共查询到20条相似文献,搜索用时 31 毫秒
1.
H. Spivak I. Nudelman V. Fuco M. Rubin P. Raz A. Peri S. Lelcuk L. A. Eidelman 《Surgical endoscopy》1999,13(10):1026-1029
Background: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse
effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia
repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with
nitrous oxide insufflation was investigated.
Methods: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures
(24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported
operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications
were collected prospectively.
Results: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time
was 39 ± 7 min for unilateral hernia and 65 ± 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients
(63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable
throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after
the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence.
Conclusions: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal
nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.
Received: 17 February 1999/Accepted: 1 July 1999 相似文献
2.
Background: Although many aspects of laparoscopic surgery have been determined, the question of which insufflation gas is the best arises
repeatedly. The aim of this study was to review the findings on the major gases used today in order to provide information
and guidelines for the laparoscopic surgeon.
Methods: We reviewed the literature for clinical and laboratory studies on the currently used laparoscopic insufflation gases: carbon
dioxide (CO2), nitrous oxide (N2O), helium (He), air, nitrogen (N2), and argon (Ar). The following parameters were evaluated: acid–base changes, hemodynamic and respiratory sequelae, hepatic
and renal blood flow changes, increase in intracranial pressure, outcome of venous emboli, and port-site tumor growth.
Results: The major advantage of CO2 is its rapid dissolution in the event of venous emboli. Hemodynamic and acid–base changes with CO2 insufflation usually are mild and clinically negligible for most patients. Although N2O is advantageous for procedures requiring local/regional anesthesia, it does not suppress combustion. Findings show that
Ar may have unwanted hemodynamic effects, especially on hepatic blood flow. There are almost no hemodynamic or acid-base sequelae
with the use of He, air, and N2, but they dissolve slowly and carry a potential risk of lethal venous emboli.
Conclusions: Clearly, CO2 maintains its role as the primary insufflation gas in laparoscopy, but N2O has a role in some cases of depressed pulmonary function or in local/regional anesthesia cases. Other gases have no significant
advantage over CO2 or N2O and should be used only in protocol studies. The relation of port-site metastasis to a specific type of gas requires further
research.
Received: 16 January 2000/Accepted: 15 March 2000/Online publication: 22 August 2000 相似文献
3.
J. R. Bessell G. Ludbrook S. H. Millard P. S. Baxter S. S. Ubhi G. J. Maddern 《Surgical endoscopy》1999,13(2):101-105
Background: This experimental study evaluated whether humidification of warmed insufflated CO2 during laparoscopic procedures would resolve the problem of laparoscopy-induced hypothermia.
Methods: Changes in core temperature were quantified over a 3-h period of high-flow CO2 insufflation in a randomized, controlled trial of five pigs. Each animal was anesthetized and studied on three occasions
under standardized conditions, acting as its own control by insufflation with no gas compared with insufflation by cool dry
gas and heated humidified gas.
Results: Core temperatures after insufflation with heated humidified gas were no different from that of controls. After insufflation
with cool dry gas, core temperature dropped by 1.8°C, which was significantly more than the 0.6°C drop experienced by control
animals and those insufflated with heated humidified gas (p < 0.01). Calculations of the heat expended in evaporation of water were also performed. The temperature drop due to water
evaporation alone in pigs insufflated with cool dry gas was calculated to be 1.5°C. This compares favorably with the measured
1.2°C temperature difference between these animals and the control group.
Conclusions: The majority of heat lost during laparoscopic insufflation is due to water evaporation, and laparoscopic hypothermia may
be prevented by using heated and humidified gas insufflation.
Received: 10 December 1997/Accepted: 28 May 1998 相似文献
4.
X. Sala-Blanch J. Fontanals G. Martínez-Palli P. Taurá S. Delgado J. Bosch A. M. Lacy J. Visa 《Surgical endoscopy》1998,12(9):1121-1125
Background: Elevated intraabdominal pressure due to gas insufflation for laparoscopic surgery may result in regional blood flow changes.
