Laparoskopik Kolesistektomi Operasyonlarinda PEEP Uygulamasının Arteriyel Oksijenasyon ve Dakika Ventilasyonu Üzerine Etkileri
Laporoskopik kolesistektomi tekniğine bağlı olarak, CO2pnömoperitonyumu ve artmış intraarteryal basinç (İAB); mekanik,hemodinamik ve respiratuar yan etkileri ortaya çıkarmakta, bu dahipoksemi, hiperkapni, hemodinamik instabilite ve oksijenasyondabozulmaya neden olabilmektedir. Temel problemler; fonksiyonel rezidüelkapasitenin azalması, ventilasyon/perfüzyon dengesinin bozulması veperitondan emilen CO2 nin sempatik stümülasyona yol açmasıdır. Bufizyopatolojik mekanizmalar perioperatif dönemde mekanik ventilasyonuygulamasının ve uygulanacak anestezik yöntemin gözden geçirilmesinigerektirir.
___
- [1] Bosch F, Wehrman U, Saeger HD, Kirch W. Laparoscopic or open
conventional cholecystectomy: clinical and economic
considerations. Eur J Surg 2002; 168:270-277.
[2] McDermott JP, Regan MC, Page R, et al. Cardiorespiratory effects
of laparoscopy with and without gas insufflation. Arch Surg 1995;
130:984-988.
[3] Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK.
Abdominal distension alters regional pleural pressures and chest
wall mechanics in pigs in vivo. J Appl Physiol
1991; 70:2611-2618.
[4] Wittgen CM, Charles HA, Stephen DF. Analysis of the
hemodynamic and ventilatory effects of laparoscopic
cholecystectomy. Arch. Surg. 1991;126:997-1001.
[5] Weisman İM, Rinaldo JE, Rogers RM. Positive end-expiratory
pressure in adult respiratory failure. The New England Journal of
Medicine. 1982;307:1381-1384.
[6] Tekant Y. Laparoskopik cerrahi. Sayek İ. (ed). Temel Cerrahi.
Ankara Güneş Kitabevi. 1996; 1609-1617.
[7] Langenbuch C. Ein Fall Von Exterpation der Gallenblase wegen
chronischer cholelthiasis. Heilung, Klin Wachenschr
1882; 19:725-727.
[8] Litynski G. Mouret, Dubois an Perissat. The French connection.
In: Highlights in the history of laparoscopy Frankfurt: Bernert,
1996.
[9] Bora S,Saydam S,Özman İ,Füzün M,Gülay H,Soylu M.
Laparoskopik kolesistektominin ilk 6 aylık sonuçları. Klin Den
Cer Derg. 1993;1:213-215.
[10] Maclntyre P. General principles for laparoscopic surgery. Allman
K.G, Wilson I. H.(ed.) Oxford Handbook of Anaesthesia
2002;289-294.
[11] Avcı C. Videolaparoskopik kolesistektomi. Kalaycı G ( ed ). Genel
Cerrahi, İstanbul, Nobel Tıp Kitapevi. 2002: 763-773.
[12] Dion YM, Morin J. Laparoscopic cholecystectomy. A review of
258 patients. Can. J. Of Surgery 1992; 35 (3):317-320.
[13] Cunningham AJ, Brull SJ. Laparoscopic cholecystectomy:
anesthetic implications. Anesth Analg. 1993;76:1120-1133.
[14] Frazee RC, Roberts JW, Okeson GC, et al. Open versus laparoscopic
cholecystectomy--a comparison of postoperative pulmonary
function. Ann Surg. 1991;213:651-653.
[15] Puri GD, Singh H. Ventilatory effects of laparoscopy under general
anesthesia. Br J Anesth. 1992;68:211-213.
[16] Taskın M, Zengin K. Laparoskopik cerrahinin tarihçesi.
Laparoskopik cerrahi. Alemdaroglu K, Taskın M, A
[17] Peters JH, Ellison CE. Safety and efficacy of laparoscopic
cholecystectomy. Ann Surg 1991;1: 3-12.
[18] Rademaker BM, Ringers J, Odoom JA, Dewit LT, Kalkman CJ,
Oosting J: Pulmonary function and stres response after laparoscopic
cholecystectomy: comparison with subcostal incision and influence
of thorasic epidural analgesia. Anesth Analg 1992, 75: 381- 385.
[19] Blobner M, Felber AR, Gogler S, et al. Zur Resorption von
Kohlendioxid aus dem Pneumoperitoneum bei laparoskopisthen
Cholezystektomien. Anaesthesist 1993;42:288-94.
[20] Meeks GR. Advanced laparoscopic gynecologic surgery. Surg Clin
North Amer 2000:1443-64.
[21] Paw P, Sackier JM. Complications of laparoscopy and thoracoscopy.
J Intensive Care Med 1994;9:290-304.
[22] Sharma KC, Kabinoff G, Ducheine Y, Tierney J, Brandstetter RD.
Laparoscopic surgery and its potential for medical complications.
Heart Lung 1997;26:52-64.
[23] Kehlet H, Rosenberg J, Ottesen BS. Laparoscopic surgery: An
update of current status. Ugeskr Laeger 2001;163:757-62.
