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임신 3기 특발성 혈소판감소성 자반증 환자의 복강경하 비장 절제술시 마취관리
김원우,최용우,문세호,홍성진,이해진,전진영,성춘호,이지영 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.5
Anesthetic management during a laparoscopic splenectomy in a third trimester pregnant patient with idiopathic thrombocytopenic purpura (ITP) is critical because of the possibility of massive intra- and postoperative bleeding either maternal, fetal, or both. Laparoscopic surgery may be beneficial in pregnant patients compared to open laparotomy, but the safety of laparoscopic operations in pregnant wornen is under investigation. Pregnancy, especially in the third trimester, has been considered a contraindication of a laparoscopic procedure because the effect of CO_2 pneumoperitoneum on the fetus and uterine blood flow is unclear. However, the benefits of laparoscopic surgery such as less stress response and a shorter hospital stay are postulated. The careful anesthetic management and close hemodynamic monitoring of patient and fetus will be helpful in making laparoscopic surgery safer in pregnant patients. We report on the anesthetic management during a laparoscopic splenectomy in a tbird trimester pregnant patient with ITP. We monitored the intestinal mucosal CO_2 using Tonocap because we considered it could sensitively represent the uterine perfusion and intestinal CO_2 status, and we also monitored the noninvasive cardiac output by using NICO. Although the arterial and intestinal mucosal CO_2 tension, PrCO_2 and CO_2 gap increased gradually during the operation, hypercapnia was not remarkable. Tonocap represented the earliest changes which made us control intraabdominal gas inflation pressure by detecting fluctuations of CO_2 gap and pHi even though other respiratory and monitorecl hemodynamic parameters were quite stable during the procedure in this case. The patient was maintained well postoperatively and discharged with an improved condition. She had preterm labor at 36 weeks and 4 days of eventful gestation, but safely delivered a healthy baby by a normal spontaneous method. (Korean J Anesthesiol 2000; 39: 757-765)
김원우,문세호,홍성진,전진영,유경아 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5
Pregnancy, especially in the third trimester, has been considered a contraindication of laparoscopic procedure because the effect of CO2 pneumoperitoneum on the fetus and uterine blood flow was unclear. However, the benefits of laparoscopic surgery such as less stress response and shorter hospital stay are postulated. Laparoscopic surgery may be beneficial in pregnant patients compared to open laparotomy, and the safety of laparoscopic operations in pregnant women is under investigation. The careful anesthetic management and close monitoring of patient and fetus will be helpful in making laparoscopic surgery safer in pregnant patients. We report the anesthetic management for laparoscopic surgery in a third trimester pregnant patient with torsion of an ovarian cyst. We monitored the intestinal mucosal CO2 using Tonocap, because we considered it could represent the uterine perfusion and intestinal CO2 status. Although the arterial and intestinal mucosal CO2 tension increased gradually during the operation, hypercapnia was not remarkable. The respiratory and monitored parameters were stable during the laparoscopic procedure. The patient has maintained uneventful pregnancy and delivered a healthy baby at 41 weeks of gestation. (Korean J Anesthesiol 1999; 37: 943∼950)