Bhavani-Shankar K, Steinbrook R A, Mushlin P S, Freiberger D
Department of Anaesthesia, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
Can J Anaesth. 1998 Feb;45(2):164-9. doi: 10.1007/BF03013257.
Respiratory acidosis during carbon dioxide (CO2) insufflation has been suggested as a cause of spontaneous abortion and preterm labour following laparoscopic cholecystectomy during pregnancy. Capnography may not be adequate as a guide to adjust pulmonary ventilation during laparoscopic surgery and hence arterial carbon dioxide (PaCO2) monitoring has been recommended. We report the feasibility and benefits of transcutaneous carbon dioxide monitoring (PtcCO2) as an approach to optimise ventilation during laparoscopic surgery in pregnancy.
A healthy parturient received general anaesthesia for laparoscopic cholecystectomy. Pulmonary ventilation was adjusted to maintain end-tidal carbon dioxide (conventional PETCO2) at 32 mmHg during CO2 insufflation. A PtcCO2 monitor was used to trend PaCO2 throughout the procedure. Mechanical ventilation was interrupted every five minutes to obtain an end-tidal PCO2 value at large tidal volume (squeeze PETCO2).
The PtcCO2 increased from 39 mmHg before induction to 45 mmHg after CO2 insufflation. This corresponds to an estimated maximum PaCO2 of 39-40 mmHg during insufflation. The PtcCO2 gradually returned to pre-induction baseline values one hour after the termination of CO2 insufflation. Squeeze PETCO2 values approximated PtcCO2 more closely than did conventional PETCO2 values (P < 0.01).
Continuous PtcCO2 measurements as well as squeeze PETCO2 may be of clinical value in trending and preventing hypercarbia during laparoscopic surgery.
二氧化碳（CO₂）气腹期间的呼吸性酸中毒被认为是妊娠期间腹腔镜胆囊切除术后自然流产和早产的原因。在腹腔镜手术期间，二氧化碳图可能不足以指导调整肺通气，因此推荐进行动脉二氧化碳（PaCO₂）监测。我们报告了经皮二氧化碳监测（PtcCO₂）作为优化妊娠腹腔镜手术期间通气方法的可行性和益处。
一名健康产妇接受了腹腔镜胆囊切除术全身麻醉。在CO₂气腹期间，调整肺通气以维持呼气末二氧化碳（传统的PETCO₂）在32 mmHg。在整个手术过程中使用PtcCO₂监测仪来监测PaCO₂趋势。每五分钟中断一次机械通气，以在大潮气量时获得呼气末PCO₂值（挤压PETCO₂）。
PtcCO₂从诱导前的39 mmHg增加到CO₂气腹后的45 mmHg。这对应于气腹期间估计的最大PaCO₂为39 - 40 mmHg。CO₂气腹结束后1小时，PtcCO₂逐渐恢复到诱导前的基线值。挤压PETCO₂值比传统PETCO₂值更接近PtcCO₂（P < 0.01）。
连续的PtcCO₂测量以及挤压PETCO₂在腹腔镜手术期间监测和预防高碳酸血症方面可能具有临床价值。
