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143 cases of laparoscopic renal cyst decortication surgery Anesthesia


No special. 4 Discussion retroperitoneal renal cyst decortication surgery success depends on: choosing the appropriate cases (after the laparoscopic surgery without contraindications and cyst diameter greater than 4cm or more) and skilled laparoscopic surgeon technique. Laparoscopic management of post-anesthesia should note the following: control of pneumoperitoneum: The retroperitoneal approach and retroperitoneal approach to the respiratory cycle was relatively small. Retroperitoneal means less absorption of CO, arterial partial pressure of oxygen, CO partial pressure change in relatively small abdominal approach. However, surgery should strictly monitor the injection pressure, injection pressure is too high if the Veress needle or strayed into the subcutaneous tissue, CO may be retroperitoneal or subcutaneous tissue with the formation of large-scale diffuse subcutaneous emphysema as well as the body, so that absorption of CO area expansion, absorption speed, absorption increased significantly, so that the rapid increase in PaCO, influence pH. Subcutaneous emphysema caused by severe chest wall stiffness, increased airway resistance, decreased minute ventilation, decreased blood vein Huixin, BP and spo decline. CO directly on the heart can be reduced 13 myocardial contractility, heart rate, so cardiac vagal response enhancement of such merger hypoxia, can lead to cardiac arrest. Pressure is too high can cause retroperitoneal retroperitoneal organs shift, so difficult to identify patients who .... We controlled through automatic pneumoperitoneum pneumoperitoneum pressure of not more than 15mmHg, monitoring of airway pressure is not higher than 30cmHO, when necessary, increase fresh air flow and minute ventilation, so that surgery PetCO maintained at 35 ~ 40mmHg, close observation of vital signs . Maintain circulation stability: senior citizens and patients with other disease resistance of the relatively poor anesthesia, body position changes can lead to orthostatic hypotension,[link widoczny dla zalogowanych], renal cysts relatively short operation time and surgical stress is small, not deep depth of anesthesia required and so on. This part of the patient before surgery to balance 2h pre-infusion liquid, add the effective blood volume. Before anesthesia with PHC's advantages are: inhibition of glandular secretion, the central role of calm and stable heart rate. Induction and maintenance of short-acting drug selection, rapid, and less impact on the cycle of drugs, such as the small amount of propofol, etomidate, vecuronium or atracurium, etc.; take a small amount of additional slow injection split medicine, or preferably the compound solution or micro pump infusion of intravenous maintenance of anesthesia (anesthesia is more stable, and reduce local anesthetic consumption); prevent drastic changes in circulation caused by too deep anesthesia and the occurrence of orthostatic hypotension, but also conducive to fast after awake. Lateral position on the respiratory and circulatory effects: kidney pad rises, tidal volume can be reduced by 14%. Due to respiratory movements after anesthesia, skeletal muscle tension,[link widoczny dla zalogowanych], myocardial contractility and vasomotor decompensation such as suppressed, a change of position caused by changes in the cardiac cycle can be more evident. As anesthesia deepened, compensatory control mechanism was progressively reduced, the blood within the circulatory system can be almost completely dominated by changes in body position. Therefore, the depth of anesthesia suitable for surgery and the regulation of ventilation, body position changes to avoid drastic changes in the respiratory cycle. Depth of anesthesia requirements: placement in the lateral position under general anesthesia,[link widoczny dla zalogowanych], the operation should be slow, action should be gentle, to be coordinated. The main task of the anesthesiologist is to ensure stable anesthesia, to avoid too deep anesthesia and anesthesia induced circulation disorders caused by too shallow cough patients, the placement of position, or lead to accidents such as endotracheal tube prolapse �� j. Renal cyst in the depth of anesthesia during the operation requested is not deep, relatively stable respiration and circulation. Body temperature monitoring: adjust the indoor temperature 22 ~ 25 �� and warm to body temperature maintained at 36 ~ 37 ��,[link widoczny dla zalogowanych], to prevent hypothermia ', to result in delayed recovery, or hyperthermia to increase metabolism. Renal cysts more common in the elderly, often associated with diseases of other systems, so anesthesia before, during and after the merger should be noted that the appropriate treatment of the disease and treatment to prevent all accidents and complications. In conclusion, anesthesiologists should be aware of characteristics of the patient's condition, familiar with the surgical procedure and anesthesia characteristics of the master with the depth of anesthesia to maintain body temperature of 36 ~ 37 ��, respiratory and circulatory function to maintain stability, control CO pneumoperitoneum pressure of not more than 15mmHg, close observation airway pressure does not exceed 30cmH0, surgery PetCO maintained at 35 ~ 40mmHg, SpO298% ~ 100%, to prevent subcutaneous emphysema, hypercapnia, CO embolism, respiratory and circulatory complications,[link widoczny dla zalogowanych], such drastic changes to ensure patient safety.
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