Total hysterectomy wake-up delay 1 case under laparoscopic

Patients, female, 52 years old, body mass 62kg,diagnosisendometrial cancer, proposedlaparoscopyunder the whole hysterectomy plus pelvic cleaning, previously has a history ofhypertension, blood pressure generally controlled at 140 to 150/ 80 to 90mmHg, ASAII level, preoperative auxiliary examination: electrocardiogram, liver, kidney work, electrolyte, hematuria routine normal, T36.6 degrees C, HR88 times /min, BP148/90mmHg, in-room monitoring: blood pressure, electrocardiogram, SpO2administered intravenous anaesthetic, with midazolam 5mg, relying on miede 18mg, Shufentani 0.03mg, Viku bromine 8mg intravenous rapid induction, ID6.5 trachea catheter, controlled breathing VT500ml, RR12/ min, I:E1:2, Plimit31mmHg, anaesthetic maintenance with riffentani 0.15mg/ (min.kg), propofol 5mg/ (h.kg), intermittent static injection vico brominated ammonium to maintain muscle looseness, gas abdominal pressure maintained at 15mmHglaparoscopicinto the abdominal cavity, adjust the position to the head low foot height, can not fully expose the surgical field of vision, re-adjust the position, until full exposure to the field of vision, surgery began, smooth in surgery, lasted about 200min, during surgery blood pressure, heart rate stable The exhalation end co2 pressure (ETCO2) rose to 55 to 65mmHg, considering the higher ETCO2, the VT was raised to 600ml, R was raised to 16 times/min, but ETCO2 remained at a high level during the period The actual moisture volume is maintained at about 200ml, far from the required capacity of the patient, taking into account the patient's condition, recovering the position to the level during surgery, and giving overventilation until ETCO2 is maintained at 25 to 30mmHg, and then continue the operation, during which ETCO2 is maintained 40 to 55mmHg or so, before the operation of the regular discontinuation of the narcotic drug propofol, riffinani; Consider the patient's muscle recovery is OK, remove the trachea catheter, and then continue to observe, about 15min after the patient sleeps, call should not, can hear snoring, blood pressure heart rate blood oxygen and other vital signs stable, about 3h after the patient awake, return edited to the ward, give the nasal catheter oxygen absorption, after 3d return visit no complications occurreddiscussionafter the cessation of the whole hemp 60 to 90min dement is still very clear can be considered full hemp wake-up delay, the reasons include the residual effect of anesthesia, low oxygen, CO2 accumulation, low temperature, water electrolyte disorders, abnormal sugar metabolism, surgical factorsFor this case of patients, propofol, rifenite are fast, short-acting drugs, continuous infusion after no accumulation, wake up fast and completely, is the ideal all-intravenous anaesthetic, theoretically not the cause of wake-up delay; Basic exclusion of water, electrolyte disorders, preoperative and postoperative blood sugar in the normal range, can also basically exclude the effect of blood sugar on wake-up delay, this case of patients in the abdominal 100min, although many times adjust the breathing parameters, but CO2 accumulation has not improved, through the restoration of body position to the horizontal position, hand-controlled auxiliary breathing, excessive ventilation can improve CO2 accumulation, can be restoredthe whole hemp recovery period of hypoxia, hypercarbonemia and wake-up delay, surgery long-term hypercarbonemia may also prolong the wake-up time, surgery long-term hypercarbonate, can increase the permeability of the blood-brain barrier, so that the brainblood vesselsdilating, Brain blood flow increased, PaCO2 reached 80mmHg, cerebral blood flow can be increased by 1 times, in severe cases can produce cerebral edema, CO2 storage, H-plus into brain cells, leading to intracellular acidosis, and even anaesthetic state the causes, and the clinical performance in this case, the reason for the wake-up delay was the mild accumulation of CO2 caused by the low ventilation caused by excessive low body position Therefore, in the implementation of general anesthesia, not only pay attention to the rational application of narcotic drugs, but also should strengthen the management and monitoring, once the wake-up delay, to find the cause in time, and actively deal with, relying on excessive ventilation alone does not guarantee the improvement of the patient's CO2 accumulation problems Therefore, in the patient's condition allows the appropriate increase of Plimit, can also actively communicate with the surgeon, can be intermittently adjusted to make the patient more smooth and safe through the anaesthetic surgery period, but also can give adequate muscle looseness, reduce the impact of gas abdominal and position on low ventilation With the development of medical treatment, minimally invasive surgery in the clinical widely carried out, more and more patients choose laparoscopic treatment, and laparoscopic surgery in the patient's special position should be caused by anesthesia and clinicians, as an anesthesiologist, in addition to allowing patients to have stable vital signs in surgery, more attention should be paid to how to better reduce the unnecessary damage caused by surgery