[Correction of cardiorespiratory disorders in laparoscopic cholecystectomy].
Carboxyperitoneum and traditional forced ventilation of the lungs have a negative impact on external respiration function during laparoscopic operations, leading to impairment of the ventilation device, pressure rise in airways, and decrease in oxygen diffusion and carbon dioxide release. This leads to accumulation of carbon dioxide in the blood and tissue with a trend to development of acidosis of mixed origin. Cardiovascular changes during laparoscopic cholecystectomy manifest by hypertension and tachicardia in the presence of increased central venous pressure and total peripheral vascular resistance, decreased stroke and cardiac indexes, decreased right-ventricular diastolic function, increased pressure in the pulmonary artery, and deceleration of venous bloodflow in the inferior and superior venae cavae. The most rational variant of forced ventilation of the lungs in laparoscopic cholecystectomy is high-frequency injection ventilation, which appreciably attenuates the negative effect of carboxyperitoneum on central hemodynamics, gas exchange, and external respiration function. The optimal variant of total anesthesia in laparoscopic cholecystectmy is endotracheal combined narcosis with diprivane and fentanide. The key factor in the choice of forced ventilation protocols is the maintenance of adequate gas exchange in the lungs in the presence of the lowest possible mean pressure in the airways.
Azbarov
A A
AA
Burov
N E
NE
Butovskiĭ
S A
SA
Zhdanova
O R
OR
Kornienko
A N
AN
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D017081:Cholecystectomy, Laparoscopic; D003627:Data Interpretation, Statistical; D004452:Echocardiography; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D007431:Intraoperative Complications / Q000517:prevention & control*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000494:pharmacology; D017300:Pipecuronium / Q000008:administration & dosage / Q000494:pharmacology; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology; D011659:Pulmonary Gas Exchange; D012119:Respiration; D012120:Respiration Disorders / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D012129:Respiratory Function Tests
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D017300:Pipecuronium; D005283:Fentanyl; D015742:Propofol