Impairments of hepatic, splanchnic, and renal blood flow during peritoneal insufflation have been reported. Therefore we set
out to investigate the effects of peritoneal insufflation with helium (He) and carbon dioxide (CO2) on hepatic blood flow in a porcine model.
Methods: Twelve pigs were anesthetized and mechanically ventilated with a fixed tidal volume after the stabilization period. Peritoneal
cavity was insufflated with CO2 (n= 6) or He (n= 6) to a maximum intraabdominal pressure of 15 mmHg. Hemodynamic parameters, gas exchange, and oxygen content were studied
at baseline, 90 mm and 150 min after pneumoperitoneum, and 30 min after desufflation. Determination of hepatic blood flow
with indocyanine green was made at all measured points by a one-compartment method using hepatic vein catheterization.
Results: A similar decrease in cardiac output was observed during insufflation with both gases. Hepatic vein oxygen content decreased
with respect to the baseline during He pneumoperitoneum (p < 0.05), but it did not change during CO2 insufflation. Hepatic blood flow was significantly reduced in both the He and CO2 pneumoperitoneums at 90 min following insufflation (63% and 24% decrease with respect to the baseline; p < 0.001 and p < 0.05, respectively) being this decrease marker in the He group (p= 0.02).
Conclusions: These findings suggest that helium intraperitoneal insufflation results in a greater impairment on hepatic blood flow than
CO2 insufflation.
Received: 27 March 1996/Accepted: 19 January 1997 相似文献
5.
Experimental studies demonstrated a severe cardiac load of the CO2 pneumoperitoneum caused by an accelerated after- and a decreased preload. Patients displaying cardiovascular risks are therefore
often rejected from laparoscopic surgery. Hence, the pathophysiological changes and the intraoperative risk of the CO2 pneumoperitoneum in high-risk cardiopulmonary patients (NYHA II–III, n= 15) undergoing laparoscopic cholecystectomy are described. The changes in cardiac after- and preload seem to be due to the
elevated intraabdominal pressure rather than transperitoneally resorbed CO2 and are reversible by desufflation. In one patient conversion to open operation had to be performed because of a severe drop
in cardiac output and right ventricle ejection fraction. Mixed oxygen saturation was predicting intraoperative worsening in
this case. The described pathophysiological changes may seem to be well tolerated even in high-risk cardiac patients. Monitoring
of hemodynamics should include an arterial catheter line and blood gas analyses. Pharmacologic interventions or pressureless
laparoscopic procedures might not be necessary as long as laparoscopic cholecystectomy is performed.
Received: 13 December 1996/Accepted: 8 January 1997 相似文献
6.
The feasibility of laparoscopic extraperitoneal hernia repair under local anesthesia 总被引:2,自引:0,他引:2
Background: Laparoscopic preperitoneal herniorrhaphy has the advantage of being a minimally invasive procedure with a recurrence rate
comparable to open preperitoneal repair. However, surgeons have been reluctant to adopt this procedure because it requires
general anesthesia.
Methods: In this report, we describe the technique used in the laparoscopic repair of inguinal hernias under local anesthesia using
the preperitoneal approach. We also report our results with 10 inguinal hernias repaired using the same technique.
Results: Ten patients underwent their primary inguinal hernia repairs under local anesthesia. None were converted to general anesthesia.
Four patients received a small amount of intravenous sedation. Three patients had bilateral hernias. There were five direct
and eight indirect hernias. The average operative time was 47 min. The average lidocaine usage was 28 cc. All patients were
discharged within a few hours of the surgery. There were no complications. Follow-up has ranged from 1 to 6 months. There
has been no recurrences to date.
Conclusions: The extraperitoneal laparoscopic repair of inguinal hernia is feasible under local anesthesia. This technique adds a new
treatment option in the management of bilateral inguinal hernias, particularly in the population where general anesthesia
is contraindicated or even for patients who are reluctant to receive general or epidural anesthesia.
Received: 22 July 1998/Accepted: 18 September 1998 相似文献
7.
