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영남의대학술지 Vol.24_No.2 Suppl. P.S527-537, Dec. 2007

Original Article

복강경 담낭절제술시와 회복시의 혈역학적 변화와 혈중 Catecholamines, Vasopressin치의 변화

Changes of Hemodynamic Parameters, Plasma Catecholamines and Vasopressin Level During Laparoscopic Cholecystectomy and in Recovery Period

김흥대
영남대학교 의과대학교 마취통증의학교실
책임저자:김흥대, 대구광역시 남구 대명동 317-1, 영남대학교 의과대학 마취통증의학교실
Tel: (053) 620-3361, Fax: (053) 626-5275
E-mail: hdkim@med.yu.ac.kr

December 30, 2007

Abstract

Background:Laparoscopic cholecystectomy produces less tissue trauma than conventional open procedure does. But, during this procedure, the deliberate pneumoperioneum with carbon dioxide(CO2) gas insufflation may cause some problems, such as hypercarbia, hypertension, tachycardia, and other changes of cardiovascular function. We analyze the physiologic mechanism of these hemodynamic effects under laparoscopic surgery with CO2 gas insufflation during inhalation general anesthesia.
Materials and Methods:We studied randomly selected 5 healthy patients undergoing laparoscopic cholecystectomy with CO2 gas insufflation. Each patient inhaled sevoflurane and nitrous oxide gas(50%). The blood pressure, heart rate, end-tidal carbon dioxide level were measured during all the anesthetic procedures. We collected venous blood samples to determine the plasma level of epinephrine, norepinephrine and vasopressin, at 10 minutes after insufflation of CO2 gas into peritoneal cavity, and at 10 minutes after patient arrived in recovery room. We measured the plasma level of epinephrine and norepinephrine using double antibody method, and vasopressin level using radioimmunoassay method.
Results:Mean arterial pressure and heart rate was significantly increased, after intraperitoneal insufflation of CO2 gas(19.3%, 44.7% respectively), and in recovery period(15.8%, 28.6% respectively). The plasma concentration of epinephine was 47.1 ± 30.3 pg/ml(reference intervals, less than 100 pg/ml) at 10 minutes after insufflation of CO2 gas, and 53.1 ± 25.8 pg/ml at 10 minutes in recovery room. The plasma concentration of norepinephine was 125.7 ± 44.8 pg/ml (reference intervals, less than 600 pg/ml) after insufflation, and 179.1 ± 42.1 pg/ml in recovery room. The plasma concentration of vasopressin was 43.3 ± 34.5 pg/ml(reference intervals, less than 6.7 pg/ml) after insufflation, and 25.3 ± 16.7 pg/ml in recovery room.
Conclusion:The laparoscopic cholecystectomy with CO2 gas insufflation in general anesthesia with sevoflurane and in recovery room results in increased mean arterial pressure, heart rate, and decreased plasma concentration of epinephine and norepinephine and increased plasma concentration of vasopressin.

Key Words: Laparoscopy, CO2 insufflation, Epinephrine, Norepinephrine, Vasopressin

References

1. Noirot DP, Joris JL, Legrand MJ, Lamy ML. Hemodynamic changes during peumoperitoneum for laparoscopic cholecystectomy. Anesthesiology 1992;77:A69
2. McLaughlim JG, Bonnell BW, Scheeres DE, Dean RJ. The adverse hemodynamic effects related to laparoscopic cholecystectomy. Anesthesiology 1992;77:A70.

3. Joris JL, Noirot DP, Legrand MJ, Jacquet NJ, Lamy ML. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993 May;76(5):1067-71.
4. Cunningham AJ, Brull SJ. Laparoscopic chol- ecystectomy: Anesthetic implications. Anesth Analg 1993 May;76(5):1120-33.

5. Westerband A, Van De Water J, Amzallag M, Lebowitz PW, Nwasokwa ON, Chardavoyne R, et al. Cardiovascular changes during lapar- oscopic cholecystectomy. Surg Gyneco Obstet 1992 Dec;175(6):535-8.

6. Lee CM. Acute hypotension during laparoscopy: a case report. Anesth Analg 1975 Jan-Feb;54 (1):142-3.
7. Desmond J, Gordon RA. Ventilation in patients anesthesized for laparoscopy. Can Anaesth Soc J 1970 Jul;17(4):378-87.

8. Carmichael DE. .Laparoscopy-cardiac conside- rations. Fertil Steril 1971;22(1):69-70.
9. Marshall RL, Jebson PJ, Davie IT, Scott DB. Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy. Br J Anesth 1972 Jul;44(7):680-4.

10. Harris MN, Plantevin OM, Crowther A. Cardiac arrythmias during anaesthesia for laparoscopy. Br J Aanesth 1984 Nov;56(11):1213-7.
11. Johannsen G, Andersen M, Juhl B. The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation. Acta Anaesthesiol Scand 1989 Feb;33(2);32-6.

