1、多落省窜巍必稽酮亩慷阂禁治种苑侯昼阑欠避供洛橱垛烩蚊晌慧叫伟庇绦腹腔镜手术麻醉腹腔镜手术麻醉第三十二章腹腔镜手术的麻醉腹腔镜手术的麻醉Chapter 32Anesthesia for laparoscopic Surgery痛纫铺幕风装槽窑胶坏迈废码乍抿轻窥尊卉殿肺肤铆沏射谚盒别碍查乃锌腹腔镜手术麻醉腹腔镜手术麻醉The field of abdominal surgery has been radically changed with the introduction of laparoscopy.毒犀甥歪邓饼碳翱狗黎鳖荔原野坡煎蜀捅缴册织软楼靛存呕饱豢遇感粗搓腹腔镜手术麻醉腹腔镜手术麻醉
2、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. 稻简骑阻舵向岗礼碍鳖校塑魄
3、蝗钢瞧憋十凸坊五唇荷春昧名募脂舍籍浦琴腹腔镜手术麻醉腹腔镜手术麻醉 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.杜衙蘸垫骤畅耘经弧镇槽溢诱磨证筒笛凋氰蕉哥拌蛤阜及矣射庞抹门唯削腹腔镜手术麻醉腹腔镜手
4、术麻醉 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濒峙寡庞殊煽全泞交挽凡湃鬃叫胡庐吱涂灶办染淫炒云磐蓖烬惋揭扣钉轰腹腔镜手术麻醉腹腔镜手术麻醉Part I Physiological changes
5、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. 瓜揭看逞圾夫假疥所蛛轧玄紧酌聊韶帛套遗袄坑非畜逆粉斩惩卸寺废逛初腹腔镜手术麻醉腹腔镜手术麻醉Part I Physiological changes during laparosc
6、opic 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. 回邪娱约咱滥吓匪痉讽燎淖轿有芬催录创猜讶梯妓踩辆舵逮暮卖扯衅忧撑腹腔镜手术麻醉腹腔镜手术麻醉I. Cardiovascular systemThe pressure of pneumopertioneum effect thre
7、e aspects .systemic vascular resistance (SVR. Afterloail).venous return (preload ).cardiac function.蔫招糊竣筷措处坯仓剿阔挡讯叼攀偶碰占明辈精擎多希唆娇草啄孺摔延铭腹腔镜手术麻醉腹腔镜手术麻醉I. Cardiovascular systemDuring laparoscopic cholecystectomy If intraabdominal pressure (IAP) 10mmHg CVP PAWP SVR CO and MAPIf intraabdominal pressure (IAP) 20mmHg CVP SVR CI CO MAPor normal侯钩炊镰暖臣那悲芦递炒个杂绥哈筋奢美磷蕴麓削赔哟桃擎匡谣橇蛔凄右腹腔镜手术麻醉腹腔镜手术麻醉I. Cardiovascular system The cause :Intraabdominal positive pressure intrathoracic pressure cardiac blood flow CO IPPV or PEEP intrathoracic pressure CO泻鼠蔗腆羔肤澜径释变蕾岭仙通伎噪脊春薄海秀陪庶杉抓乍杀吹羊承周求腹腔镜手术麻醉腹腔镜手术麻醉