Laparoscopic surgery in newborn infants 总被引:14,自引:1,他引:13
Background: Thanks to various technical innovations and advances in instrumentation, laparoscopic surgical intervention is now possible
for certain congenital anomalies in children. To test the applicability of laparoscopic surgery in neonates, we reviewed our
personal experience of neonatal laparoscopic surgery, focusing on cardiopulmonary function, surgical procedures, problems
with devices, and degree of associated surgical stress.
Methods: We performed 65 laparoscopic procedures in neonates. Their ages ranged from 2 to 30 days old, and their body weights ranged
from 1,980 to 4,780 g. All 65 laparoscopic procedures were carried out without mortality or serious morbidity.
Results: As complications, we encountered four cases of hypothermia due to rapid insufflation of carbon dioxide (CO2). We also found that relative hypercapnea (increase in end-tidal CO2 as high as 61 mmHg) developed unless hyperventilation and a relatively high peak insufflation pressure were maintained during
pneumoperitoneum. No cardiac depression developed at this insufflation pressure. Fluid and electrolyte balance during our
cases of newborn laparoscopic surgery, as well as the doses and volumes of fluid and electrolytes administered, were identical
to those required for open surgery. Interleukin-6 (IL-6) was measured serially to estimate the degree of associated surgical
stress and was found to be significantly lower in neonates who had received laparoscopic procedures than in those who had
received open procedures.
Conclusion: Laparoscopic surgery can be carried out safely even in neonates.
Received: 9 June 1998/Accepted: 22 September 1998 相似文献
8.
Postoperative drowsiness and emetic sequelae correlate to total amount of carbon dioxide used during laparoscopic cholecystectomy 总被引:1,自引:1,他引:0
Background: After laparoscopy with carbon dioxide (CO2) insufflation early postoperative recovery is often complicated with drowsiness and postoperative nausea and vomiting (PONV).
Methods: 25 ASA I − II patients undergoing elective laparoscopic cholecystectomy under standardized anaesthesia were studied in a
randomized, prospective study.
The conventional CO2 pneumoperitoneum was compared with the mechanical abdominal wall lift (AWL) method with minimal CO2 insufflation with special reference to postoperative recovery.
Results: Postoperative drowsiness was of a significantly longer duration with the conventional method (p < 0.001) compared with the
AWL technique. There was a positive correlation with the total amount of CO2 used and the duration of drowsiness (r = 0.75, p < 0.01). PONV was seen significantly more often in patients with CO2 insufflation of more than 121 (p < 0.05).
Conclusions: Avoiding excessive CO2 is beneficial for smoother and more uneventful recovery after laparoscopic cholecystectomy.
Received: 11 January 1996/Accepted: 29 May 1996 相似文献
9.
Background: Gas embolism is a potential hazard during laparoscopic procedures. The aim of this study was to evaluate the effects of nitrous
oxide (N2O) inhalation in the case of gas embolism with carbon dioxide (CO2) and helium during pneumoperitoneum.
Methods: For this study, 20 anesthetized pigs were ventilated with N2O (67% inspired) in O2 (n= 10) or with halothane (0.7–1.5 inspired) in O2 (n= 10). In each group, CO2 (n= 5) or helium (n= 5) pneumoperitoneum was established and gas embolism induced at different rates (CO2 at 0.5, 1, or 2 ml/kg/min; helium at 0.025, 0.05, or 0.1 ml/kg/min) through the left femoral vein a maximum of 10 min while
all hemodynamic parameters were continuously monitored.
Results: In the CO2 group without N2O, all the animals tolerated rates of 0.5 and 1 ml/kg/min over the 10 min, whereas only 3 of 4 animals in the CO2 group with N2O tolerated a rate of 0.5 ml/kg/min, and 2 of 4 animals a rate of 1 ml/kg/min. In the helium group without N2O, all the animals tolerated gas embolism at all rates, whereas in the helium group with N2O, 4 of 5 animals needed to be resuscitated at a rate of 0.1 ml/kg/min and one death occurred.
Conclusions: Inhalation of N2O worsens the negative cardiovascular effects of venous CO2 or helium gas emboli and increases the risk of emboli-induced death when CO2 or helium are used to establish pneumoperitoneum. The volume of venous venous helium gas emboli causing such effects is substantially
smaller than that for venous CO2 gas emboli.