12. El-Minawi MF, Wahbi O, El-Bagouri IS, Sharawi M, El-Mallah SY. Physiologic changes during CO2 and N2O pneumoperitoneum in diagnostic laparoscopy. A comparative study. J Reprod Med 1981 Jul;26(7):338-46.

13. Alexander GD, Noe FE, Brown EM. Anesthesia for pelvic laparoscopy. Anesth Analg 1969 Jan-Feb;48(1):14-8.
14. Hodgson C, McClelland RMA, Newton JR. Some effects of the peritoneal insufflation of carbon dioxide at laparoscopy. Anesthesia 1970 Jul;25(3):382-90.

15. Kelman GR, Swapp GH, Smith I, Benzie RJ, Gordon NL. Cardiac output and arterial blood gas tension during laparoscopy. Br J Anaesth 1972 Nov;44(11):1152-62.
16. Motew M, Ivankovich AD, Bieniarz J, Albrecht RF, Zahed B, Scommegna A. Cardiovascular effects and acid-base and blood gas changes during laparoscopy. Am J Obstet Gynecol 1973 Apr;115(7):1002-12.

17. Baratz RA, Karis JH. Blood gas studies during laparoscopy under general anesthesia. Anesthsiology 1969 Apr;30(4):463-4.
18. Millar RA. Plasma adrenaline and noradrenaline during diffusion respiration. J Physiol 1960 Jan;150:79-90.

19. Johannsen G, Andersen M, Juhl B. The effect of general anaesthesia on the haemodynamic events during laparoscopy with CO2-insufflation. Acta Anaesthesiol Scand 1989 Feb;33(2):132-6.

20. Wahba RW, Beique F, Kleiman SJ. Cardiopul- monary function and laparoscopic cholecystectomy. Can J Anaesth 1995 Jan;42(1):51-63.
21. Torrielli R, Cesarini M, Winnock S, Cabiro C, Mene JM. Hemodynamic changes during coelioscopy: a study carried out using thoracic electric bioimpedance. Can J Anaesth 1990 Jan;37(1):46-51.

22. Joris JL. Chiche JD, Canivet JL, Jacquet NJ, Legros JJ, Lamy ML. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol 1998 Nov;32(5):1389-96.

23. 김순임, 김선종, 채원석, 이정석. 복강경 담낭절제술시 기복이 혈장 Catecholamines와 Vasopressin에 미치는 영향. 대한마취과학회지 1999;37(4): 619-23.
24. Melville RJ, Frizis HI, Forsling ML, LeQuesne LP. The stimulus for vasopressin release during laparoscopy. Surg Gynecol Obstet 1985 Sept;161(3):253-6.

25. Felber AR, Blobner M, Goegler S: Plasma vasopressin in laparoscopic cholecystectomy. Anesthesiology 1993;79:A32.
26. Viinamki O, Punnonen R, Vasopressin release during laparoscopy: Role of increased intra- abdominal pressure. Lancet 1982 Jan16;1(8264): 175-6.

27. Koivusalo AM, Kellokumpu I, Lindqren L. Gassless laparoscopic cholecystectomy: comparison of postoperative recovery with conventional technique. Br J Surg 1996 Nov; 77(5):576-80.

28. Boniface KJ, Brown JM. Effects of carbon dioxide excess on the contractile force of heart, in situ. Am J Physiol 1953 Mar;172(3):752-6.
29. Odeberg S, Ljunqqvist O, Svenberg T, Sollevi A. Lack of neurohumoral response to pneumo- peritoneum for laparoscopic cholecystectomy. Surg Endosc 1998 Oct;12(10):1217-23.

30. Reid LC, Brace DE. Irritation of respiratory tract and its reflex effect on heart rate. surg Gyne Obst 1940;70:157.
31. Burstein CL, Lopinto EJ, Newman W. Electro- cardiographic studies during endotracheal intubation. I. Effects during usual routine technics. Anesthesiology 1950 Mar;11(2):224-37.

32. Rosner S, Newman W. Burstein CL. Electro- cardiographic studies during endotracheal intubation. IV. Effects during anesthesia with thiopental sodium conbined with a muscle elaxant. Anesthesiology 1953 Nov;14(6):591-5.

33. Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol 1969 Jan;200(1): 25-49.

34. 김성열. 마취후 부적절한 항이뇨 홀몬분비로 인한 저 Na+혈증후군. 대한마취과학회지 1985;18 (4):342-56.
35. Philbin DM. Antidiuretic hormone. Seminars in Anesthesia 1984;3:238.

36. Cryer PE. Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system. N Eng J Med. 1980 Aug;303(8):436- 44.
37. Finn RS, Moss J. Effect on sympathetic nervous system function and vasopressin function. Anesth Clin N Am 1987;5:411.

