文档介绍:第三十二章 腹腔镜手术的麻醉 Chapter 32 Anesthesia for laparoscopic Surgery
The field of abdominal surgery has been radically changed with the introduction of laparoscopy.
Recent advance in robotic and video technology have made the use of laparoscopic procedures more widely applicable.
With the evolution of laparoscopy,a substantial number of abdominal procedures are being performed using this approach, including cholecystectomy, myomectomy, and so on.
Compared with the traditional open abdominal laparoscopic approach is:
less postoperative pain.
shorter hospital stay.
fewer overall adverse event.
more rapid return to normal activity
significant cost savings.
However, it is important that the benefits of laparoscopic procedures be weighed against plications.
A thorough knowledge of potential plications is necessary to provide optimal patient care
Part I Physiological changes during laparoscopic surgery
The first step in laparoscopy is establishment of pneumoperitoneum.
The ideal insufflating gas would be colorless, nonexplosive, Physiologically inert
and readily soluble
in plasma.
Part I Physiological changes during laparoscopic surgery
CO2 is used extensively in clinic. The speed and pressure of the pneumoperitioneum effect the absorption of CO2.
Positioning changes will effect the physiological function.
I. Cardiovascular system
The pressure of pneumopertioneum effect three aspects .
systemic vascular resistance (SVR. Afterloail).
venous return (preload ).
cardiac function.
I. Cardiovascular system
During laparoscopic cholecystectomy
If intraabdominal pressure (IAP) >10mmHg
CVP ↑PAWP↑ SVR↑ CO and MAP↑
If intraabdominal pressure (IAP) >20mmHg
CVP ↓ SVR↑↑ CI CO↓ MAP↑↓or normal
I. Cardiovascular system
The cause :
Intraabdominal positive pressure intrathoracic pressure cardiac blood flow CO
IPPV or PEEP intrathoracic pressure CO