Neira Victor M, Kovesi Thomas, Guerra Luis, Campos Maria, Barrowman Nicholas, Splinter William M
Department of Anesthesiology, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada,
Can J Anaesth. 2015 Jul;62(7):798-806. doi: 10.1007/s12630-015-0369-0. Epub 2015 Apr 23.
The aim of this study was to describe the changes in respiratory system compliance and other measures of respiratory mechanics associated with peritoneal insufflation (12 mmHg pressure) with carbon dioxide (PNP12) and 20° Trendelenburg positioning (TDG20) in pediatric patients undergoing laparoscopic surgery for abdominal cryptorchidism.
Twelve subjects with abdominal cryptorchidism undergoing orchiopexy were enrolled in the study. General anesthesia was conducted with sevoflurane/O2/air, fentanyl, and rocuronium. Pressure-controlled ventilation with a peak inspiratory pressure (PIP) of 10-15 cm H2O and a positive end-expiratory pressure of 5 cm H2O was titrated to achieve a tidal volume (VT/kg) of 6-10 mL·kg(-1) and end-tidal carbon dioxide (EtCO2) of 35-40 mmHg. Adjustments of PIP and respiratory rate (RR) were made to maintain the initial VT/kg and EtCO2 < 50 mmHg. Measurements of weight-corrected dynamic compliance (Cdyn/kg), VT/kg, and EtCO2 were recorded at baseline, after PNP12, at TDG20, and again after deflation and return to the level position.
Adjustments in PIP were required in all subjects to maintain the target VT/kg. The Cdyn/kg decreased 42% (95% confidence interval [CI]: 30 to 51; P < 0.001) after PNP12, and it remained below baseline until deflation. The TDG20 caused only minimal additional reductions in Cdyn/kg (10% decrease; 95% CI: 0 to 19; P = 0.048). The VT/kg decreased 42% (95% CI: 31 to 52; P = 0.048) with PNP12, and after TDG20, it decreased a further 10% (95% CI: 4 to 19; P = 0.038). After deflation, the VT/kg increased by 56% (95% CI: 28 to 90; P = 0.001) and was then adjusted back to the initial values.
The PNP12 significantly decreases Cdyn/kg and VT/kg in pediatric patients. The use of TDG20 produces a relatively minor additional impact in respiratory mechanics. This study emphasizes the need to adjust ventilator settings to maintain normal gas exchange during this procedure.
本研究旨在描述在接受腹腔镜隐睾固定术的儿科患者中，二氧化碳腹膜充气（12 mmHg压力）（PNP12）和头低脚高位20°（TDG20）相关的呼吸系统顺应性变化及其他呼吸力学指标。
12例接受隐睾固定术的腹部隐睾患者纳入本研究。采用七氟醚/O₂/空气、芬太尼和罗库溴铵进行全身麻醉。以10 - 15 cm H₂O的吸气峰压（PIP）和5 cm H₂O的呼气末正压进行压力控制通气，调整通气量以达到6 - 10 mL·kg⁻¹的潮气量（VT/kg）和35 - 40 mmHg的呼气末二氧化碳分压（EtCO₂）。调整PIP和呼吸频率（RR）以维持初始VT/kg且EtCO₂ < 50 mmHg。在基线、PNP12后、TDG20时以及放气并恢复至平卧位后记录体重校正动态顺应性（Cdyn/kg）、VT/kg和EtCO₂的测量值。
所有受试者均需调整PIP以维持目标VT/kg。PNP12后Cdyn/kg下降42%（95%置信区间[CI]：30%至51%；P < 0.001），放气前一直低于基线水平。TDG20仅使Cdyn/kg有轻微额外降低（下降10%；95% CI：0至19%；P = 0.048）。PNP12时VT/kg下降42%（95% CI：31%至52%；P = 0.048），TDG20后又进一步下降10%（95% CI：4%至19%；P = 0.038）。放气后，VT/kg增加56%（95% CI：28%至90%；P = 0.001），随后调整回初始值。
PNP12显著降低儿科患者的Cdyn/kg和VT/kg。TDG20的使用对呼吸力学产生相对较小的额外影响。本研究强调在此手术过程中需要调整呼吸机设置以维持正常气体交换。
