이산화탄소를 이용한 복강경검사시 호기말 이산화탄소 분압의 변동

Laparoscopy is a useful technique for a diagnostic purpose of pelvic diseases in gynecologic patients, but it may be associated with many complications related to a steep Trendelenburg position and a usage of Trocar. It may also be developed that a large amount of CO₂ insufflation into the peritoneal cavity causes respiratory acidemia and its related hemodynamic changes. To investigate the influence of the CO₂, insufflation and the positional changes on the end-tidal CO₂, tension (P>CO₂), blood pressure and heart rate during laparoscopy in gynecologic patients, the authors observed the changes in PetCO₂,heart rate, and blood pressure before the CO₂, insufflation, at 1,3,5,7 and 10 minutes after the CO₂, insufflation and at 2,5 and 10 minutes after the CO₂, exsufflation respectvely under general endotracheal anesthesia with controlled ventilation (tidal volume 10 ml/kg, ventilatory rate 10 breaths/min). The results were as follows. 1) Pet>CO₂ was increased until 10 minutes after CO₂ insufflation. 2) PetCO₂ was decreased at 2,5 and 10 minute after CO₂ exsufflation but increased from the control value. 3) Heart rate was decreased at 1,3,5,7 and 10 minutes after CO₂ insufflation and at 2,5 and 10 minutes after CO₂ exsufflation from the control value respectively. 4) Systolic and diastolic blood pressures were increased after CO insuffiation and unti15 minutes after CO₂ exsufflation. On the basis of the above results, because an increase of the PetCO₂, and the hemodynamic changes occur during the laparoscopy using CO₂ under general endotracheal anesthesia with controlled ventilation, it is recommended to monitor carefully PetCO₂, heart rate and blood pressure to control adequately ventilation, blood pressure and heart rate.