Joshi G P
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas, USA.
Anesthesiol Clin North Am. 2001 Mar;19(1):89-105. doi: 10.1016/s0889-8537(05)70213-3.
The frontiers of laparoscopic surgery have extended from gynecologic procedures to general surgical techniques. As new applications for laparoscopy emerge, anesthesiologists must be familiar with the possible complications associated with the various laparoscopic procedures. Only by an appreciation of the potential complications of a procedure can their overall incidence be minimized. A systematic approach must consider all potential complications during laparoscopy. In addition to routine evaluation (i.e., depth of anesthesia and volume status), anesthesiologists must confirm that intra-abdominal pressure is less than 15 mm Hg, and that inadvertent endobronchial intubation, pneumothorax, and gas embolism have not occurred. In the case of precipitous changes in vital signs not responding to routine management, it is imperative to release the pneumoperitoneum and place the patient in the supine (or Trendelenburg) position. After cardiopulmonary stabilization, cautious slow reinsufflation then can be attempted. With persistent signs of significant cardiopulmonary impairment, however, it is sometimes necessary to convert to an open procedure.
腹腔镜手术的前沿领域已从妇科手术扩展到普通外科技术。随着腹腔镜手术新应用的出现，麻醉医生必须熟悉与各种腹腔镜手术相关的可能并发症。只有认识到手术的潜在并发症，才能将其总体发生率降至最低。系统的方法必须考虑腹腔镜手术期间的所有潜在并发症。除了常规评估（即麻醉深度和容量状态）外，麻醉医生必须确认腹内压低于15毫米汞柱，且未发生意外支气管内插管、气胸和气体栓塞。如果生命体征急剧变化且对常规处理无反应，必须解除气腹并将患者置于仰卧位（或头低脚高位）。在心肺功能稳定后，然后可以谨慎地缓慢重新充气。然而，如果持续存在明显心肺功能损害的迹象，有时有必要转为开放手术。
