ABSTRACT
BACKGROUND: To determine if positive pressure pneumoperitoneum has adverse effects on autonomic nervous system function, we examined baroreflex sensitivity (BRS) during carbon dioxide pneumoperitoneum in patients undergoing laparoscopic surgery. METHODS: Twenty adult patients scheduled for laparoscopic gynecologic surgery were selected for the study. After general anesthesia was induced with sevoflurane, continuous electrocardiography and blood pressure were monitored. Spontaneous BRS was achieved using sequence method immediately before, and 5 minutes after, pneumoperitoneum. Heart rate variability (HRV) was also determined. RESULTS: After pneumoperitoneum, BRS decreased from 12.9 +/- 1.8 ms/mmHg to 8.1 +/- 1.1 ms/mmHg (P < 0.05), and the power of the high frequency band decreased from 237.8 ms2/Hz to 49.6 ms2/Hz (P < 0.05). CONCLUSIONS: Compared to recordings obtained before pneumoperitoneum, BRS was decreased during pneumoperitoneum. This may predispose patients undergoing laparoscopic surgery to hemodynamic instability in addition to pneumoperitoneum itself.
Subject(s)
Adult , Female , Humans , Anesthesia, General , Autonomic Nervous System , Baroreflex , Blood Pressure , Carbon , Carbon Dioxide , Electrocardiography , Gynecologic Surgical Procedures , Heart Rate , Hemodynamics , Laparoscopy , Methyl Ethers , PneumoperitoneumABSTRACT
Given improvements in the diagnosis and treatment of congenital heart disease, more patients with heart disease reach adolescence or adulthood and require noncardiac surgery. Since 1971, the Fontan operation has been widely used for the management of tricuspid atresia and a variety of univentricular heart malformations. Although the life expectancy of these patients has increased, few reports are available on their anaesthetic management when a noncardiac operation is indicated. We report on the anaesthetic management of a 40-years-old male patient scheduled for permanent pacemaker insertion who underwent a modified Fontan procedure at the age of 27 years for pulmonary stenosis, common atrioventricular cushion defect, and for corrected transposition of the great arteries
Subject(s)
Adolescent , Adult , Humans , Male , Anesthesia , Arteries , Diagnosis , Fontan Procedure , Heart , Heart Defects, Congenital , Heart Diseases , Life Expectancy , Pulmonary Valve Stenosis , Tricuspid AtresiaABSTRACT
BACKGROUND: Levobupivacaine is known to be less cardiotoxic than racemic bupivacaine but some authors have reported there were no differences in cardiotoxic profiles between two agents. We will investigate the full course to cardiovascular collapse induced by bupivacaine stereoisomers in anesthetized dogs and would find out the differences if any, and explain the causative factors. METHODS: Twenty dogs were assigned to two groups, racemic bupivacaine group (BUP) and levobupivacaine group (LBUP), equally (n=10, each). Under general anesthesia each drug was infused continuously (0.5 mg/kg/min) until cardiovascuar collapse (CVC, MAP=40 mmHg) occurred. During the experiment, hemodynamic data, CO, SVR, PVR, ECG parameters and drug concen tration were gathered and analyzed. RESULTS: Two groups were not different in terms of dose for CVC, plasma drug concentration and time for CVC. MAP maintained initial values during the early period and declined during the late period without any between-group difference. Otherwise CO decreased continuously and significantly higher in LBUP than in BUP throughout. Calculated SVR showed the same feature as CO in opposite direction and was higher in BUP. Correlation test revealed high correlation between CONC and SVR or PVR and between CO and cSvO2. CONCLUSIONS: In assessment of cardiovascular collapse induced by stereoisomers of bupivacaine, monitoring with only MAP can lead to misinterpretation and invasive monitoring including CO or cSvO2 measurement might be needed.