腹腔镜胆囊切除术的麻醉体会

Experience in anesthesia in patients undergoing loparoscopic cholecystectomy

目的 探讨腹腔镜胆囊切除术麻醉方法及术中并发症的处理。方法 60例患者均采用气管内插管静脉复合麻醉 ,先用 2 .5 %硫喷妥钠 6～ 8mg kg ,司可林 1.5～ 2mg kg ,芬太尼 1.0～ 2 .0 μg kg诱导 ,术中用异丙酚 2～ 4mg·kg- 1 ·h- 1 ,维库溴铵 0 .6～ 1.2mg·kg- 1 ·h- 1 ,1%～ 2 %异氟醚维持麻醉。结果 气腹建立后 ,3 2例出现血压升高和心率增快 ,占 5 3 .3 % ;1例发生严重皮下气肿 ,占 1.67% ;1例出现频发室性早搏 ,占 1.67% ,经处理后无 1例发生意外。

Objective To explore the methods for anesthesia and the management of intraoperative complications in laparoscopic cholecystectomy. Methods General anesthesia by endotracheal intubation was performed in all the 60 cases. Administration of 2.5% pentothal sodium at the dose of 6-8 mg/kg, succinylcholine at the dose of 1.5-4 mg/kg, and fentanyl at the dose of 1.0-2.0 μg/kg was conducted for the induction of anesthesia. Intraoperative administration of propofol at the dose of 2-4 mg·kg -1 ·h -1 , vecuronium at the dose of 0.6-1.2 mg·kg -1 ·h -1 , and 1%-1.2% isoflurane was also conducted through oxygen inhalation to maintain the anesthetic effect. Conclusion After setting up pneumoperitoneum, higher blood pressure and faster heart beats were found in 32 cases, account to 53.3%. Severe subcutaneous emphysema occurred in 1 case, accounting to 1.67%. Frequent ventricular premature beats were found in 1 case, accounting to 1.67%. Conclusion After setting up pneumoperitoneum, the dosage of the carbon dioxide at the primary stage should not exceed 1 L/min and maintenance of a steady abdominal pressure would be good for prevention of the reaction of the heart and blood vessels. General anesthesia through endotracheal intubation is safe and effective during laparoscopic cholecystectomy.