Clinical Study Of Hemodynamic Changes During Anesthesia In The Laparoscopic Radical Resection Of Colorectal Cancer

Objective:To explor the changes of hemodynamics during anesthesia in the laparotomies and laparoscopic resection of colorectal cancer under different pneumoperitoneum.Methods:45 ASA class Ⅰ～Ⅱ patients with colorectal cancer were divided into laparotomy group （AS group, n= 15） and laparoscopic surgery group（LS group,n= 30）, and the carbon dioxide pneumoperitoneum pressure 12mmHg was divided as LS1 group （n= 15）,16mmhg was LS2 group （n= 15）. All patients were no severe respiratory, circulatory and endocrine system disease in pre-operation examinations, and also were no aortic, oropharynx and esophagus diseases or operation history. General anesthesia induction with midazolam 0.06 mg·kg-1, fentanyl 2～4 ug·kg-1, benzene sulfonic acid Shun cisatracurium 0.2 mg·kg-1, etomidate 0.3 mg · kg-1,after the induced tracheal intubation, detect the end tidal carbon dioxide partial pressure （PetCO 2）.The internal jugular vein catheterization were inserted, and the heart rate （HR）,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,cardiac output （CO）,central venous pressure （CVP）,airway pressure （PAW）,end tidal carbon dioxide partial pressure （PetCO₂） and peripheral resistance （SVR） were monitored continuously using by multifunction color Doppler ultrasound monitoring system. The time of extubation and patients waking were recorded at the time points of before the pneumoperitoneum （TO）, after pneumoperitoneum 10 min（T1）,20 min （T2）,30 min （T3）,45 min （T4）,60 min （T5）,75 min （T6） and 90min （T7）.Results:（1）Compared within these three groups, HR was changed significantly at T1 than that the other time points, HR-change was more significantly in LS2 group than that the LS1 and AS Groups （mean P<0.07）;（2）Compared with the AS group,the CVP, SBP, DBP, PetCO₂ and airway pressure were significantly increased in the LS group, and the pneumoperitoneum pressure were continued maintain at a high level until the pneumoperitoneum lifted （P< 0.01）;（3）The CO was decreased at the T1, and significantly increased at 20-30min （T2-T3） after pneumoperitoneum, and then CO decreased gradually with prolonged pneumoperitoneum;（4）Compared with the AS group, the SVR was obviously changed in the LS group,and the SVR was more significantly changed in the LS 2 group than that the LS1 group（P<0.01）（5）Compared with the AS group,the waking time and extubation time were longer in the LS group,and it was longer in the LS2 group than that the LS1 group （P<0.01）.Conclusion:The laparoscopic vision were satisfied when the carbon dioxide pneumoperitoneum pressure was in the 12mmHg,and influence of hemodynamics was less and patients recovered smoothly after general anesthesia.