복강경수술시 Trendelenburg 체위와 Reverse Trendelenburg 체위는 최고흡기압과 동맥혈 가스의 변화에 영향을 주는가?

Abstract

Background: Laparoscopic surgery has increased in popularity due to its small skin incision, reduced postoperative pain and short hospital day. But increased abdominal pressure caused by CO2 insufflation and Trendelenburg position or reverse Trendelenburg position affects cardiovascular function and pulmonary ventilation. Some studies suggested that Trendelenburg position affect more serious results on pulmonary ventilation than reverse Trendelenburg position, but others do not. So we designed this study to compare the difference of peak inspiratory pressures and arterial blood gases between Trendelenburg position and reverse Trendelenburg position in laparoscopic surgery.

Methods: Twenty patients undergoing laparoscopic operation were randomized into two groups. Group Ⅰ (n=10) was laparoscopic gynecological surgery under Trendelenburg position, and group Ⅱ (n=10) was laparoscopic cholecystectomy under reverse Trendelenburg position. All patients were mechanically ventilated (a tidal volume of 12 ㎖/㎏ at a respiratory rate of 12 breaths/minute) with 50% nitrous oxide and 50% oxygen with enflurane. We measured peak inspiratory pressure, PaO2 and PaCO2 at pre-CO2 insufflation, 10 minute after CO2 insufflation, 30 minute after CO2 insufflation and 10 minute after CO2 deflation, respectively.

Results: There were no significant differences between the two groups in peak inspiratory pressure, PaCO2 and PaO2.

Conclusions: We suggest that there are no changes in pulmonary ventilation between Trendelenburg and reverse Trendelenburg position in patients undergoing laparoscopic surgery.