Kılınç Leyla, Türk Hacer Şebnem, Sayın Pınar, Çınar Surhan, Demir Mesut, İslamoğlu Serkan
Department Anaesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Department of Pediatric Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2021 Apr;49(2):138-143. doi: 10.5152/TJAR.2020.153. Epub 2020 Dec 1.
Pneumoperitoneum can cause disruption in splanchnic perfusion. This study aims to investigate effects of pneumoperitoneum on splanchnic oxygenation during abdominal laparoscopic surgery in paediatric patients with NIRS (Near-Infrared Spectroscopy).
A total of 45 patients between 1 and 4 years of age with ASA physical status I-II and scheduled to undergo abdominal laparoscopic surgery under general anaesthesia were enrolled in this prospective, observational surgery. No premedication was used. Standard monitoring and regional splanchnic saturation (rSPcO), regional cerebral oxygen saturation (rScO) with NIRS were established before anaesthesia. Anaesthesia was induced with an inhalational agent and maintained with an oxygen/air mixture and sevoflurane. Peripheral oxygen saturation (SPO), rSPcO, rScO, heart rate (HR), mean arterial pressure (MAP), end tidal CO (Et-CO), and insufflation pressure (IP) were continuously monitored during administration of anaesthesia and recorded. After intubation (baseline T0); before CO insufflation induced pneumoperitoneum (PP) (T1); CO PP insufflation (T2); 5 minutes after PP insufflation (T3); 10 minutes after PP insufflation (T4); 15 minutes after PP insufflation (T5); 20 minutes after PP insufflation (T6); 30 minutes after PP insufflation (T7), 60 minutes after PP insufflation (T8), and after desufflation (T9). Bradycardia and hypotension were recorded. Paracetamol IV 10 mg kg was applied for post-operative analgesia. p<0.05 wasconsidered significant.
HR, rScO, and rSPcO decreased at all measured time intervals when compared to T0 (p<0.01) MAP decreased at T1 compared to T0 (p<0.001). Et-CO increased at T3-T4-T5-T6 compared to T0 (p<0.001).
We found that pneumoperitoneum reduced splanchnic oxygenation during laparoscopic abdominal surgery in paediatric patients, which was measured using NIRS.
气腹可导致内脏灌注中断。本研究旨在利用近红外光谱（NIRS）研究气腹对小儿患者腹部腹腔镜手术期间内脏氧合的影响。
本前瞻性观察性手术共纳入45例1至4岁、ASA身体状况为I-II级且计划在全身麻醉下接受腹部腹腔镜手术的患者。未使用术前用药。麻醉前建立标准监测及使用NIRS测量局部内脏饱和度（rSPcO）、局部脑氧饱和度（rScO）。使用吸入性药物诱导麻醉，并用氧气/空气混合气体和七氟醚维持麻醉。麻醉期间持续监测外周血氧饱和度（SPO）、rSPcO、rScO、心率（HR）、平均动脉压（MAP）、呼气末二氧化碳（Et-CO）和充气压力（IP）并记录。插管后（基线T0）；二氧化碳充气诱导气腹（PP）前（T1）；二氧化碳PP充气时（T2）；PP充气后5分钟（T3）；PP充气后10分钟（T4）；PP充气后15分钟（T5）；PP充气后20分钟（T6）；PP充气后30分钟（T7）；PP充气后60分钟（T8）；以及放气后（T9）。记录心动过缓和低血压情况。静脉注射对乙酰氨基酚10 mg/kg用于术后镇痛。p<0.05被认为具有统计学意义。
与T0相比，所有测量时间点的HR、rScO和rSPcO均下降（p<0.01）；与T0相比，T1时MAP下降（p<0.001）。与T0相比，T3-T4-T5-T6时Et-CO升高（p<0.001）。
我们发现，在小儿患者的腹腔镜腹部手术期间，气腹会降低内脏氧合，这是通过NIRS测量得出的。