Received: 20 September 1999/Accepted: 1 October 2000/Online publication: 4 August 2000 相似文献
10.
Portal venous flow during CO2 pneumoperitoneum in the rat 总被引:18,自引:0,他引:18
Backround: CO2 gas insufflation is routinely used to extend the abdominal wall. The resulting pneumoperitoneum has a number of local and
systemic effects on the organism. Portal blood flow, which plays an important role in hepatic function and cell-conveyed immune
response, is one of the affected parameters.
Methods: An established animal model (rat) of laparoscopic surgery was modified by implanting a perivascular flow probe. Hemodynamics
in the portal vein were then measured during increasing intraabdominal pressure generated by carbon dioxide insufflation.
Results: Using this technique, an adequate flowmetry of the portal vein was achieved in all animals. The creation of a CO2 pneumoperitoneum with increasing intraabdominal pressure led to a linear decrease in portal venous flow.
Conclusions: Elevated intraabdominal pressure caused by carbon dioxide insufflation may compromise hepatic function and cell-conveyed
immune response during laparoscopic surgery.
Received: 28 January 1998/Accepted: 22 June 1998 相似文献
11.
T. Yoshida E. Kobayashi Y. Suminaga H. Yamauchi T. Kai N. Toyama H. Kiyozaki A. Fujimura M. Miyata 《Surgical endoscopy》1997,11(9):907-910
Background: Changes in blood hormone and cytokine were investigated in patients who underwent laparoscopic cholecystectomy via insufflation
(CO2 group) vs those who had abdominal wall-lifting (Air group).
Methods: Seventeen female patients with cholecystolithiasis were randomly divided into two groups. Peripheral blood samples were obtained
during perioperative period, and plasma hormone levels (ACTH, cortisol) and serum cytokine levels (TNFα, IL-1β, IL-6, IL-10)
were measured.
Results: The number of circulating lymphocytes significantly decreased at 1 h after surgery in both groups, but the decrease in the
CO2 group was significantly smaller than that in the Air group. There was no significant difference in hormone elevation between
groups. Serum concentrations of IL-6 and IL-10 in the Air group were significantly higher than in the CO2 group.
Conclusions: CO2 insufflation may reduce cytokine production in laparoscopic cholecystectomy.
Received: 10 November 1996/Accepted: 19 February 1997 相似文献
12.
Effect of CO2 insufflation on bacteremia and bacterial translocation in an animal model of peritonitis 总被引:4,自引:0,他引:4
Background: The widespread adoption of the laparoscopic approach has created some concern over the potential for increased risk of bacteremia
and sepsis due to increased intraabdominal pressure in patients with intraabdominal infection and peritonitis. This study
examines the effect of the CO2 pneumoperitoneum on bacteremia and bacterial translocation.
Methods: New Zealand white rabbits were assigned into three groups of 10 animals. In group 1, 100 ml of sterile saline was infused
into the peritoneal cavity under 10 mmHg CO2 insufflation for 1 h. Group 2 received 100 ml of saline containing 109 CFU/ml (colony-forming units) E. coli strain 0163 and 10 mmHg CO2 insufflation for 1 h. Group 3 received an identical bacterial inoculum, followed by a 10-cm midline laparotomy. Blood samples
were taken for culture by cardiac puncture at various intervals during the experiment. At 6 h after being subjected to the
experimental procedures, the rabbits were killed and their organs were cultured quantitatively for translocating bacteria.
Results: In group 1, neither blood nor organ cultures were positive, whereas in group 2 all blood cultures became positive in 1 h,
and intraperitoneally infused bacteria translocated to the lung and kidney in all rabbits. In group 3, blood cultures became
positive in 1 h, all but two of the rabbits had translocated bacteria in their lungs, and kidney samples from two of the rabbits
were culture-positive.
Conclusions: Our results indicate that both CO2 pneumoperitoneum and laparotomy increase the incidence of bacterial translocation from the peritoneal cavity into the bloodstream.
Thus, the risk of translocation to extraperitoneal organs such as lung and kidney is increased significantly by laparoscopy.
