Laparoscopic Cholecystectomy: Anesthetic Implications
Laparoscopic Cholecystectomy: Anesthetic Implications
复制标题
腹腔镜胆囊切除术：麻醉的影响
DOI：
10.1213/00000539-199305000-00035
复制
发表时间：
1993
影响因子：
5.7
通讯作者：
S. Brull
中科院分区：
文献类型：
--
作者：
A. Cunningham;S. Brull
腹腔镜胆囊切除术是一种相对较新的外科手术，越来越受到人们的欢迎，同时也给麻醉带来了新的挑战。与传统的开腹胆囊切除术相比，住院时间短、恢复正常活动快的优点与较小的有限切口相关的疼痛较少、术后肠梗阻较少。并发症主要是由于盲插套管针过程中遭受的创伤，以及与患者体位和气腹产生相关的生理变化。腹腔镜胆囊切除术的麻醉技术选择通常仅限于全身麻醉。控制呼吸可避免高碳酸血症，一种结合了止吐和非类固醇抗炎药的麻醉技术减少了术后的恶心和呕吐。在腹腔镜胆囊切除术中使用一氧化二氮和麻醉剂是有争议的。在治疗有症状性胆囊病的患者方面，腹腔镜胆囊切除术是一个重大进步。然而，在目前的成本控制时代，年龄较大和病情较重的患者可能会在手术当天在没有充分的术前评估的情况下进行这一手术。因此，如果在手术过程中出现血流动力学、氧合或呼吸困难，麻醉师应准备好建议改用开放手术。
Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. Complications are mostly due to traumatic injuries sustained during blind trocar insertion, and physiologic changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for laparoscopic cholecystectomy is limited most frequently to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal antiinflammatory agents has reduced postoperative nausea and vomiting. The use of nitrous oxide and narcotics during laparoscopic cholecystectomy is controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gallbladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists thus should be prepared to recommend conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties occur during the procedure.