- 期刊
Use of Laryngeal Mask Airway in Gynecological Laparoscopy: Ventilatory Effects of Pneumoperitoneum
應用Laryngeal Mask Airway作婦科腹腔鏡手術：Pneumoperitoneum對於肺換氣功能的影響
摘要
目的：用以評估在婦科腹腔鏡手術麻醉中以Laryngeal Mask Airway（LMA）作呼吸道處理時氣腹（pneumoperitoneum）對於肺換氣的影響。病人與方法：本臨床研究包括15位接受婦科腹腔鏡手術女姓病患，全身麻醉使用fentanyl與pentothal作誘導，以isoflurane和N2O作維持。以LMA作麻醉中呼吸道處理，麻醉中呼吸換氣量設定為100mL/kg與10bpm。手術麻醉中CO2p pneumoperitoneum維持在腹腔內壓15 mmHg。呼吸氣體及各類換氣變數（compliance of respiratory system，peak與plateau airway pressures，expiratory tidal volume）都作監測。結果：於CO2 pneumoperitoneum時peak與plateau airway pressures都上升約9 cmH2O，而compliance of respiratory system減少有46%。Expiratory tidal volume未見明顯改變。End-tidal CO2平均增加9.5 mmHg。整個手術過程動脈血氧飽和度維持在100%。結論：LMA可以成功地應用在婦科腹腔鏡手術之麻醉中呼吸道處理而不會明顯影響肺換氣功能。
關鍵字
換氣效果並列摘要
Objective: To evaluate the ventilatory effects of pneumoperitoneum when using a laryngeal mask airway for the airway manage-ment in anesthesia during gynecological laparoscopy. Patients and Methods: This clinical study included 15 women scheduled for laparoscopic cystectomy or hysterectomy. Anesthesia was induced with fentanyl and pentothal, and maintained with isoflurane and N2O in O2 (50%). A laryngeal mask airway was used for airway management during anesthesia. Minute ventilation was set at 100 mL/kg at a rate of 10 breaths/min during anesthesia. CO2 pneumoperitoneum was maintained at an intraabdominal pressure of 15 mmHg for surgical manipulation. Respiratory gases and ventilatory variables including compliance of the total respiratory system, peak and plateau airway pressures, and expiratory tidal volume were monitored. Results: During CO2 pneumoperitoneum, the peak and plateau airway pressures increased by around 9 cmH2O. The compliance of the total respiratory system decreased by 46%. The expiratory tidal volumes did not change significantly. End-tidal CO2 increased by 9.5 mmHg. The arterial O2 saturation was well maintained at 100% throughout the whole course of surgery. Conclusions: We conclude that the laryngeal mask airway can be used successfully for anesthesia management in laparoscopic surgery without significant changes in pulmonary ventilation.
延伸閱讀
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