Lindekaer Astrid Listov, Halvor Springborg Henrik, Istre Olav
Department of Anesthesiology, Aleris-Hamlet Hospitals, Soeborg, Denmark.
J Vis Exp. 2013 Jun 25(76):50045. doi: 10.3791/50045.
Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that lowering the insufflation pressure during surgery may reduce the risk of post-operative pain. In this pilot study, a method is presented for measuring the intra-abdominal space available to the surgeon during laproscopy, in order to examine whether the relaxation produced by deep neuromuscular blockade can increase the working surgical space sufficiently to permit a reduction in the CO2 insufflation pressure. Using the laproscopic grasper, the distance from the promontory to the skin is measured at two different insufflation pressures: 8 mm Hg and 12 mm Hg. After the initial measurements, a neuromuscular blocking agent (rocuronium) is administered to the patient and the intra-abdominal volume is measured again. Pilot data collected from 15 patients shows that the intra-abdominal space at 8 mm Hg with blockade is comparable to the intra-abdominal space measured at 12 mm Hg without blockade. The impact of neuromuscular blockade was not correlated with patient height, weight, BMI, and age. Thus, using neuromuscular blockade to maintain a steady volume while reducing insufflation pressure may produce improved patient outcomes.
肩部疼痛是子宫肌瘤切除术或子宫切除术等腹腔镜手术后常见的症状，最近的研究表明，在手术过程中降低气腹压力可能会降低术后疼痛的风险。在这项初步研究中，提出了一种在腹腔镜检查期间测量外科医生可用腹腔空间的方法，以检查深度神经肌肉阻滞产生的松弛是否能充分增加手术工作空间，从而允许降低二氧化碳气腹压力。使用腹腔镜抓钳，在两种不同的气腹压力下测量从岬部到皮肤的距离：8毫米汞柱和12毫米汞柱。在初始测量后，给患者使用神经肌肉阻滞剂（罗库溴铵），然后再次测量腹腔容积。从15名患者收集的初步数据表明，在8毫米汞柱气腹压力下使用阻滞剂时的腹腔空间与在12毫米汞柱气腹压力下未使用阻滞剂时测量的腹腔空间相当。神经肌肉阻滞的影响与患者的身高、体重、体重指数和年龄无关。因此，在降低气腹压力的同时使用神经肌肉阻滞来维持稳定的容积可能会改善患者的预后。
