복강경 담낭절제술시와 회복시의 혈역학적 변화와 혈중 Catecholamines, Vasopressin치의 변화

Abstract

Background：Laparoscopic cholecystectomy produces less tissue trauma than conventional open procedure does. But, during this procedure, the deliberate pneumoperioneum with carbon dioxide(CO2) gas insufflation may cause some problems, such as hypercarbia, hypertension, tachycardia, and other changes of cardiovascular function. We analyze the physiologic mechanism of these hemodynamic effects under laparoscopic surgery with CO2 gas insufflation during inhalation general anesthesia. Materials and Methods：We studied randomly selected 5 healthy patients undergoing laparoscopic cholecystectomy with CO2 gas insufflation. Each patient inhaled sevoflurane and nitrous oxide gas(50%). The blood pressure, heart rate, end-tidal carbon dioxide level were measured during all the anesthetic procedures. We collected venous blood samples to determine the plasma level of epinephrine, norepinephrine and vasopressin, at 10 minutes after insufflation of CO2 gas into peritoneal cavity, and at 10 minutes after patient arrived in recovery room. We measured the plasma level of epinephrine and norepinephrine using double antibody method, and vasopressin level using radioimmunoassay method. Results ：Mean arterial pressure and heart rate was significantly increased, after intraperitoneal insufflation of CO2 gas(19.3%, 44.7% respectively), and in recovery period(15.8%, 28.6% respectively). The plasma concentration of epinephine was 47.1 ± 30.3 pg/ml(reference intervals, less than 100 pg/ml) at 10 minutes after insufflation of CO2 gas, and 53.1 ± 25.8 pg/ml at 10 minutes in recovery room. The plasma concentration of norepinephine was 125.7 ± 44.8 pg/ml (reference intervals, less than 600 pg/ml) after insufflation, and 179.1 ± 42.1 pg/ml in recovery room. The plasma concentration of vasopressin was 43.3 ± 34.5 pg/ml(reference intervals, less than 6.7 pg/ml) after insufflation, and 25.3 ± 16.7 pg/ml in recovery room. Conclusion：The laparoscopic cholecystectomy with CO2 gas insufflation in general anesthesia with sevoflurane and in recovery room results in increased mean arterial pressure, heart rate, and decreased plasma concentration of epinephine and norepinephine and increased plasma concentration of vasopressin