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KMID : 0381219900220040428
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Journal of RIMSK
1990 Volume.22 No. 4 p.428 ~ p.438
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Effect of Trendelenberg Position on Acid-base Balance and Cardiovascular System during Pelviscopic Surgery
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Abstract
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In addition to its diagnostic value, pelviscopic surgery is minimally invasive surgical technique and effective procedure in gynecologic disease. But it may be associated with many complications concerning the steep Trendelenberg position and the use of Trocar. During Pelviscopy and intraabdominal insufflation of C02, Cardiopulmonary accidents following increased PaCO2 may occur.
We observed the changes in PaCO2, PH, heart rate and blood pressure during pelviscopic surgery under general anesthesia in 49 gynecologic patients. PaCO2 and PH were checked before the CO2 insufflation and 60 minutes after CO2 insufflation. Heart rate and blood pressure were checked before induction, 30 and 60 minutes after induction under general anesthesia with controlled ventilation (tidal volume 10 ml/kg, respiratory rate 12 bpm) and at recovery state. The results were as follows; 1) PaCO2 and PH of 1 hour after beginning of operation was significantly increased and decreased relatively compared with control value. 2) Heart rate of 30 or 60 minutes after CO2 insufflation was significantly increased compared with control value. 3) After CO2 insufflation systolic blood pressure was relatively unchanged compared with control value, but diastolic blood pressure and mean arterial pressure of 30 or 60 minute after CO2 insufflation were significantly increased compared with control value. 4) Post anesthetic major complications of pelviscopy were nausea (53%), vomiting (37%) and generalized edema (12%).
Respiratory acidosis caused by hypercapnia, and hemodynamic changes such as transient tachycardia and hypertension may occur by CO2 insufflation into abdominal cavity and Trendelenberg position during pelviscopic surgery.
Therefore it is recommendable to monitor acid-base balance by arterial blood gas analysis, and vital signs such as heart rate and blood pressure carefully during pelviscopic surgery.
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