복강경하 위아전절제술 중 발생한 숨겨진 후복막강 출혈 감지를 위한 경식도 도플러의 유용성
Usability of Esophageal Doppler for Monitoring of Concealed Retroperitoneal Hemorrhage during Laparoscopy Assisted Subtotal Gastrectomy
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초록
Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, DeltexTM, UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.
Abstract
Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, DeltexTM, UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.
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