The Application Of Different Airway Managements And Ventilation Modes In Laparoscopic Cholecystectomy

ObjectiveTo observe the influence of different airway managements andventilation patterns on hemodynamics and respiratory mechanics inlaparoscopic cholecystectomy.MethodsThis study included100patients, who were undergoing laparoscopiccholecystectomy in Bethune First Hospital of Jilin University from January2014to January2015. These patients were divided into2teams,50of themusing Laryngeal mask airway,the other50ones using endotrachealintubation.Each team of the patients were randomized to the VCV group (n=25) or PCV group (n=25) according to a table of random numbers. In theoperating room, standard monitoring was established. After anesthesia wasinduced, endotracheal intubation and laryngeal mask airway were completed(male ID=7.0mm, female ID=6.5mm;male4#LMA,female3#LMA) and thepatient’s lungs were ventilated by a Ventilator. In the VCV group, the Ventilatorsettings were tidal volume (Vt)8mL/kg, RR was12times/minute，all these wereadjusted to maintain PETCO225-45mmHg. In the PCV group, Pmax was set at30cmH2O with RR was12times/minute，they were adjusted to maintain PETCO225-45mmHg. Inspired oxygen concentration and I/E ratio were held constantthroughout the study in every groups. The induced of anesthesia was takensupine position. CO2pneumoperitoneum was established when patient wasstable and the IAP was maintained at12mmHg, and then an angle of declination by20degree to the left and trendelenburg with an angle ofdeclination by30degree position was established. The patient was return to thesupine position after pneumoperitoneum. The systolic pressure (SBP), diastolicpressure(DBP), heart rate (HR)， plateau pressure（Pplat）， peak airwaypressure（Ppeak）， and End-tidal carbon dioxide pressure(PETCO2) wererecorded at the time before insertion of endotracheal intubation or laryngealmask airway(T0),after the insertion of endotracheal intubation or laryngealmask airway immediately(T1),pneumoperitoneum immediately（T2）， and5minutes after pneumoperitoneum（T3）.Result1, There were no differences between the4groups in patientcharacteristics and operative conditions.2, At the same airway management conition,there were no differencebetween the two ventilation modes’patients’SBP、DBP and HR at T1、T2andT3.And at T2and T3, the Ppeak and Plat of the PCV group patiens weresignificantly lower than the VCV group.but the Cdyn and Cst of the PCV grouppatients were significantly higher than the VCV group.3,At the same ventilation mode condition,the TB group patients’ SBP、DBP and HR were significantly higher than LMA group at T1,but there wereno difference between the two groups’ Ppeak、Plat、Cdyn and Cst at T1.Conclusion1,In laparoscopic cholecystectomy surgery， at the same airwaymanagement,pressure controlled ventilation was better than volume controlledventilation in respiratory mechanics.2,At the same ventilation pattern,LMA management was better thanendotrocheal intubation in hemodynamics.