Therefore, laparoscopic surgery should be avoided or used cautiously in the setting of acute peritonitis. 相似文献
13.
The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy 总被引:11,自引:0,他引:11
Background: The increased intra-abdominal pressure during pneumoperitoneum, together with the head-up tilt used in upper abdominal laparoscopies,
would be expected to decrease venous return to the heart. The goal of our study was to determine whether laparoscopy impairs
cardiac performance when preventive measures to improve venous return are taken, and to analyze the effects of positioning,
anesthesia, and increased intra-abdominal pressure.
Methods: Using invasive monitoring, hemodynamic changes were investigated in 15 ASA class I or II patients under isoflurane–fentanyl
anesthesia during laparoscopic cholecystectomy. Before laparoscopy, the patients received an intravenous (IV) infusion of
colloid solution if cardiac filling pressures were low, and their legs were wrapped from toes to groin with elastic bandages.
Measurements were taken while the patients were awake in the supine (baseline) and head-up tilt (15–20°) positions, and after
the induction of anesthesia in the same positions. Measurements were repeated at regular intervals during laparoscopy (intra-abdominal
pressure at 13–16 mmHg), after deflation of the gas, and in the recovery room.
Results: With the passive head-up tilt in awake and anesthetized patients, the cardiac index (CI), stroke index (SI), central venous
pressure (CVP), and pulmonary capillary wedge pressure (PCWP) decreased, and systemic vascular resistance increased. With
the patient under anesthesia, SI decreased, but CI did not change significantly as a result of the compensatory increase in
heart rate. Carbon dioxide (CO2) insufflation at the start of laparoscopy produced increases in CVP and PCWP as well as mean systemic and mean pulmonary
arterial pressures without changes in CI or SI. Toward the end of the laparoscopy, CI decreased by 15%. The hemodynamic values
returned to nearly prelaparoscopic levels after deflation of the gas, and CI was elevated during the recovery period, whereas
systemic vascular resistance was decreased in comparison with the baseline.
Conclusions: By correcting relative dehydration and preventing the pooling of blood, CI decreased less than 20% during pneumoperitoneum
as compared with the baseline awake level. The head-up positioning accounts for many of the adverse effects in hemodynamics
during laparoscopic cholecystectomy.
Received: 6 November 1998/Accepted: 8 July 1999 相似文献
14.
Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy 总被引:10,自引:4,他引:6
S. Takagi 《Surgical endoscopy》1998,12(5):427-431
Background: Laparoscopy under carbon dioxide (CO2) pneumoperitoneum has many advantages. However, the risks of CO2 pneumoperitoneum during laparoscopic hepatectomy (LH) have not been defined.
Methods: The hemodynamics of the hepatic vein were examined during CO2 pneumoperitoneum both pre- and posthepatectomy in eight pigs. Portal blood flow was measured with Doppler ultrasound during
laparoscopic cholecystectomy in 10 human patients.
Results: Experimentally, elevated intraabdominal pressure (IAP) with CO2 insufflation produced significant increases in CO2 partial pressure and echogenicity of the hepatic vein in the posthepatectomy group. Clinically, elevated IAP caused significant
narrowing of the portal vein and significant decreases in portal blood velocity. The mean portal flow was significantly decreased
with elevation of IAP >10 mmHg.
Conclusions: LH with CO2 pneumoperitoneum may lead to embolism caused by CO2 bubbling through the hepatic vein. Elevated IAP may cause a decrease in hepatic blood flow and induce severe liver damage,
especially in patients with poor liver function. Gasless laparoscopy using abdominal wall lifting should be employed in LH
to avoid the risks of CO2 embolism and liver damage.
Received: 28 March 1997/Accepted: 12 September 1997 相似文献
15.
The effect of laparoscopy on the movement of tumor cells and metastasis to surgical wounds 总被引:4,自引:1,他引:3
G. Mathew D. I. Watson T. Ellis N. De Young A. M. Rofe G. G. Jamieson 《Surgical endoscopy》1997,11(12):1163-1166
Background: A variety of mechanisms have been proposed to explain tumor growth in port sites following laparoscopic cancer surgery. We
devised two experimental models to determine whether carbon dioxide (CO2) insufflation during laparoscopic surgery influences the movement of tumor cells and leads to tumor implantation and growth
in surgical wounds.
