Noninvasive monitoring during laparoscopic nephrectomy

ABSTRACT

Thirty seven adult patients divided into 3 groups undergoing laparoscopic nephrectomy were used for this study. They were premedicated with oral diazepam. Thiopentone sodium, suxamethonium were used for induction of anesthesia and endotracheal intubation. Maintenance of anesthesia was with N2O O2 halothane in group 1 and N2O O2 morphine in group 2. In group 3, epidural analgesia using bupivacaine [0.8 mg/kg] and morphine [2 mg] preceded general anesthesia that was maintained with N2O 02. Pancuronium was the muscle relaxant used to control ventilation. Intraperitoneal CO2 insufflation was performed in lateral decubitus position. Monitoring of pulse, systolic and diastolic blood pressure,% oxygen saturation either arterial or by pulse oxymetry and CO2 in arterial blood [PaCO2] and expired air [PETCO2], was done during the whole procedure. No sharp swings were recorded by monitoring pulse and blood pressure. Satisfactory% O2 saturation was maintained as detected by both methods of monitoring during the operation. Significant increase in both PaCO2 and PETCO2 was seen after CO2 insufflation. Both methods of monitoring CO2 run together with no significant difference between them in all groups studied. Noninvasive monitoring may be satisfactory for the majority of patients, while invasive cardiovascular and blood gas monitoring may be necessary for compromised patients