The clinical applicationof amended concave position in gynecological laparoscopy surgery / 中国医学装备

Objective:To evaluate the clinical effects of amended concave position in gynecological laparoscopy surgery.Methods: Eighty ASAⅠ~Ⅱ patients with gynecological laparoscopy surgery were randomly divided into two groups, the patients in group A were adopted Trendelenburg position; the patients in group B were adopted amended concave position. The Ppeak and PETCO2 in the two groups were recorded during surgery, the time of extubation and the adverse effects as nausea, vomiting, shivering was recorded after surgery.Results: The Ppeak and PETCO2 of group A were higher than that of group B(t=2.526,t=2.838, t=2.881;P<0.05). The time of extubation of group A were higher than that of group B after surgery(t=2.515,t=2.436;P<0.05).Conclusion: Adopting amended concave position can reduce Ppeak and PETCO2 in gynecological laparoscopic surgery, and it is helpful for postoperative recovery of the patients with gynecological laparoscopy surgery.

Positioning of double lumen endobronchial tube by three combined ethods with fibroptic bronchoscope / 临床麻醉学杂志

Objective To observe the correctly positioning rate of left-sided double lumen endobronchial tube by combined adjustment of auscultation,PETCO2 and airway pressure changes.Methods Sixty adult patients undergoing thoracic surgery were intubated with Robertshaw DLTs. DLT position is checked and adjusted by fiberoptic bronchoscope（FOB）. Results In the supine position,successful intubation is 57 cases by three combined methods,one of cases is shallower,two of cases are deeper,satisfactory rate is 95 percents;In the lateral decubitus position,successful intobution is 56 cases by three combined methods,two of cases is shallower,two of cases are deeper,satisfactory rate is 93.4 percents.Conclusion Three combined methods that are simple,reliable can be used repeatedly during postural changes without increasing the opportunities for injury,it is clinically a very good approach,but the absolute scope of safety is very small,FOB is necessary for positioning.

Effects of esomeprazole premedication on gastric pH during laparoscopic surgery / 대한마취과학회지

BACKGROUND: The use of CO2 for pneumoperitoneum during laparoscopic surgery provokes a decrement in the gastric pH. Since the incidence rate of PONV increases after laparoscopic surgery, the possibility of lung aspiration of gastric juice with a low pH during a postanesthetic emergence may increase and this could be fatal for the patient. We conducted this study to determine the effects of esomeprazole premedication on inhibiting the decrement of the gastric pH during laparoscopic surgery. METHODS: 40 adult patients with no underlying diseases were chosen and 20 patients each were grouped as C (the control group) and E (the esomeprazole group). In both group, 0.2 mg glycopyrrolate was given intramuscularly 30 minutes prior to the surgery. In group E, esomeprazole was given orally 2 hours prior to the surgery. The pH, PaCO2, and PETCO2 were measured via pH probe, an ABGA and an capnogram at preinsufflation and 15, 30 and 60 minutes after the CO2 insufflation and right before CO2 exhaustion (predeflation). RESULTS: Comparing the measurements of the gastric pH between group E and group C, all the results showed a significant increase in group E (P < 0.05). The difference of the PaCO2 and PETCO2 in the two groups was not significance. CONCLUSIONS: In contrast to the decrease in the gastric pH as the PaCO2 and PETCO2 increased in group C, the gastric pH in group E remained high until the end of the surgery despite the increase in the PaCO2 and PETCO2. Esomeprazole premedication seem to have an effect for inhibiting the gastric pH decrement regardless of the increase in the PaCO2 and PETCO2 during laparoscopic surgery.