[24] Cunningham AJ. Anesthetic implications of laparoscopic surgery.
Yale J Biol Med 1998;71:551-78.
[25] Nathanson LK, Shimi S, Cuschieri A. Laparoscopic cholecysectomy:
the Dundee tecnique. Br.J. Surgery 1991;78:155-159.
[26] Flowers JL, Bailey RW, Scovill WA. et al. The Baltimore experience
with laparoscopic management of acut cholecystitis. The American
J. of Surgery. 1991;161:388-392
[27] Sharma KC, Brandstetter RD, Brensilver JM, Jung LD.
Cardiopulmoner physiolojy and pathophysiology consequence of
laparoscopic surgery. Chest 1996;110:810-815.
[28] Odeberg S, Ljungqvist O, Svenberg Tluence, et al: Haemodynamic
effects of pneumoperitoneum and the influence of posture during
anesthesia dor laparoscopic surgery. Acta Anesthesiol Scand
1994; 38:276.
[29] Lentschener C, Axler O, Fernandez H, et al: Haemodynamic
changes and vazopressin release are not consistently associated
with carbon dioxide pneumoperitoneum in humans. Acta
Anesthesiol Scand 2001; 45:527.
[30] Rosmussen JP, Douchot PJ, De Palma RG, et al. Cardiac function
and hipercarbia. Arch Surg 1978;10: 1196-1200.
[31] Joris JL, Chiche JD, Canivet JL, et al: Hemodynamic changes
during laparoscopic cholecystectomy. Br J Anaesth 1997;78:264.
[32] Diebel L, Wilson R, Dulchavsky S, Saxe J. Effect of increased
intra-abdominal pressure on hepatic arterial, portal venous and
hepatic microcirculatory blood flow. J Trauma 1992;33:279-282.
[33] Eric J. K, John T. ., Amira S. Impairment of Cardiac Performance
by Laparoscopy in Patients Receiving Positive End-Expiratory
Pressure. Arch Surg. 1999;134:76-80.
[34] Kraut EJ, Amira S, Ronald B, Bruce MW. Impairment of cardiac
performance by laparoscopy in patients receiving positive endexpiratory
pressure. Arch Surg. 1990;134(1):76-80.
[35] Ulukaya S, Ayanoğlu HÖ, Demir F, Anadol Ö. Laparoskopik
kolesistektomi sırasında 5 cmH2O PEEP uygulanmasının solunum
mekanikleri ve ölü boşluk ventilasyonu üzerine etkisi.
TARK 2000; s:408.
[36] Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici
S, Eccher LG, Gattinoni L. Positive end-expiratory pressure
improves respiratory function in obese but not in normal subjects
during anesthesia and paralysis. Anesthesiology
1999:91:1221-1231.
[37] Cunnigham AJ, Brull SJ. Laparoscopic cholecystectomy:
Anesthetic implications. Anesth. Analg 1993;76:1120-33.
[38] Baraka A, Jabbour S, Hammoud R, Aoud M, Najjar F, Khoury G et
al. End-tidal Carbon dioxide tension during laparoscopic
cholecystectomy. Anaesthesia 1994:49;304-306.
[39] Rauh R, Hemmerling T.M, Rist M., Jacobi K. E. Influence
of Pneumoperitoneum and Patient Positioning on Resiratory
System Compliance. Journal of Clinical anesthesia
2001;13:361-365.
[40] R. L. Marshall, J. R. Jebson, I. T. Davıe. Cırculatory Effects Of
Carbon Dıoxıde Insufflatıon Of The Perıtoneal Cavıty For
Laparoscopy. British Journal of Anaesthesia, 1972,
Vol. 44, No. 7:680-684.
[41] Haris SN, Ballantyne GH, Luther MA, Perrino mc. Alterations
of cardiovascular performance during laparoscopic colectomy: a
combined hemodynamic and echocardiographic analysis. anesth
analg 1996;83(3):482-87.
[42] Fallot R, Snow M. Cardiopulmonary bedside monitoring. Principles
and applications of cardiorespiratory care equipment. Missouri,
Mosby İnc.1994:283-331
[43] Köprülü Ş, Esen F, Tütüncü A ve ark. Laparoskopik cerrahinin
akciğer mekaniğine etkileri. Türk Anest Rean Cem Mecmuası
1995; 23:427-430.
[44] Oikkonen M, Tallgren M. Changes in respiratory compliance at
laparoscopy: measurements using side stream spirometry. Can J
Anaesth 1995; 42:495-497.
[45] Wahba RW, Beique F, Kleiman SJ. Cardiopulmonary function and
laparoscopic cholecystectomy. Can J Anaesth 1995; 42:51-63.
[46] Hirvonen EA, Nuutinen LS, Kauko M. Ventilatory effects, blood
gas changes, and oxygen consumption during laparoscopic
hysterectomy. Anesth Analg 1995; 80:961-966.
[47] Kendall AP, Bhatt S, Oh TE. Pulmonary consequences of carbon
dioxide insufflation for laparoscopic cholecystectomies.
Anaesthesia 1995; 50:286-289.