腹腔镜你手术麻醉.ppt

第三十二章 腹腔镜手术的麻醉  Chapter 32 Anesthesia for laparoscopic Surgery The field of abdominal surgery has been radically changed with the introduction of laparoscopy. Recent advance in robotic and video technology have made the use of laparoscopic procedures more widely applicable. With the evolution of laparoscopy，a substantial number of abdominal procedures are being performed using this approach, including cholecystectomy, myomectomy, and so on. Compared with the traditional open abdominal approach.the laparoscopic approach is: less postoperative pain. shorter hospital stay. fewer overall adverse event. more rapid return to normal activity significant cost savings. However, it is important that the benefits of laparoscopic procedures be weighed against associated complications. A thorough knowledge of potential perioperative complications is necessary to provide optimal patient care Part I Physiological changes  during laparoscopic surgery The first step in laparoscopy is establishment of pneumoperitoneum. The ideal insufflating gas would be colorless, nonexplosive, Physiologically inert and readily soluble in plasma. Part I Physiological changes  during laparoscopic surgery CO2 is used extensively in clinic. The speed and pressure of the pneumoperitioneum effect the absorption of CO2. Positioning changes will effect the physiological function. I. Cardiovascular system The pressure of pneumopertioneum effect three aspects . systemic vascular resistance (SVR. Afterloail). venous return (preload ). cardiac function. I. Cardiovascular system During laparoscopic cholecystectomy If intraabdominal pressure (IAP) 10mmHg CVP ↑PAWP↑ SVR↑ CO and MAP↑ If intraabdominal pressure (IAP) 20mmHg CVP ↓ SVR↑↑ CI CO↓ MAP↑↓or normal I. Cardiovascular system The cause : Intraabdominal positive pressure intrathoracic pre