Methods: Model 1: Viable adenocarcinoma cells were introduced into the upper abdomen of six syngeneic immune-competent rats during laparoscopy
with CO2 insufflation; the same procedure was followed for a further six rats during gasless laparoscopy. A length of plastic tubing
introduced through the anterolateral aspect of the rats' left lower abdominal wall was used to vent the insufflation gas through
the abdomen of a recipient rat for 30 min. After 21 days, the peritoneal cavity and surgical wounds of the recipient rat were
examined for implanted tumor. Model 2: A suspension of radiolabeled adenocarcinoma cells was introduced into the upper abdomen of five rats during laparoscopy with
CO2 insufflation and an additional five rats during gasless laparoscopy. A length of plastic tubing introduced through the anterolateral
aspect of the left lower abdominal flank was used to vent the insufflation gas through phosphate-buffered saline solution.
After 30 min, the solution was counted for radioactivity.
Results: Tumor growth occurred at the site of both the insufflation and venting ports in the second rat in five of the six rats from
the group undergoing insufflation, but it was found in none of the gasless laparoscopy group (p= 0.015). In the second model, significant transfer of tumor cells to the vented gas occurred only in the rats undergoing
laparoscopy with insufflation (median, 2.71% versus 0% of the introduced labeled cells; p= 0.008).
Conclusions: Carbon dioxide insufflation results in tumor dissemination during laparoscopy, leading to port site metastasis. Gasless laparoscopy
may prevent this problem.
Received: 17 March 1997/Accepted: 6 June 1997 相似文献
16.
Transesophageal echocardiographic assessment of hemodynamic function during laparoscopic cholecystectomy in healthy patients 总被引:4,自引:0,他引:4
D'Ugo D Persiani R Pennestri F Adducci E Primieri P Pende V De Cosmo G 《Surgical endoscopy》2000,14(2):120-122
Background: This study aimed by means of transesophageal echocardiography, to evaluate hemodynamic changes induced by pneumoperitoneum
in patients with normal cardiac performance.
Methods: In this study, 11 ASA I–II patients (mean age, 39 years) with normal cardiac performance undergoing laparoscopic cholecystectomy
were evaluated. A 5-MHz transesophageal biplane phased-array transducer connected to an echocardiographer was inserted after
induction of anesthesia. Data were collected at three different times: before insufflation (T1), 10 min after insufflation
(T2), and 5 min after desufflation (T3). At these same times, heart rate, systolic blood pressure, diastolic blood pressure,
end-tidal carbon dioxide (CO2), and peak airway pressure were recorded. Statistical analysis was performed using one-way and two-way analysis of variance
(ANOVA). A p value less than 0.05 was considered significant.
Results: End-systolic and end-diastolic diameters of the left ventricle, contractility, and performance parameters did not change
significantly. Conversely, at insufflation, color Doppler area of the mitral backflow increased significantly (p < 0.05) when already present or showed up abruptly (T1: 0.22 ± 0.28 cm2; T2: 1.28 ± 1.02 cm2; T3: 0.49 ± 0.53 cm2).
Conclusions: Such an event is not interpreted as a mitral insufficiency. It is possibly the result of a ``contrast effect' caused by
the absorption of CO2 microbubbles in the blood.
Received: 12 April 1998/Accepted: 23 June 1999 相似文献
17.
Influence of acute hemorrhage and pneumoperitoneum on hemodynamic and respiratory parameters 总被引:2,自引:0,他引:2
Background: We examined the questions of whether resuscitated (compensated) acute hemorrhage enhances the negative effects of carbopneumoperitoneum
on hemodynamic and respiratory parameters and whether pneumoperitoneum with helium has any advantages under these circumstances.
Our investigation focused on the influence of acute hemorrhage with different gases on the cardiovascular and respiratory
system as well as on hepatic and renal blood flow in a porcine model.
Methods: Cardiac and hemodynamic function were monitored via implantation of catheters in pulmonary artery, femoral vein, and artery.
