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首页> 外文期刊>Surgical Endoscopy >Videoscopic surgery under local and regional anesthesia with helium abdominal insufflation.
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Videoscopic surgery under local and regional anesthesia with helium abdominal insufflation.

机译：局部和区域麻醉下的氦气腹腔镜下的视频手术。

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BACKGROUND: High-risk patients may not be good candidates for laparoscopic surgery due to the metabolic consequences of transperitoneal absorption of insufflated CO(2) gas and the necessity of general anesthesia because CO(2) insufflation produces pain. Helium gas is metabolically inert and does not produce pain. Thus it permits an alternative approach to performing laparoscopic surgery in high-risk patients. METHODS: Laparoscopic cholecystectomy, appendectomy, hernia repair, and peritoneal dialysis catheter procedures were performed under local or regional anesthesia in high-risk patients utilizing helium gas as the insufflation agent. RESULTS: Twenty-one patients underwent laparoscopic procedures under local or regional anesthesia. None of the procedures initiated under local-regional anesthesia required abandonment of the laparoscopic approach or conversion to general anesthesia. There were no operative or perioperative mortalities. Two incidences of pneumothorax occurred with extraperitoneal hernia repair; one required a tube thoracostomy. CONCLUSIONS: Helium gas should be considered the agent of choice for intraperitoneal insufflation in high-risk patients not only because helium avoids the metabolic consequences of CO(2) insufflation but also because it permits selected procedures to be performed under local-regional anesthesia. Helium may be contraindicated for laparoscopic procedures involving extraperitoneal insufflation due to the increased risk for pneumothoraces.
机译：背景：由于经腹膜吸收吸入的CO（2）气体的代谢后果和全身麻醉的必要性，高风险的患者可能不适合进行腹腔镜手术，因为CO（2）的注入会产生疼痛。氦气是代谢惰性的，不会产生疼痛。因此，它允许在高危患者中进行腹腔镜手术的替代方法。方法：在高危患者中使用氦气作为吹入剂，在局部或区域麻醉下进行腹腔镜胆囊切除术，阑尾切除术，疝修补术和腹膜透析导管程序。结果：21例患者在局部或区域麻醉下进行了腹腔镜手术。在局部麻醉下启动的任何程序都不需要放弃腹腔镜手术或转换为全身麻醉。没有手术或围手术期死亡。腹膜外疝气修补术发生了两次气胸事件。一个需要开胸胸腔切开术。结论：氦气应被视为高危患者腹腔内吹入的首选药剂，这不仅是因为氦避免了CO（2）吹入的代谢后果，而且因为它允许在局部区域麻醉下进行选定的手术。腹腔镜手术涉及腹膜外吹气时，氦气可能是禁忌的，因为增加了气胸的风险。

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