Effects Of Different Angles Of Trendelenburg Position On Diaphragm Function In Patients Undergoing Laparoscopic Radical Rectal Resection

ObjectiveIn this study,the diaphragm function of patients with different angles of trendelenburg position was monitored by ultrasound,and the effect of different angles of trendelenburg position on diaphragm function in patients undergoing laparoscopic radical rectal cancer surgery was explored.MethodsA total of 90 patients with laparoscopic radical rectal resection(Dixon procedure)were divided into two groups:A(head lowering angle less than 30°)and B(head lowering angle greater than 30°)according to random number table method.After the patient is admitted to the room,NIBP,ECG,SpO2,and BIS monitoring are routinely performed.Under local anesthesia,intrajμg ular central venous puncture was performed,and compound sodium chloride solution was infusion,and the patient was given a loading dose of dexmedetomidine of 0.5μg/kg,and the infusion was completed in 10min.The radial artery puncture catheter under local anesthesia monitors the direct arterial pressure in real time.Sufentanil 0.5μg/kg,propofol 2mg/kg,cis-atracurium besylate 0.2mg/kg for injection were used for anesthesia induction.After the patient’s consciousness disappears,the mask is pressurized and ventilated for 3 minutes,and then the strengthening endotracheal tube is inserted through the mouth.The endotracheal tube is connected to the anesthesia machine,the mechanical ventilation mode is controlled by volume,the inhalation ratio is adjusted to 1:2,the tidal volume is 8mL/kg,the respiratory rate is 10-15 breaths,the oxygen flow is 2L/min,and the partial pressure of carbon dioxide at the end of breath is monitored.0.375%ropivacaine 40 mL with bilateral transverse abdominal plane block.The medium pressure was maintained at 12mmHg,and the propofol 4-12mg/kg/h,refentanyl for injection 0.1μg/kg/min,cis-atracurium besylate for injection 1.0μg/kg/min were used for anesthesia maintenance,and the dose was added according to intraoperative feedback.Adjust the respiratory rate according to the partial pressure of carbon dioxide at the end of breath to maintain the end of breath at 35-45mmHg;The maintenance dose of propofol was adjusted according to the BIS value to maintain the BIS value between 40-60;The rate of rehydration is adjusted according to central venous pressure,and the crystalline-to-rubber ratio is 2:1,and low-dose norepinephrine or urapidil is given intraoperatively to maintain blood pressure fluctuations of less than 20%according to changes in blood pressure.Pumping of benzenesulfon cis-atracurium is stopped half an hour before the end of surgery,and all anesthetic drugs are stopped at the end of surgery.And add self-controlled analgesic pump,analgesic pump drug ratio:sufentanil 2μg/kg,azasetron hydrochloride sodium chloride injection 10mg.When the patient wakes up and meets the following extubation criteria,the tracheal tube is removed,and the patient is given neostigmine 40μg/kg and atropine 20μg/kg before extubation.The extubation criteria are:(1)The patient is conscious and the BIS value is greater than 80,and the eyes can be opened according to the doctor’s advice,and the cough and swallowing reflexes can be restored.(2)Be able to raise your head for more than 5 seconds,raise your hand and clench your fist strongly.(3)Regular and stable breathing,the frequency is 10-20 times/min,and the tidal volume can reach 6-7mL/kg.(4)The partial pressure of carbon dioxide at the end of breathing is less than or equal to 45mmHg.After extubation,the mask is given oxygen,the oxygen flow is 5L/min,the mask is removed after 10min,and the observation is continued for more than 20min,and it can be evaluated as 6 points according to the Steward scoring standard before leaving the resuscitation room and transferring to the ward.All surgeries are performed by experienced surgeons.The diaphragm mobility(DE-QB)during quiet breathing(DE-QB)and diaphragm mobility(DE-DB)during deep breathing(DEDB)were recorded at five time points before surgery(T0),immediately after removal of the endotracheal tube(T1),10 min(T2)and 30 min(T3)and one day after surgery(T4).Adverse respiratory events during resuscitation were also recorded.ResultsThere were no significant differences in age,sex,BMI,ASA grade,duration of surgery,duration of anesthesia,and length of trendelenburg position between the two groups(P>0.05).In the intra-group comparison,DE-QB and DE-DB were significantly reduced between the two groups at T1-3 time point and T0 time point(P<0.05).At the T1 time point,both groups of patients DE-QB and DE-DB were smaller than the same group of T0 time point(P<0.05).At the T2 time point,both groups of patients DE-QB and DE-DB were smaller than the T0 time point(P<0.05)and greater than the T1 time point(P<0.05).At the T3 time point,both groups of patients DE-QB and DE-DB were smaller than the T0 time point(P<0.05)and greater than the T1-2 time point(P<0.05).There was no significant comparison between DE-QB and DEDB and T0 at T4(P>0.05)and greater than T1-3(P<0.05)Comparison between groups:There was no significant difference between the two groups between patients before surgery(P>0.05).Compared with group A,DE-DB were significantly reduced at T1 and T2(P<0.05),and there was no significant difference between DE-QB and de-DB in the rest of the time points between the two groups(P>0.05).There was no significant difference in the incidence of adverse respiratory events between the two groups(P>0.05).Conclusions1.During laparoscopic radical rectal resection,the Trendelenburg position results in slight impairment of diaphragm function during postoperative anesthesia awakening,which can be restored to preoperative levels one day after surgery.2.The trendelenburg position greater than 30° had a greater effect on diaphragm function,manifested by decreased mobility of the diaphragm during awakening.Trendelenburg position angle less than 30° has little effect on diaphragm function.