Renal and hepatic blood flow were recorded using a transonic volume flow meter placed at the renal and hepatic artery and
portal vein. Twelve animals were randomly assigned to one insufflation gas (carbon dioxide [CO2] or helium [He]). Following baseline recordings, acute hemorrhage (20 ml/kg) was induced by continuous bleeding over 30 min.
Animals then received a colloidal solution (20 ml/kg 6% hydroxyethylstarch solution) over 30 min. Pneumoperitoneum of 12 mmHg
was established, and all parameters were measured after 30 min of adaptation. The major endpoints of the study were cardiac
output (CO), arterial pressure (MAP), systemic vascular resistance (SVR), and central venous pressure (CVP), as well as blood
flow in hepatic and renal artery and portal vein.
Results: While CO and hemodynamic parameter as well as hepatic and renal blood flow were markedly reduced after hemorrhage, they returned
nearly to their previous levels after resuscitation. Pneumoperitoneum with 12 mmHg did not further depress the cardiovascular
system or reduce hepatic and renal blood flow. Pneumoperitoneum did not alter hepatic or renal blood flow. Pneumoperitoneum
with helium did not substantially change the reaction of the cardiovascular system after resuscitated hemorrhage.
Conclusions: If hemorrhage is compensated by proper resuscitation and hypovolemia is avoided, laparoscopic surgery with pneumoperitoneum
of 12 mmHg appears to be not harmful. Using helium as the insufflating gas had no clear advantage over the carbon dioxide
model.
Received: 30 July 1997/Accepted: 24 October 1997 相似文献
18.
Effect of pressure and gas type on intraabdominal, subcutaneous, and blood pH in laparoscopy 总被引:36,自引:9,他引:27
Kuntz C Wunsch A Bödeker C Bay F Rosch R Windeler J Herfarth C 《Surgical endoscopy》2000,14(4):367-371
Background: According to the literature, the number of port-site metastases in laparoscopic surgery varies considerably depending on
the type of gas used for the pneumoperitoneum. In order to investigate this observation we studied the changes in blood, subcutaneous,
and intra-abdominal pH during laparoscopy with helium, CO2 and room air in a rat model. In addition, we looked at the influence of intra-abdominal pressure and duration of pneumoperitoneum
on the pH during the laparoscopy.
Methods: pH was measured by tonometry, intra-abdominally and subcutaneously. A pH electrode was additionally placed into the subcutaneous
tissue and the results compared to those measured by tonometry. Blood samples were taken from a catheter in the carotid artery.
The intra-abdominal pressure was 0, 3, 6, 9 mmHg for 30 min in each case. We investigated the effect of pneumoperitoneum with
CO2, helium and air in randomized groups of 5 rats. In an additional series the pressure was held constant at 3 mmHg and the
pH was measured every 30 min.
Results: Due to the different absorption capacity of the peritoneum, laparoscopy with CO2 decreases the subcutaneous pH from 7.35 to 6.81. Blood pH is reduced from 7.37 to 7.17 and the intra-abdominal pH from 7.35
to 6.24. Other, less absorbable gases induce smaller changes of blood and subcutaneous pH (only 10% of CO2). In a variance analysis the p value is less than 0.001. The influence of duration of laparoscopy (30 min vs 90 min) on the subcutaneous pH is less compared
to the influence of intra-abdominal pressure (0, 3, 6, 9 mmHg).
Conclusions: Depending on the type of gas (CO2, air, helium) used for laparoscopy blood, subcutaneous and intra-abdominal pH are influenced differently. Because lower pH
is known to impair local defense mechanisms, these results may be one explanation for the higher incidence of port-site metastasis
in laparoscopy with CO2 than with other gases, as reported in the literature.
Received: 11 June 1998/Accepted: 12 February 1999 相似文献
19.
Sato N Kawamoto M Yuge O Suyama H Sanuki M Matsumoto C Inoue K 《Surgical endoscopy》2000,14(4):362-366
Background: The effects of pneumoperitoneum on the activity of the cardiac autonomic nervous system have not been completely understood.
