| Japanese |
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| Title | 右室駆出率測定用スワンガンツカテーテルを用いた腹腔鏡下腎摘出術の麻酔管理 |
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| Subtitle | 症例 |
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| Authors | 藤瀬久美子*, 山田功*, 河本慶子*, 内田盛夫** |
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| Authors(kana) | |
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| Organization | *関西医科大学麻酔科学教室, **田附興風会北野病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 13 |
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| Number | 3 |
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| Page | 491-496 |
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| Year/Month | 1992/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」二酸化炭素(CO2)を気腹に用いた腹腔鏡下腎摘出術の10時間40分にわたる術中管理に, 右室駆出率測定用スワンガンツカテーテルおよびコンピュータを用い血行動態諸量の変化を検討した. 気腹開始より終了時までPaCO2, 終末呼気二酸化炭素分圧, 気道内圧の上昇を認めた. 気腹開始直後には徐脈と低血圧をきたしたが30分以内に回復した. その間, 中心静脈圧, 肺毛細管楔入圧, 肺動脈圧の上昇にもかかわらず, 末梢血管抵抗, 肺血管抵抗は低下し, 心拍出量は増加した. 右室駆出率は気腹前と比較して気腹中に一時低下を示したが, 全経過を通じて正常範囲内にあった. 腹腔内圧上昇により静脈還流量は増加し, また気腹により血中CO2増加を生じ, その結果, 血管拡張, 即ち末梢血管抵抗の低下を来たし, 心ポンプ機能は代償された. 「はじめに」腹腔鏡手術は侵襲の少ない手術法として婦人科領域で開発され用いられてきた1)2). |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Laparoscopy, CO2, Anesthetic management, Hemodynamic changes |
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| English |
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| Title | The use of pulmonary artery catheter with a fast-response thermistor for the measurement of right ventricular performance in management of laparoscopic nephrectomy |
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| Subtitle | |
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| Authors | Kumiko Fujise*, Kou Yamada*, Keiko Khomoto*, Morio Uchida** |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology,Kansai Medical University, **Department of Anesthetics,Kitano Hospital |
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| Journal | Circulation Control |
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| Volume | 13 |
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| Number | 3 |
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| Page | 491-496 |
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| Year/Month | 1992/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A pulmonary artery catheter specifically designed to measure right ventricular performance by means of thermodilution technique and a microprocessor (model REE-1; Edwards Laboratory); was used during the anesthetic management of laparoscopic nephrectomy. Following insufflation by CO2, the PaCO2, end-tidal CO2(EtCO2) and peak airway pressure were increased. Immediately after establishing the pneumoperitoneum, the patient was noted to develop bradycardia and hypotension: this however recovered within 30 minutes without any treatment. In spite of increases in central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP) and pulmonary artery pressure (PAP), there were reductions in systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) and increase in cardiac output (CO). Although when compared with baseline values, the right ventricular ejection fraction showed a slight reduction during laparoscopy, the values were within the normal range throughout laparoscopy. Despite cardiac overload with increased intra-abdominal pressure, cardiac function was well maintained, probably because of reduction in SVR and PVR (probably due to direct vasodilation with accumulation of CO2), and increased venous return. |
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| Practice | Basic medicine |
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| Keywords | Laparoscopy, CO2, Anesthetic management, Hemodynamic changes |
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