Effect Of Anesthesia Management Guided By Muscular Tissue Oxygen On Lactate Metabolism During Laparoscopic Hysterectomy

Background and objectiveA continuous and adequate supply of oxygen is essential for maintaining the integrity of human tissues.According to the redistribution regulation mechanism of blood flow,when the cardiac output(CO)is reduced,the blood flow of important organs such as the heart and brain may be maintained at the expense of peripheral tissue perfusion such as kidney and muscle.Therefore,indicators of oxygen metabolism in peripheral tissues like kidney and muscle can be used as indicators of poor tissue perfusion.With the advancement of technology,it is currently possible to monitor the oxygen saturation of a variety of tissues by placing electrode pads at different locations using near-infrared spectroscopy(NIRS)monitoring technology.Continuous CO2 pneumoperitoneum and Trendelenburg posture during laparoscopic surgery may adversely affect patients’ peripheral tissue perfusion.Lactic acid is one of the most popular indicators of tissue perfusion.when tissue perfusion is insufficient,tissue cells of kidneys and muscles can produce a large amount of lactic acid through the glycolysis pathway.Current studies have shown that goal-directed therapy using cerebral oxygen saturation can reduce lactic acid accumulation and improve patient prognosis.There are few relevant studies on muscular oxygen saturation monitoring.The purpose of this study is to explore the effect of anesthesia management based on intraoperative muscular oxygen saturation monitoring on lactate metabolism during patients undergoing laparoscopic hysterectomy.MethodEighty patients,aged 18-65 years,ASA physical status I or II,scheduled for elective laparoscopic hysterectomy were randomly divided into intervention group(group I)and control group(group C),according to the envelope method.Each group had 40 patients.After patients entering the operating room,the flank(SfmtO2)and forearm muscular tissue oxygen saturation(SamtO2)were monitored and the basic values were recorded.After the induction of general intravenous anesthesia,a laryngeal mask was placed for mechanical ventilation.For patients in group Ⅰ,the anesthesiologist maintained the SfmtO2 and SamtO2 not less than 70%or not less than the basic value according to the established intervention plan.For patients in group C,anesthesiologists managed anesthesia according to clinical routine.At recording baseline values(T0),immediately before opening the pneumoperitoneum(T1),40min after opening the pneumoperitoneum(T2),and 10 minutes after closing the pneumoperitoneum(T3)record the following indicators:heart rate(HR)and mean arterial pressure(MAP),cardiac index(CI),stroke volume(SV),systemic circulation resistance(SVR)as well as SfmtO2 and SamtO2.Drew central venous blood at Ti,T2,and T3 for blood gas analysis and recorded the pH,central venous carbon dioxide pressure(PcvCO2),central venous oxygen pressure(PcVO2),central venous oxygen saturation(ScvO2),hemoglobin concentration(Hb),and blood glucose concentration(Glu),lactic acid concentration(Lac),bicarbonate concentration(HCO3-),base excess(BE)and end-tidal carbon dioxide partial pressure(PE rCO2).Record 24 h postoperative QoR-15 scale scores,the hospital stay time,postoperative complications and other postoperative indicators.Results1.Intraoperative infusion of crystal fluid and colloid fluid in group Ⅰ patients was higher than that in group C(P<0.05).The blood loss and urine volume of patients in group Ⅰ were higher than those in group C(P<0.05).The QoR-15 scores in group Ⅰwere higher than those in group C at 24 hours after operation(P<0.05).The incidence of nausea within 24 hours after operation in group Ⅰ was significantly lower than that in group C(P<0.05).There were no significant differences in age,BMI,ASA classification,operating time,postoperative hospital stay time,incidence of PONV,and incidence of postoperative complications between the two groups(P>0.05).2.The central venous blood lactic acid value of group Ⅰ was significantly lower than that of group C from T2 to T3(P<0.05).At T3,PETCO2 in group Ⅰ was lower than that in group C(P<0.05);there was no significant difference in pH,PcvCO2,PcvO2,ScvO2,Hb,Glu,HCO3-between the two groups at each time point.At T1-T3,SamtO2in group Ⅰ was significantly higher than that of group C(P<0.05);At T2-T3,SVR of groupⅠ was significantly lower than that of group C(P<0.05)and SfmtO2 was significantly higher than that of group C(P<0.05).At T2,CI of group Ⅰ was significantly higher than group C(P<0.05).There were no significant differences in HR,MAP,CO,CI,and SVV between the two groups at each time point.3.At T2,SfmtO2 was negative correlated with lactic acid(R=-0.329,P<0.05)and positively correlated with SamtO2(R=0.372,P<0.01),MAP(R=0.233,P<0.05)and CI(R=0.2 70,P<0.05).At T3,SfmtO2 were also positively correlated with SamtO2(R=0.312,P<0.01),MAP(R=0.227,P<0.05)and CI(R=0.303,P<0.05).Conclusions1.Anesthesia management guided by muscular tissue oxygen during laparoscopic hysterectomy can improve the flank and forearm muscular tissue oxygen saturation,reduce lactate concentration,improve regional tissue perfusion,and improve postoperative recovery quality.2.Flank muscular tissue oxygen saturation has a certain value in monitoring tissue hypoperfusion during laparoscopic hysterectomy.