A Study on the Effects of CO2 Pneumoperitoneum and Trendelenburg position on Arterial Acid-Base Balance and Middle Cerebral Artery Hemodynamics in Gynecologic Laparoscopic Surgery / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to identify arterial acid-balance and cerebral hemodynamics in patients undergoing gynecologic laparoscopic operations according to induction of CO2 pneumoperitoneum and Trendelenburg position. METHODS: Twenty patients without cardiopulmonary disease undergoing various laparoscopic pelvic surgeries were resulted in data of arterial blood and hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pCO2, pH, pO2, middle cerebral blood flow velocity (MCABFV), pulsatile index (PI), resistance index (RI). Under the standardized setting of general anesthesia, arterial blood and hemodynamic parameters were determined in supine position (base line) before CO2 insufflation, and 15 minutes, 30 minutes, 45 minutes in Trendelenburg position after CO2 insufflation, and 10 minutes in supine position after CO2 defflation. RESULTS: The arterial BP, pCO2 and MCABFV increased significantly in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. PI decreased significantly compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. RI decreased significantly as compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. CONCLUSION: Intraoperative arterial blood gas analysis is required in patients with high risk of hypercarbia during gynecologic laparoscopic surgery, and clinicians should anticipate an increase in cerebral blood flow and decrease in cerebral vascular resistance after CO2 pneumoperitoneum and Trendelenburg position, and gynecologic laparoscopy may be safe in view point of cerebral hemodynamics.

The Effects of Epidural Anaesthesia for Caesarean Section on Maternal Uterine and Fetal Umbilical Artery Blood Flow Velocity Waveforms / 대한산부인과학회잡지

OBJECTIVE: To study the effects of maternal epidural anaesthesia on the maternal uterine circulation and the fetal umbilical placental circulation by using Doppler ultrasound techniques. STUDY DESIGN: Twenty-seven patients delivered by elective caesarean section under lumbar epidural anaesthesia were studied. All had a normal pregnancy with no indication of fetal compromise and no indication of maternal disease. Each patient received a 1 litre intravenous crystalloid infusion over 20~30 minutes before an epidural bupivacaine injection. The uterine and fetal umbilical artery velocity waveforms were recorded. And then intravenous cannula and an epidural catheter were inserted. The local anaesthetic agent were injected through the epidural catheter(0.5% bupivacaine 10ml, 20% lidocaine 10 ml). At achieve sensory blockade to the T-4 level after the injection of the anaesthetic agent, the uterine and fetal placental circulation flow velocity-time waveforms were again recorded by using Doppler ultrasound(Multigon 500A, 4 MHz). Significance was tested by means of the paired student t-test. RESULTS: 1. Significant differences were observed between the two groups(Before anaesthesia, S/D ratio of fetal umbilical artery was 2.48+/-0.50. Following anaesthesia, S/D ratio of fetal unbilical artery was 2.24+/-0.40, p < 0.005). 2. Significant differences were observed between the two groups(Before anaesthesia, S/D ratio of maternal uterine artery was 2.29+/-0.41. Following anaesthesia, S/D ratio of maternal uterine artery was 1.95+/-0.25, p < 0.001). CONCLUSION: This study suggests a beneficial fetal effect from the improved maternal uterine perfusion after epidural anesthesia.