The Effect of Intravenous Injection of Nalbuphine Hydrochloride on CO2 Response Curve in Normal Volunteers / 대한마취과학회지

Nalbuphine, a recently introduced agonist-antagonist analgesic is considered to have analgesic potency similar to morphine in common clinical doses and has been reported to possess an ceiling effect on respiratory depression and to be effective in reversing respiratory depression induced by oxymorphone or hydromorphone. To evaluate the respiratory depression of nalbuphine hydrochloride, we use displacement of CO2 response by a rebreathing method as the index of respiratory depression. Eight healthy male subjects were given the nalbuphine at a dose of 0.1 mg/kg(nalbuphine group) or same volume of normal saline as a placebo(placebo group) intravenously, at interval of 2 weeks by a double blind test. We measured end-tidal PCO2(PETCO2), minute ventilation (VE), tidal volume(VT), and respiratyory frequency(f) at 10 min, 30 min, 60 min and 90 min after the injection. The linear regression equations of VE in response to PCO2 10 min, 30 min, 60 min and 90 min after injection are y=-11.3+0.34X(R=0.66), y=-11.5+0.3X(R=0.53), y=-9.85+0.33X(R =0.61) and y=-11.8+0.37X(R=0.67) in placebo group and y=-11.1+0.30X(R=0.54), y= 13.1+0.35X(R=0.64), y=-11.3+0.33X(R=0.66) and y=-13.4+0.37X(R=0.63) in nalbuphine group.There were no significant differences in the slope of the CO2 response curves between placebo group and nalbuphine group. But there were rightward displacements of the CO2 response curves, which were significant rightward displacements at 60 min and 90 min after the injection(P<0.05). These findings demonstrate that nalbuphine hydrochloride might be a respiratory depressant.

Comparison of the End-Tidal PCO2 Measurements Sampled at the Distal and Proximal Ends of the Endotracheal Tube in Adults / 대한마취과학회지

To determine whether the site of gas sampling affects end-tidal gas measurements in adult patients during anesthesia, end-tidal pCO2(PetCO2) was measuredcontinuously from the distal and proximal ends of the endotracheal tube(SHERIDAN) in 33 adults ventilated with Drager anesthesia ventilator. These data were compared with simultaneous arterial PCO2 (PaCO2) measurements. The study was commenced after each patients was ventilated no less than 15 minutes at the desired ventilator settings. Gas was continuously aspirated at 230 ml/min. for measurement of the PetCO2 using SARA Cap.A.G,Capnometer'sampled from the distal and proximal ends of the endotracheal tube for 3-minutes of each sampling port, alternativiely measured at 5 minutes interval. And each measurement was repeated twice and calculated mean values. The results were as follows: The mean PetCO2 sampling from the distal end was 31.6+/-2.4 mmHg. and the proximal end was 31.0+/-2.3mmHg. The difference between two results was statistically not significant(p> 0.05). The correlation coefficients of PetCO2 vslues for the distal end and the proximal end samplings to the PaCO2 values were r =0.48 and r=0.45 respectively, and statistically significant(p< 0.05) We concluded that the measured PetCO2 sampled from the distal end of the ETCO cuffed endotracheal tube' does not show any statistically significance to the proximal one. However, distally sampled PetCO2 measurements were more approximate PaCO2 measurements than proximally sampled one.

The Effectiveness of the Use of ETCO2 Cuffed Tracheal Tube for the Measurement of End Tidal CO2 Tension / 대한마취과학회지

To evaluate the relationship between arterial and ent tidal carbon dioxide teneion, we use ETCO2cuffed tracheal tude. Twenty five patients were selected for the study. The anesthesia was induced by pentothal sodium 4-5mg/kg, succinylcholine 1-1.5mg/kg After intubation, anesthesia was maintained by halothane, nitrous oxide and oxygen. The patients were ventilated mechanically with tidal bolume 10 ml/kg and respiration rate 12/min When anesthesia was stabilized, end tidal cardon dioxide tension were measured at proximal and distal site of ETO2cuffed tracheal tube. The arterial blood sample were taken for arterial carbon dioxide tension from radial artery simultaneously. The results were as follows: 1) Both the end tidal carbon dioxide tension at proximal and distal sites of the tube showed close correlationship with arterial carbon dioxide tension 2) There was no statistical significant difference in carbon dioxide tension between proximal and distal site of ETCO2cuffed tracheal tube.