Methods: In this study, 45 unpremedicated adult patients who underwent laparoscopic cholecystectomy were anesthetized with either
3.5% sevoflurane, 2% isoflurane, or 8 mg/kg/h propofol (15 patients in each group). The status of cardiac autonomic nervous
activity was evaluated by heart rate variability analysis three times: once when the patient was awake, once after induction
of general anesthesia, and once after insufflation for pneumoperitoneum. Intra-abdominal pressure was maintained automatically
at 10 mmHg by a carbon dioxide (CO2) insufflator. For each measurement, electrocardiogram was recorded for 256 s and played back offline to detect R-R intervals.
Power spectral analysis of heart rate variability was applied, and the low-frequency (LF, 0.04–0.15 Hz) and high-frequency
(HF, 0.15–0.40 Hz) bands of the spectral density of the heart rate variability were obtained from a power spectra of R-R intervals
using the fast-Fourier transform algorithm. The HF/LF ratio also was analyzed.
Results: Measurements of heart rate variability in the three groups showed similar change. Although the power of HF, which represents
parasympathetic nervous activity, did not change, the power of LF, which represents both sympathetic and parasympathetic nervous
activity, decreased during the anesthetized stage and increased during the insufflated stage. The HF/LF ratio, which represents
the balance of parasympathetic and sympathetic activity, increased after induction of general anesthesia, and decreased after
insufflation.
Conclusions: Our results suggest that pneumoperitoneum increases sympathetic cardiac activity. The choice of general anesthetic did not
seem to have a major influence on the change in the cardiac autonomic nervous system after induction of pneumoperitoneum for
laparoscopic cholecystectomy.
Received: 22 January 1999/Accepted: 22 March 1999 相似文献
20.
Intraperitoneal immunity and pneumoperitoneum 总被引:15,自引:5,他引:10
E. G. Chekan C. Nataraj E. M. Clary T. Z. Hayward F. J. Brody J. C. Stamat M. C. Fina W. S. Eubanks C. J. Westcott 《Surgical endoscopy》1999,13(11):1135-1138
Background: Carbon dioxide (CO2) pneumoperitoneum has been implicated as a possible factor in depressed intraperitoneal immunity. Using in vitro functional
assays, CO2 has been shown to decrease the function of peritoneal macrophages harvested from insufflated mice. However, an effective
in vivo assessment is lacking. Listeria monocytogenes (LM), an intracellular pathogen, has served as a well-established in vivo model to study cell-mediated immune responses in mice.
This study examines the immune competence of mice based on their ability to clear intraperitoneally administered LM following CO2 vs helium (He) insufflation.
Methods: Eighty-five mice (C57Bl/6, males, 4–6 weeks old) were divided between the following four treatment groups: CO2 insufflation, He insufflation, abdominal laparotomy (Lap), and control (anesthesia only). Immediately postoperatively, each
group was inoculated percutaneously and intraperitoneally with a sublethal dose (.015 × 106 org) of virulent LM (EGD strain). Half of the animals were killed on postoperative day 3 and half on day 5. Spleens and livers (sites of bacterial
predilection) were harvested, homogenized, and plated on TSB agar. The amount of bacteria (1 × 106
LM/spleen and liver) from each group was then compared. Statistical significance was set at p≤ 0.05.
Results: Control animals had nominal bacteria on day 3 (0.016 × 106
LM/spleen and liver), and the bacterial burden remained low at day 5 (0.038 × 106
LM/spleen and liver) postchallenge. On day 3, the bacterial burden was significantly higher in the CO2 group (5.46 × 106
LM/spleen and liver) as compared to He (0.093 × 106
LM/spleen and liver) and controls. The Lap group (3.44 × 106
LM/spleen and liver) had significantly more bacteria than the controls. There were no significant differences between any of
the groups on day 5.
Conclusions: In this animal model, CO2 pneumoperitoneum impaired cell-mediated intraperitoneal immunity significantly more than He pneumoperitoneum and controls
on day 3. Also on day 3, laparotomy caused impairment of intraperitoneal immunity when compared to controls. Finally, intraperitoneal
immunosuppression resolved by day 5.
Received: 22 July 1998/Accepted: 3 March 1999 相似文献