Sivaci Remziye, Orman Ayse, Yilmazer Mehmet, Yilmaz Sezgin, Ellidokuz Hülya, Polat Coskun
Department of Anesthesiology and Re-animation, Kocatepe University, Afyon, Turkey.
J Laparoendosc Adv Surg Tech A. 2005 Apr;15(2):125-9. doi: 10.1089/lap.2005.15.125.
This study was designed to investigate the effects of inhaled anesthetic agents on respiratory mechanics with low flow anesthesia in laparoscopic abdominal surgery. Two inhaled anesthetics, desflurane and sevoflurane, have a lower solubility in blood and tissues than all previous volatile anesthetics, and have become the preferred volatile anesthetics for routine surgical procedures.
Twenty-six patients were examined. Patients were randomly assigned to two groups, to receive sevoflurane (n = 13) or desflurane (n = 13). Tidal volume and ventilation rate were kept unchanged throughout the operation. Intra-abdominal pressure was kept constant at the level of 12 mm Hg. Respiratory mechanics such as peak inspiratory pressure (PIP), respiratory resistance (Rr), and dynamic compliance (Cdyn) measurements were recorded by a Datex-Ohmeda respiratory device (Datex-Ohmeda, Finland) at four timepoints: 5 minutes after mechanical ventilation started (T1), after insufflation of the peritoneum (T2), in the 30-degree Trendelenburg position (T3), and after desufflation of the peritoneum (T4).
In our study, desflurane caused a statistically significant increase in PIP and Rr and decrease in C(dyn). When the two groups were compared, Rr values in the deslurane group showed significant increases at T2, T3, and T4 compared to the sevoflurane group (P < 0.05). These values did not change in the sevoflurane group, while PIP significantly increased at T2, T3, and T4 after desufflation in the desflurane group (P < 0.05). Cdyn values decreased significantly at all 4 timepoints in the desflurane group compared to the sevoflurane group (P < 0.05).
We concluded that respiratory mechanics were affected by desflurane with low flow anesthesia in patients undergoing laparoscopic abdominal surgery. No significant influence on respiratory mechanics was seen with sevoflurane anesthesia.
本研究旨在探讨吸入麻醉药在腹腔镜腹部手术低流量麻醉下对呼吸力学的影响。与以往所有挥发性麻醉药相比，两种吸入麻醉药地氟烷和七氟烷在血液和组织中的溶解度较低，已成为常规手术的首选挥发性麻醉药。
对26例患者进行检查。患者随机分为两组，分别接受七氟烷（n = 13）或地氟烷（n = 13）。整个手术过程中潮气量和通气率保持不变。腹内压维持在12 mmHg水平恒定。通过Datex-Ohmeda呼吸设备（芬兰Datex-Ohmeda公司）在四个时间点记录呼吸力学指标，如吸气峰压（PIP）、呼吸阻力（Rr）和动态顺应性（Cdyn）：机械通气开始后5分钟（T1）、腹膜充气后（T2）、头低脚高30度体位时（T3）以及腹膜放气后（T4）。
在我们的研究中，地氟烷导致PIP和Rr有统计学意义的增加以及Cdyn降低。两组比较时，地氟烷组的Rr值在T2、T3和T4时与七氟烷组相比显著升高（P < 0.05）。七氟烷组这些值未改变，而地氟烷组在腹膜放气后的T2、T3和T4时PIP显著升高（P < 0.05）。与七氟烷组相比，地氟烷组在所有4个时间点的Cdyn值均显著降低（P < 0.05）。
我们得出结论，在接受腹腔镜腹部手术的患者中，低流量麻醉下的地氟烷会影响呼吸力学。七氟烷麻醉对呼吸力学无显著影响。
