Comparison of volume-controlled and pressure-controlled ventilation using a laryngeal mask airway during gynecological laparoscopy / 대한마취과학회지

BACKGROUND: Several publications have reported the successful, safe use of Laryngeal Mask Airway (LMA)-Classic devices in patients undergoing laparoscopic surgery. However, there have been no studies that have examined the application of volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV) using a LMA during gynecological laparoscopy. The aim of this study is to compare how the VCV and PCV modes and using a LMA affect the pulmonary mechanics, the gas exchange and the cardiovascular responses in patients who are undergoing gynecological laparoscopy. METHODS: Sixty female patients were randomly allocated to one of two groups, (the VCV or PCV groups). In the VCV group, baseline ventilation of the lung was performed with volume-controlled ventilation and a tidal volume of 10 ml/kg ideal body weight (IBW). In the PCV group, baseline ventilation of the lung using pressure-controlled ventilation was initiated with a peak airway pressure that provided a tidal volume of 10 ml/kg IBW and an upper limit of 35 cmH2O. The end-tidal CO2, the peak airway pressures (Ppeak), the compliance, the airway resistance and the arterial oxygen saturation were recorded at T1: 5 minutes after insertion of the laryngeal airway, and at T2 and T3: 5 and 15 minutes, respectively, after CO2 insufflation. RESULTS: The Ppeak at 5 minutes and 15 minutes after CO2 insufflation were significantly increased compared to the baseline values in both groups. Also, at 5 minutes and 15 minutes after CO2 insufflation, there were significant differences of the Ppeak between the two groups. The compliance decreased in both groups after creating the pneumopertoneim (P < 0.05). CONCLUSIONS: Our results demonstrate that PCV may be an effective method of ventilation during gynecological laparoscopy, and it ensures oxygenation while minimizing the increases of the peak airway pressure after CO2 insufflation.

Lapraroscopic Surgery for the Treatment of Achalasia / 医学研究杂志

Objective To investigate the safety and feasibility of lapraroscopic Heller myotomy combined with Dor fundoplication surgery. Methods Three cases with achalasia have been treated with laproroscopic Heller-Dor surgery since February, 2005. Before surgery, patients were examined for generally esophageal barium meal and esophageal manometry. Results The operation time ranged from 110 and 120 minutes with the bleeding volumes between 40 to 50 ml, and the hospitalized time for patients post operation was 6 to 7 days. During a month after surgery, the patients showed the normal lower esophageal sphincter pressure and remnant pressure, increased the rate of relaxation,disappeared reversed peristalsis and gastroesophageal reflux, and no recurred symptoms. Conclusions In comparison to conventional surgery, Heller-Dor procedure results in smaller wound, less pain, fewer complications, faster recovery, shorter hospitalized days, and better therapeutic effectiveness. The Heller-Dor procedure is safe and feasible.