Noguchi J, Takagi H, Konishi M
Department of Anesthesiology, Kawasaki Municipal Hospital.
Masui. 1993 Apr;42(4):602-5.
A 41-year old, 50 kg female was scheduled for laparoscopic cholecystectomy. Anesthesia was induced with thiopental 250 mg IV and endotracheal intubation was performed using succinylcholine 60 mg IV. Anesthesia was maintained with N2O (67%)-oxygen-sevoflurane (1.5-2%) and pancuronium was used for muscle relaxation. The lungs were mechanically ventilated with TV 500 ml and RR 12.min-1. Immediately after the start of incision, PECO2 was 30 mmHg. But about thirty minutes after introducing carbon dioxide pneumoperitoneum, subcutaneous emphysema and high PECO2 (60 mmHg) were noted and arterial blood gas analysis showed PaCO2 63.2 mmHg, PaO2 135.4 mmHg and pH 7.32. Generally in laparoscopic cholecystectomy, subcutaneous emphysema is more common than in gynecologic laparoscopy and especially with severe subcutaneous emphysema, there is a risk of hypercapnia. This is because carbon dioxide in subcutaneous tissue is more absorbable than that in peritoneal cavity. As carbon dioxide in subcutaneous tissue is absorbed continuously after the operation, the patient should be carefully observed postoperatively.
一名41岁、体重50公斤的女性计划接受腹腔镜胆囊切除术。静脉注射硫喷妥钠250毫克诱导麻醉，并静脉注射琥珀酰胆碱60毫克进行气管插管。麻醉维持采用N2O（67%）-氧气-七氟醚（1.5-2%），并使用潘库溴铵进行肌肉松弛。采用潮气量500毫升、呼吸频率12次/分钟进行机械通气。切口开始后即刻，呼气末二氧化碳分压（PECO2）为30毫米汞柱。但在引入二氧化碳气腹约30分钟后，发现皮下气肿和高PECO2（60毫米汞柱），动脉血气分析显示动脉血二氧化碳分压（PaCO2）63.2毫米汞柱、动脉血氧分压（PaO2）135.4毫米汞柱、pH值7.32。一般来说，在腹腔镜胆囊切除术中，皮下气肿比妇科腹腔镜手术中更常见，尤其是严重皮下气肿时，存在高碳酸血症风险。这是因为皮下组织中的二氧化碳比腹腔内的更易吸收。由于术后皮下组织中的二氧化碳持续被吸收，术后应对患者进行仔细观察。
