The Effect of Lithotomy-Trendelenburg Position and Carbon Dioxide Insufflation on the Distance from the Upper Incisor to the Carina / 대한마취과학회지

BACKGROUND: The carbon dioxide (CO2) insufflation and lithotomy-Trendelenburg position are required in the laparoscopic gynecologic surgery. However, they can change the distance from the upper incisor to the carina. This may increase the risk of endobronchial intubation. METHODS: Nineteen patients, aged 29-50 yr, who were undergoing laparoscopic surgery were enrolled. We measured the distance from the upper incisor to the carina of them with fiberoptic bronchoscope. Measurements were taken in the each point of lithotomy position, lithotomy-Trendelenburg position, and lithotomy-Trendelenburg position after CO2 insufflation. RESULTS: The average distance from the upper incisor to the carina was 23.1 +/- 1.4 cm in the lithotomy position (0 degree) and was significantly decreased to 22.6 +/- 1.4 cm in the lithotomy-Trendelenburg position (15 degrees) (P<0.05). After CO2 insufflation into the abdominal cavity, the mean distance in the lithotomy-Trendelenburg position (15 degrees) was significantly decreased to 22.1 +/- 1.4 cm (P<0.05). CONCLUSIONS: The lithotomy-Trendelenburg position and CO2 insufflation decrease the distance from the upper incisor to the carina.

The Effect of the Lithotomy-Trendelenburg Position on Respiratory and Hemodynamic Changes during General Anesthesia / 대한마취과학회지

BACKGROUND: The effects of Trendelenburg positions used to expose the surgical field may induce intraoperative hemodynamic and respiratory changes that complicate anesthetic management. This study was performed to evaluate the effects of the lithotomy-Trendelenburg position on respiratory and hemodynamic changes with time passage during general anesthesia. METHODS: Twenty patients undergoing anorectal surgery with general anesthesia were studied. Hemodynamic and respiratory parameters were measured before the lithotomy-Trendelenburg position (L) and 3 min (LT3), 6 min (LT6), 12 min (LT12), 30 min (LT30) and 60 min (LT60) after the 30 degree Trendelenburg position. The cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), airway resistance (Raw) and dynamic compliance (Cdyn) were measured by a non-invasive cardiac output monitor. RESULTS: Central venous pressure and peak inspiratory pressure were markedly increased from the lithotomy to the lithotomy-Trendelenburg position. Heart rate was slightly increased while SV, CI, SVR and MAP were decreased. No significant changes of the SV or CI were observed during surgery. The Cdyn was significantly decreased. CONCLUSIONS: The steep lithotomy-Trendelenburg position induces moderate adverse hemodynamic and respiratory effects in healthy patients. These findings indicate the need for more active hemodynamic and respiratory monitoring in patients with a compromised cardiopulmonary function.

Effects of Pelviscopy on the PaCO2 and Hemodynamics / 대한마취과학회지

BACKGROUND: Pelviscopy has become popular because of the advantage of which less painful, less scarring, and shortening the hospitalizing stays, so to reduce the cost. This procedure require lithotomy- Trendelenburg position and pneumoperitoneum with carbon dioxide(CO2) gas insufflation, that affect arterial blood gas and hemodynamics. We studied the effects of pelviscopy on the PaCO2 and hemodynamics. METHODS: Twenty patients scheduled for pelviscopic hysterectomy were studied. All patients anesthetized with enflurane (2.0 vol%) - nitrous oxide (1.5 L/min) and oxygen (1.5 L/min), and controlled ventilation(tidal volume 10 ml/kg, respiratory rate 12 /min). Central venous pressure, blood pressure, heart rate and PaCO2 measured at postinduction(control), position change with CO2 gas insufflation, and every 15 minutes after pneumoperitoneum. RESULTS: Central venous pressure increased (P<0.05) through the procedure after position change and CO2 gas insufflation. Systolic blood pressure and heart rate decreased at 45min after pneumoperitoneum(P<0.05). Mean arterial pressure decreased at 75 min after pneumoperitoneum. PaCO2 increased at 15 min after position change and pneumoperitoneum(P<0.05). CONCLUSION: In our study, because central venous pressure and PaCO2 increased, we should attend to patients with hypertension, increased intracranial pressure, and increased PaCO2.