Uhrbrand B, Hansen H S
Odense Universitetshospital, anaestesiologisk-intensiv afdeling V.
Ugeskr Laeger. 1994 Aug 15;156(33):4700-4.
A review of anaesthesia for gynaecologic laparoscopic surgery is given. Special criteria are needed for selection of patients, choice of anaesthesia and intraoperative monitoring. The cardiovascular and respiratory system are affected by tension from the pneumoperitoneum, absorption of CO2 and Trendelenburg position. Gas insufflation can provoke venous gas embolism, pneumothorax, pneumomediastinum, pneumopericardium and subcutaneous emphysema. The introduction of laparoscopic instruments may result in unintentional injuries to intra-abdominal organs. The possibility that the procedure may have to be converted to open laparotomy needs to be considered. Bowel burns may result in perforation, peritonitis and sepsis. Laparoscopy is contraindicated in patients with serious cardiac disease, extensive bowel adhesions or intestinal obstruction. General anaesthesia with muscle paralysis, tracheal intubation and controlled ventilation is the preferred technique in these cases. Short acting anaesthetics are preferred in day case laparoscopy. Central neural blockade or infiltration anaesthesia supplemented with sedation and analgetics can be used for short laparoscopic procedures. The electrocardiogram, noninvasive arterial pressure monitor, airway pressure monitor, intra-abdominal pressure monitor, pulse oximeter and CO2 monitor are used routinely. Antiemetics and analgetics may be needed postoperatively.
本文对妇科腹腔镜手术的麻醉进行了综述。患者选择、麻醉方式选择及术中监测均需要特殊标准。气腹的张力、二氧化碳吸收及头低脚高位会影响心血管和呼吸系统。气体注入可引发静脉气体栓塞、气胸、纵隔气肿、心包积气和皮下气肿。腹腔镜器械的插入可能导致腹腔内器官的意外损伤。需要考虑手术可能不得不转为开腹手术的可能性。肠道灼伤可能导致穿孔、腹膜炎和脓毒症。严重心脏病、广泛肠粘连或肠梗阻患者禁忌行腹腔镜检查。在这些情况下，首选全身麻醉加肌肉松弛、气管插管和控制通气。日间腹腔镜手术首选短效麻醉药。对于短时间的腹腔镜手术，可采用中枢神经阻滞或浸润麻醉并辅以镇静药和镇痛药。常规使用心电图、无创动脉压监测仪、气道压力监测仪、腹腔内压力监测仪、脉搏血氧饱和度仪和二氧化碳监测仪。术后可能需要使用止吐药和镇痛药。
