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Arterial to end-tidal carbon dioxide tension difference during laparoscopic colorectal surgery

机译：腹腔镜结直肠手术期间的动脉至终潮二氧化碳张力差异

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BACKGROUND: Determination of end-tidal carbon dioxide pressure (PET(CO2)) is effective to confirm adequate ventilation, because arterial to end-tidal carbon dioxide tension difference (deltaa-ET(CO2)) does not change normally during operation. But deltaa-ET(CO2) may change during laparoscopic surgery, because peritoneal insufflation of CO2 will increase CO2 production and reduce functional residual volume. Changes in deltaa-ET(CO2) were reported in laparoscopic cholecystectomy with cardiovascular complication, but there is controversy about how deltaaET(CO2) will change in more complicated and long laparoscopic surgery. In this prospective study, we examined changes in deltaa- ET(CO2) during laparoscopic colorectal surgery. METHODS: Fifty patients received combined general and epidural anesthesia. CO2 pneumoperitoneum was initiated after obtaining arterial blood for gas analysis. Mechanical ventilation was used to maintain PET(CO2) at a stable value between 30 and 40 mmHg during the procedure. Arterialblood gas analysis was performed 10, 60, 120 minutes after CO2 insufflation, and 10 minutes after the termination of insufflation. RESULTS: The mean +/- SD for deltaa-ET(CO2) was 5.8 +/- 4.1 before pneumoperitoneum, 7.1 +/- 4.8, 8.1 +/- 5.4, 6. 4 +/- 4.9 in 10, 60, 120 minutes after pneumoperitoneum, and 6.4 +/- 4.9 in 10 minutes after the termination of pneumoperitoneum. deltaa-ET(CO2) increased significantly during pneumoperitoneum, but did not increase further even if CO2 insufflation was longer than 60 minutes. CONCLUSIONS: In laparoscopic colorectal surgery, Pa(CO2) should be checked for at least the first 60 minutes to confirm adequate ventilation.
机译：背景：呼气末二氧化碳压力（PET（CO 2））的测定是有效的，以确认有足够的通风，因为动脉到呼气末二氧化碳张力差（deltaa-ET（CO 2））通常不操作期间改变。但deltaa-ET（CO2）可以腹腔镜手术过程中改变，因为二氧化碳的腹膜吹气会增加二氧化碳的产量，减少功能残气量。据报道与心血管并发症腹腔镜胆囊切除术在deltaaET（CO2）的变化，但有大约deltaaET（CO2）如何将更为复杂和长期的腹腔镜手术改变的争议。在这项前瞻性研究中，我们腹腔镜结直肠手术期间审查deltaa- ET（CO2）的变化。方法：50例接受联合一般和硬膜外麻醉。 CO2气腹是获得动脉血气分析之后开始。机械通气用于在手术期间30和40毫米汞柱之间的稳定的值，以保持PET（CO 2）。进行Arterialblood气体分析10，60，120分钟后CO2吹入，和注入结束后10分钟。结果：平均+/- SD为deltaa-ET（CO2）是5.8±4.1气腹前，7.1 +/- 4.8，8.1 +/- 5.4，6.4 +/- 4.9 10 60 120分气腹后，和6.4 +/- 4.9在10分钟内气腹终止后。 deltaa-ET（CO2）气腹期间显著上升，但并没有进一步增加，即使气腹长于60分钟。结论：在腹腔镜结直肠手术，PA（CO2）应进行检查，至少在第60分钟以确认足够的通风。

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