38. Bhargava KP, Kulshrestha VK, Santhakumari G Srivastava YP. Mechanism of histamine- induced antidiuretic response. Br J Pharmacol 1973 Apr;47(4):700-6.
39. Philbin DM. Antidiuretic hormone. Seminar in Anesthesiology 1984;3:238.

40. 구본업, 백운이, 김병권. 전신마취시 혈장 anti- diuretic hormone 및 beta-endorphine의 변화. 대한마취과학회지 1987;20(2):195-203.
41. Oyama T, Taniguchi K, Ishihara H, Matsuki A, Maeda A, Murakawa T, et al. Effects of enflurane anaesthesia and surgery on endocrine function in man. Br J Anaesth 1979 Feb;51(2): 141-8.

42. Oyama T, Sato K, Kimura K. Plasma levels of antidiuretic hormone in man during halothane anesthesia and surgery. Can Anaesth Soc J 1971 Nov;18(6):614-20.
43. Stockke DB, Christensen NJ, Hole P, Andersen PK, Juhl B. Plasma catecholamines during equipotent anaesthesia with cyclopropane and halothane-N2O in man. Anaesthetist 1978 Oct; 27(10):469-74.

44. Liu WS, Bidwal AV, Lunn JK, Stanley TH. Urine catecholamine excretion after large doses of fentanyl, fentanyl and diazepam, and fentanyl, diazepam and pancuronium. Can Anaesth Soc J 1977 May;24(3):371-9.
45. Husain MK, Manger WM, Rock TW, Weiss RJ, Frantz AG. Vasopressin release due to manual restraint in the rat: role of body compression and comparison with other stressful stimuli. Endocrinology 1979 Mar;104(3):641-4

46. Cousins MJ, Greenstein LR, Hitt BA, Mazze RI. Metabolism and renal effects of enflurane in man. Anesthesiology 1976 Jan;44(1):44-53.
47. Philbin DM, Coggins CH. Plasma antidiuretic hormone levels in cardiac surgical patients uring morphine and halothane anesthesia. Anesthesiology 1978 Aug;49(2):95-8.

48. Devault M, Greifenstein FE, Harris LC, Jr. Circuratory responses to endotracheal intubation in light general anesthesia- the effect of atropine and phentolamine. Anesthesiology 1960 Jul-Aug;21:360-2.
49. Oyama T, Wakayama S. Effect of anesthetics on endocrine function. ACTH, sex hormone, beta-endorophins, thyroid hormones. Anesth Clin N Am 1987;5:443.

50. Ahima RS, Prabakaran D, Mantzoros C, Qu D, Lowell B, Maratos-Flier E, et al. Role of leptin in the neuroendocrine response to fasting. Nature 1996 Jul18;382(6588):250-2.
51. Bevan DR. Perioperative Care: Intraoperative fluid balance. Br J Hosp Med 1978 May;19(5): 445-53.

52. Solis Herruzo JA, Castellano G, Larrodera L, Morillas JD, Moreno Sanchez D, Provencio R, et al. Plasma arginine vasopressin concentration during laparoscopy. Hepatogastroenterology 1989 Dec;36(6):499-503.
53. Joris JL, Lamy M. Neuroendocrine changes during pneumoperitoneum for laparoscopic cholecystectomy. Br J Anaesth 1993;70:A33.

54. Kumar A, Pontoppidan H, Baratz RA, Laver MB. Inappropriate response to increased plasma ADH during mechanical ventilation in acute respiratory failure. Anesthesiology 1974 Mar;40(3):215-21.
55. Hemmer M, Viquerat CE, Suter PM, Vallotton MB. Urinary antidiuretic hormone excretion during mechanical ventilation and weaning in man. Anesthesiology 1980 May;52(5):395-400.

56. Jamberg PO, de Villota ED, Eklund J, Granberg PO. Effects of positive end-expiratory pressure on renal function. Acta Anaesthesiol Scand 1978;22(5):508-14.
57. Frass M, Popovic R, Hartter E, Auinger C, Woloszczuk W, Leithner C. atrial natriuretic peptide decrease during spontaneous breathing with continuous positive airway pressure in volume-expanded healthy volunteers. Crit Care Med 1988 Sep;16(9):831-5.

58. Brenner BN, Rector FC Jr. The kidney. WB Saunders(Philadelphia).1976, p596.
59. Lightman SL, Forsling ML. Evidence for endogenous opioid control of vasoperssin release in man. J Clin Endocrinol Metab 1980 Mar; 50(3):569-71.

60. Moran WH Jr, Zimmermann B. Mechanism of antidiuretic hormone(ADH) control of importance to the surgical patient. Surgery 1967 Oct;62 (4):639-44.