4, P < 0.01/18 ± 3 to 25 ± 5, P < 0.01), central venous pressure (CVP, mmHg: 7 ± 2 to 15 ± 3, P < 0.01/7 ± 2 to 12 ± 2, P < 0.01), pulmonary capillary wedge pressure (PCWP, mmHg: 9 ± 4 to 16.3, P < 0.01/8 ± 2 to 15 ± 6, P < 0.01) and in systemic vascular resistance (SVR, dynes s cm−5: 1415 ± 375 to 1873 ± 412, P < 0.01/1502 ± 360 to 2067 ± 647, P < 0.01). Cardiac index (CI, L min−1 m−2: 2.3 ± 0.3 to 1.9 ± 0.3, P < 0.05/2.2 ± 0.4 to 2.2 ± 0.5 P = 0.76) and oxygen delivery index (DO2I, mL min−1 m−2: 388 ± 54 to 324 ± 61, P < 0.05/358 ± 69 to 353 ± 82, P = 0.77) decreased in group 1 but not in group 2. Heart rate, stroke index, pulmonary vascular resistance, arteriovenous oxygen content difference and oxygen consumption index were unchanged. After head-up tilt MAP (mmHg, 92 ± 15, P < 0.05/101 ± 17, P < 0.01), MPAP (mmHg, 20 ± 3, P < 0.01/22 ± 4, P < 0.05), CVP (mmHg, 12 ± 2, P < 0.01/10 ± 2, P& lt; 0.01) and PCWP (mmHg, 12 ± 3, P < 0.05/12 ± 5, P < 0.05) remained elevated compared with T1 in both groups, SVR (dynes s cm−5, 1575 ± 372, P = 0.13/1793 ± 528, P < 0.01) in group 2 only. No complications occurred. The results indicate that PP is associated with significant but relatively benign haemodynamic changes. Anaesthesia for laparoscopic cholecystectomy may be performed safely also in elderly ASA class III patients with increased cardiac risk. An adequate haemoto dynamic monitoring is recommended.