伴有Fontan生理和严重低氧血症的患者在Trendelenburg位腹腔镜手术的麻醉管理:1例报告。

IF 1 Q3 ANESTHESIOLOGY
Shunsuke Okano, Masahiro Kuroki, Shun Abe, Yu Matsuura, Ayuka Narisawa, Hiroaki Toyama
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引用次数: 0

摘要

背景:气腹和Trendelenburg定位被认为会增加肺血管阻力(PVR)。在Fontan循环中,PVR升高与心室预负荷降低直接相关,可导致循环衰竭。病例介绍:一名23岁的女性Fontan生理患者被诊断为左侧卵巢旁囊肿扭转并行腹腔镜膀胱切除术。室内空气中SpO2含量为70%。全身麻醉由雷马唑仑、芬太尼和罗库溴铵诱导,并由雷马唑仑和瑞芬太尼联合腹壁阻滞维持。SpO2和中心静脉血氧饱和度(ScvO2)的差异在麻醉诱导时增大,随着气腹和Trendelenburg定位的开始进一步增大,但在手术结束时恢复。结论:Fontan生理和严重低氧血症患者在严格的管理下可以耐受Trendelenburg位短期腹腔镜手术。在这些患者中,监测ScvO2为气腹和Trendelenburg定位的影响提供了重要的循环信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anesthesia management for laparoscopic surgery in the Trendelenburg position in a patient with Fontan physiology and severe hypoxemia: a case report.

Background: Pneumoperitoneum and Trendelenburg positioning are thought to increase pulmonary vascular resistance (PVR). In Fontan circulation, increased PVR is directly related to decreased ventricular preload and can result in circulatory failure.

Case presentation: A 23-year-old female patient with Fontan physiology was diagnosed with left paraovarian cyst torsion and underwent laparoscopic cystectomy. SpO2 was 70% in room air. General anesthesia was induced with remimazolam, fentanyl, and rocuronium and maintained with remimazolam and remifentanil combined with an abdominal wall block. The difference between SpO2 and central venous oxygen saturation (ScvO2) increased during the induction of anesthesia and further increased with the initiation of pneumoperitoneum and Trendelenburg positioning but recovered at the completion of the surgery.

Conclusions: Patients with Fontan physiology and severe hypoxemia can tolerate short-term laparoscopic surgery in the Trendelenburg position under strict management. In these patients, monitoring ScvO2 provides important circulatory information regarding the effects of pneumoperitoneum and Trendelenburg positioning.

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来源期刊
JA Clinical Reports
JA Clinical Reports ANESTHESIOLOGY-
CiteScore
1.30
自引率
0.00%
发文量
90
审稿时长
9 weeks
期刊介绍: JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.
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