Valuability of Propofol as Anesthetics and Effect of Hypercarbia on Awakening after Propofol TCI during Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: It used to induce hypercarbia that carbon dioxide insufflated into the peritoneum in laparoscopic surgery. It might stimulate sympathetic nervous system, and decrease splanchnic circulation, hepatic function, and metabolism of anesthetics. The purpose of the present study was to examine the influence of hypercarbia on concentrations of propofol at the time of eye opening and recovery of orientation after propofol target controlled infusion (TCI) during a laparoscopic cholecystectomy. METHODS: Fifty patients were divided randomly into a laparoscopic group (group 1, n = 25) and an exploratory group (group 2, n = 25). A propofol infusion was started at a propofol target concentration of 6microgram/ml, and anesthesia was maintained at 4microgram/ml by using a Diprifusor (TM) turing the operation, intraabdominal pressure was maintained automatically at 12 14 mmHg by a CO2 insufflator and controlled ventilation settings were adjusted about 50 mmHg of PaCO2 after peritoneal insufflation. This ventilatory setting was not changed throughout the operation. We evaluated the estimated plasma concentrations of propofol at the time of eye opening and recovery of orientation in each group using user interface of a Diprifusor (TM). RESULTS: In the laparoscopic group, PaCO2, and PetCO2 increased significantly at 5, 15, 30 minutes after carbon dioxide insufflation, but there was no significant difference in concentrations of propofol at eye opening and orientation after propofol TCI between the two groups. CONCLUSIONS: Hypercarbia induced by insufflation of carbon dioxide into peritoneum didn't give rise to an influence on awakening concentrations after propofol TCI during a laparoscopic cholecystectomy.

Cardiovascular and Respiratory Instability Induced by Excessive Packing during Lower Abdominal Surgery: A case report / 대한마취과학회지

Retractor and packing usually aid to expose the surgical field and fascilitate surgical procedures. but excessive packing can impede venous return and reduce cardiac output. We experienced severe hypotension and ventilatory difficulty associated with excessive packing and traction in a patient undergoing radical hysterectomy. After removing the packing and extracting the intestine exterior to abdominal cavity, patient's ventilatory condition improved immediately and cardiovascular stability was achieved.