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Management of mechanical ventilation during laparoscopic surgery

机译：腹腔镜手术中的机械通气管理

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摘要

Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO_2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.
机译：腹腔镜检查广泛用于多种疾病的外科治疗。人们普遍认为，基于外科专业知识和最先进的设备，其优势在于其最小的侵入性，更好的美容效果和较短的住院时间。数以千计的腹腔镜手术程序安全地证明，腹腔镜麻醉期间的机械通气被绝大多数患者很好地耐受。但是，气腹的作用与潜在的肺部疾病患者以及体重指数高于正常水平的患者人数增加特别相关。此外，当使用腹腔镜技术进行手术时，许多外科手术的持续时间明显更长。综上所述，这些因素对腹腔镜手术期间的机械通气管理应给予特别注意。审查的目的是总结气腹对麻醉期间机械通气的标准监测的后果，并讨论在腹腔镜手术中使用保护性通气策略的基本原理。强调了气腹期间胸壁错乱对气道压力和中心静脉压的影响，以及潮气末CO_2监测的作用。讨论了保护肺的通气和非通气策略。

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