Choi S H, Lee S J, Rha K H, Shin S K, Oh Y J
Department of Anaesthesiology and PAin medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Anaesthesia. 2008 Dec;63(12):1314-8. doi: 10.1111/j.1365-2044.2008.05636.x.
This study compared cerebral blood flow-carbon dioxide (CBF-CO2) reactivities in the supine and modest Trendelenburg position under pnemoperitoneum during sevoflurane anaesthesia. After induction of anaesthesia in 25 patients, mechanical ventilation was adjusted to increase Paco2 from 4.7 (T1) to 6.0 kPa (T2) in the supine position, and the change in jugular bulb oxygen saturation was measured as an index of CBF. Then, after establishment of pneumoperitoneum and 30 degrees Trendelenburg position, the CO(2) step and measurement of CBF were repeated. The CBF-CO2 reactivity was 7.5 (3.3) %xkPa(-1) (% change in jugular bulb oxygen saturation per unit change in Paco2) in the supine position and 6.8 (2.3) %xkPa(-1) in the 30 degrees Trendelenburg-pneumoperitoneum condition (p = 0.086). We conclude that CBF-CO2 reactivity is unchanged by the modest Trendelenburg position under pneumoperitoneum during sevoflurane anaesthesia.
本研究比较了七氟醚麻醉下气腹期间仰卧位和适度头低脚高位时脑血流量-二氧化碳（CBF-CO₂）反应性。25例患者麻醉诱导后，在仰卧位将机械通气调整为使动脉血二氧化碳分压（Paco₂）从4.7kPa（T1）升高至6.0kPa（T2），并测量颈静脉球血氧饱和度的变化作为CBF指标。然后，在建立气腹和30°头低脚高位后，重复二氧化碳阶梯变化及CBF测量。仰卧位时CBF-CO₂反应性为7.5（3.3）%·kPa⁻¹（Paco₂每单位变化时颈静脉球血氧饱和度的变化百分比），在30°头低脚高位-气腹条件下为6.8（2.3）%·kPa⁻¹（p = 0.086）。我们得出结论，七氟醚麻醉下气腹期间适度头低脚高位不会改变CBF-CO₂反应性。
