Lung volume reduction surgery for severe emphysema by video-assisted.thoracoscopy / 中国微创外科杂志

Objective To investigate clinical effects of video assisted thoracoscopic lung volume reduction surgery(LVRS) for severe emphysema. Methods Six patients with severe emphysema underwent lung volume reduction surgery by video assisted thoracoscopy.The LVRS was performed unilateraly in 4 and bilateraly in 2 through median stemination.20%～30% of total volume of lung was resected. Results There was no operative death.All patients were followed up for 3 to 17 months.After LVRS,the mean forced expiratory volume in 1 second(FEV 1) and PaO 2 increased by 24 6% and 8 3%,respectively,Total lung capacity(TLC),residual volume(RV) and ventilatory assistance decreased by 24 6%,20 3% and 47 1% respectively Conclusions LVRS by video-assited thoracoscopy is an effective and safe technique for patients with severe emphysema.It can relieve dyspnea and improve excise tolerance and the quality of life.

Effects of Insufflation on Hemodynamics and Arterial Blood Gas during Thoracoscopic Surgery / 대한마취과학회지

BACKGROUND: To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide (CO2) insufflation under positive pressures has been advocated during thoracoscopic surgery. We hypothesized that positive-pressure insufflation during thoracoscopy would cause significant hemodynamic and ventilatory compromise. METHODS: Thirty patients underwent general anesthesia with a single lumen endotracheal tube and placement of an arterial line. Noninvasive cardiac output monitoring was done on both the side of the neck and chest. Baseline measurements of hemodynamic indices and arterial blood gas analysis (ABGA) were taken before CO2 insufflation. Data was obtained at 5 minutes after CO2 insufflation. ABGA was taken 5 minutes after CO2 deflation. RESULTS: Insufflation of CO2 resulted in an increase in heart rate (HR), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI). Whereas cardiac index (CI), accelerated contractility index (ACI), PH, and arterial oxygen saturation (SaO2) were decreased. CONCLUSIONS: Positive pressure insufflation of CO2 during thoracoscopy resulted in hemodynamic and arterial blood gas changes. Therefore, we propose that low pressure (< 10 mmHg) insufflation is a safe adjunct to routine thoracoscopic surgical procedures.

Effects of Carbon Dioxide Insufflation on Hemodynamics and Arterial Blood Gas Tension during Thoracoscopy under General Anesthesia / 대한마취과학회지

BACKGROUND: Video-assisted thoracic surgical procedure via thoracoscopy has recently gained popularity, as it avoids a thoracotomy, reducing intraoperative blood loss, postoperative pain, respiratory dysfunction and hospital stay. However, to visualize adequately the intrathoracic structures, creation of artificial pneumothorax by carbon dioxide insufflation during thoracoscopy would cause significant hemodynamic compromise. The aim of this study was to evaluate the effect of CO2 insufflation into the pleural cavity on the hemodynamics and the arterial blood gas tension under general anesthesia. METHODS: Twenty-five patients, after intubation with single lumen endotracheal tube, underwent enflurane (1~2%) and N2O-O2 (1:1) general anesthesia. Before placement of a thoracoscope, the baseline mean arterial pressure and heart rate were obtained. Measurements were taken at 5, 10, and 20 min. after the beginning of carbon dioxide insufflation (3~5 mmHg) and 10 min. after gas evacuation. Blood gas analyses were done before, during CO2 insufflation and after CO2 evacuation. Data were analyzed using Student t-test. RESULTS: Positive-pressure CO2 insufflation (3~5 mmHg) caused a decrease of mean arterial pressure (5~7%) and an increase of airway pressure (1.5 times) and heart rate (13~20%) throughout the gas insufflation period (p<0.05). Blood gas analyses revealed no significant change. CONCLUSIONS: These results suggest that low CO2 insufflation pressures (3~5 mmHg) may cause cardiovascular depression during thoracoscopy. Therefore careful monitorings should be done during this procedure.

Differences of Hemodynamics and Arterial Blood Gas in Right and Left Lung Ventilation during Thoracoscopic Surgery with CO2 Insufflation / 대한마취과학회지

BACKGROUNDS: There is difference of blood flow between right and left lung, and it is also affected by positional change. The purpose of this study is to compare hemodynamics and arterial blood gas changes between two lungs in thoracoscopic surgery with CO2 insufflation METHODS: Fourteen thoracoscopic-surgical patient were randomly selected and divided into two groups; Group I : right lung ventilation, Group II: left lung ventilation. Blood gas analysis, blood pressure and heart rate were measured at three stages in lateral position; stage I: 10minutes after two-lung ventilation, stage II: 10minutes after one-lung ventilation and CO2 insufflation, stage III: 10minutes after two-lung ventilation and CO2 deflation. RESULTS: In both groups, blood pressure and heart rate were slightly increased at stage II, pH was decreased, PaO2 and PaCO2 were increased at stage II and stage III. But changes of pH and PaCO2 were greater in left lung ventilation. Arterial oxygen saturation and base excess did not change in all stages. CONCLUSIONS: Thoracoscopic surgery with CO2 insufflation did not increase the risk of hypoxemia if FiO2 is 1.0. However blood CO2 retension is higher in left lung ventilation than in right one. So we have to observe PaCO2 more carefully when the left lung is ventilated.