Lobato E B, Paige G B, Brown M M, Bennett B, Davis J D
Department of Anesthesiology, University of Florida, Gainesville 32610-0254, USA.
Anesth Analg. 1998 Feb;86(2):301-3. doi: 10.1097/00000539-199802000-00016.
Patients undergoing gynecological surgery under laparoscopic guidance usually receive general anesthesia with endotracheal intubation and mechanical ventilation. The creation of a pneumoperitoneum and the Trendelenburg position, both of which are used to improve visualization, are associated with cephalad movement of the diaphragm. This may increase the risk of endobronchial intubation. We studied the change in the distance from the tip of the endotracheal tube (ETT) to the carina with a fiberoptic bronchoscope in 30 patients aged 21-40 yr who were undergoing laparoscopic tubal ligation (n = 28) or hysterectomy (n = 2). Measurements were taken in the supine and Trendelenburg positions before and after pneumoperitoneum. The average distance from the ETT to the carina in the supine position was 2.1 +/- 0.8 cm and in the Trendelenburg position was 1.8 +/- 0.8 cm (P = not significant). After insufflation of the abdominal cavity, the mean distance decreased to 0.7 +/- 1.4 cm in the supine position (P < 0.05) and was associated with endobronchial intubation in eight patients. The addition of the Trendelenburg position to an established pneumoperitoneum resulted in minimal displacement (0.54 +/- 1.4 cm, P < 0.05) and one additional endobronchial intubation. We conclude that the insufflation of gas in the abdominal cavity, and not the change in patient position, is the main risk factor for endobronchial intubation in patients undergoing laparoscopic gynecologic surgery.
This study demonstrated that in anesthetized women, the insufflation of gas into the abdomen during laparoscopy for gynecologic surgery is the main risk factor for migration of the endotracheal tube into a bronchus.
接受腹腔镜引导下妇科手术的患者通常接受气管插管全身麻醉和机械通气。气腹的建立以及头低脚高位（两者均用于改善视野）与膈肌向头侧移动有关。这可能会增加支气管内插管的风险。我们使用纤维支气管镜研究了30例年龄在21至40岁、正在接受腹腔镜输卵管结扎术（n = 28）或子宫切除术（n = 2）的患者，气管导管（ETT）尖端至隆突的距离变化。在气腹前后分别于仰卧位和头低脚高位进行测量。仰卧位时ETT至隆突的平均距离为2.1±0.8 cm，头低脚高位时为1.8±0.8 cm（P值无统计学意义）。腹腔充气后，仰卧位时平均距离降至0.7±1.4 cm（P < 0.05），8例患者出现支气管内插管。在已建立气腹的基础上增加头低脚高位导致位移最小（0.54±1.4 cm，P < 0.05），并新增1例支气管内插管。我们得出结论，腹腔充气而非患者体位改变是接受腹腔镜妇科手术患者发生支气管内插管的主要危险因素。
本研究表明，在接受麻醉的女性中，妇科腹腔镜手术期间向腹腔内充气是气管导管移入支气管的主要危险因素。
