Yoshida Hitoshi, Kushikata Tetsuya, Kabara Shizuko, Takase Hajime, Ishihara Hironori, Hirota Kazuyoshi
Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.
Anesth Analg. 2007 Dec;105(6):1749-52, table of contents. doi: 10.1213/01.ane.0000290293.13532.60.
Hypercapnia during laparoscopy with CO2 is predicted in the following situations: compromised pulmonary function, retroperitoneal insufflation, and subcutaneous emphysema. We present a case of sudden electroencephalogram (EEG) depression in response to severe hypercapnia during laparoscopic ureteronephrectomy in a 77-yr-old patient with chronic pulmonary emphysema. During intraperitoneal and retroperitoneal insufflation, subcutaneous emphysema and difficult ventilation occurred. Severe hypercapnia ensued, with pH = 6.94, and Paco2 = 137 mm Hg. Subsequent EEG activity was markedly depressed with a minimum Bispectral Index of 4, accompanied by an increase in arterial blood pressure and heart rate. Termination of the laparoscopic procedure improved ventilation, EEG, and hemodynamics. These EEG changes may result from the narcotic properties of CO2 or hypercapnia-induced neurological abnormalities.
肺功能受损、腹膜后充气和皮下气肿。我们报告一例77岁慢性肺气肿患者在腹腔镜输尿管肾切除术期间因严重高碳酸血症导致突然脑电图（EEG）抑制的病例。在腹腔和腹膜后充气期间，出现皮下气肿和通气困难。随后发生严重高碳酸血症，pH = 6.94，动脉血二氧化碳分压（Paco2）= 137 mmHg。随后脑电图活动明显抑制，最低脑电双频指数为4，同时动脉血压和心率升高。终止腹腔镜手术改善了通气、脑电图和血流动力学。这些脑电图变化可能是由二氧化碳的麻醉特性或高碳酸血症引起的神经异常所致。
