Precision Anesthesia Management And Lung Protection In Laparoscopic Surgery In Trendelenburg Position

Background:During laparoscopic surgery in Trendelenburg position,CO₂ pneumoperiton-eum and Trendelenburg position would have a great impact on the physiological functions of multiple systems of patients.Among them,the circulation and respiratory system were the most affected,which were mainly manifested as the fluctuation of intraoperative circulation,the increase of Ppeak and Pplat,and the decrease of Cdyn during mechanical ventilation.It brings great challenges to the management of perioperative anesthesia.Improper management may bring complications such as cardiovascular and cerebrovascular accidents,atelectasis and lung injury to patients.Objective:To explore the laparoscopic surgery with Trendelenburg position,Through BIS combined with NMT monitoring to guide accurate use of anesthesia drugs and bedside lung ultrasound to guide manual pulmonary reopening and titration of PEEP,whether they can improve perioperative circulatory fluctuation,atelectasis and lung injury.To provide reference for the anesthesia management and lung protection in laparoscopic surgery with Trendelenburg position.Methods:Sixty patients undergoing laparoscopic surgery in Trendelenburg position under general anesthesia were randomly divided into two groups:precision anesthesia group（Z group）and experience anesthesia group（Y group）,each with 30 cases.In group Z,precise anesthesia management strategy was applied（BIS monitoring combined with NMT monitoring was used to guide the use of anesthetic drugs to maintain the depth of anesthesia,lung ultrasound was used to guide the retraction of lung and titration of optimal PEEP was used to guide the management of mechanical ventilation）.Group Y was treated with an empirical anesthesia management strategy（using the experience of the anesthesiologist to guide the management of anesthesia and mechanical ventilation）.Record two groups of patients before anesthesia induction（T0）,before surgical skin cutting（T1）,5 minutes after pneumoperitoneum（T2）,5 minutes after the Trendelenburg position（T3）,60 minutes after Trendelenburg position（T4）,the end of surgery（T5）each time point of mean arterial pressure（MAP）,heart rate（HR）,the airway peak pressure（Ppeak）,airway platform（Pplat）,pulmonary compliance（Cdyn）;The number of cases using vasoactive agents（norepinephrine,urapidil）during operation was recorded;Lung ultrasound（LUS）scores at each time point before anesthesia induction（T0）,15minutes after tracheal extubation（T6）,24 hours after surgery（T7）,and 3 days after surgery（T8）were recorded in both groups;Pa O₂/Fi O₂,CC16,MDA,SOD at T0 and T6 were compared and analyzed.Results:There were no significant differences in gender,age,weight,height,anesthesia time,operation time,intraoperative blood loss and infusion volume between the two groups（P>0.05）;Compared with T0,MAP and HR in group Y were decreased at T1,T4 and T5,MAP increased at T2 and T3（<0.05）,HR was no statistical significance at T2 and T3（P>0.05）.MAP and HR of group Z at each time point from T1 to T5 were not statistically significant（P>0.05）;Noradrenaline and Urapidil were used more frequently in group Y than in group Z（P<0.05）;Compared with T1,the Ppeak and Pplat of T2-T4 in both groups increased,while Cdyn decreased,but the Ppeak and Pplat of Y group increased more obviously than that of Z group,while Cdyn decreased more obviously（P<0.05）;Compared with T0,LUS score of T6,T7and T8 in the two groups increased（P<0.05）.At T6 and T7,LUS score in group Y was higher than that in group Z（P<0.05）,and there was no statistical difference between the two groups at T8（P>0.05）;Compared with T0,Pa O₂/Fi O₂and SOD in the two groups decreased at T6,but the decrease in group Y was more obvious than that in group Z（P<0.05）.Compared with T0,MDA increased in both groups at T6,but increased more significantly in group Y（P<0.05）.Compared with T0,CC16increased at T6 in group Y（P<0.05）,there was no significant difference in CC16 in group Z（P>0.05）.Conclusion:During laparoscopic surgery in Trendelenburg position,precision anesthesia management can reduce the fluctuation of perioperative circulatory and respiratory system parameters,and reduce atelectasis and lung injury compared with empirical anesthesia.