关键词: 腹腔镜精索静脉结扎术, 硬膜外麻醉, 全身麻醉

Abstract:

Objective To compare the adverse effects in between epidural and general anesthesia for laparoscopic varicocelectomy（LV）, to explore the feasibility of epidural anesthesia in short procedures to meet the preference of some mothers and surgeons.Methods A prospective study was made in 40 cases randomly selected from two matchable groups of children, 20 from each group, who come for LV under either epidural anesthesia（group E） or inhalation anesthesia（group I） according to the preference of anesthetists and mothers. The followings are recorded including: anxiety of induction, smoothness during operation, intubation time, postoperative pain and recovery of eating and walking. During anesthesia, the HR, MAP, SpO₂, P_ET CO₂（group I）, Ppeak（group I）and RR（group E）were recorded continuously. Arterial blood gas analyses were done at definite time: 5 min before pneumoperitoneum, 5 min and 15 min after pneumoperitoneum and 5 min after decompression of pneumoperitoneum.Results 1) General comparisons were made on the smoothness of operation, pre-and post-operative reaction and recovery; there was no significant difference between the two groups of anesthesia. 2) In the group E, compared with the HR before pneumoperitoneum, the HR was significantly lowered 15 min after pneumoperitoneum and 5 min after decompression of pneumoperitoneum（ P <0.05）; while the HR showed no marked change before and after pneumoperitoneum in the Group I（ P >0.05）. 3) the respiratory rate（RR） in the group E remarkably increased after pneumoperitoneum（ P <0.05）and remained at a high level at 5 min after decompression of pneumoperitoneum. 4) Arterial blood gas: the PaCO₂ and HCO₃ - were significantly elevated after pneumoperitoneum in group E.Conclusion Although inhalation anesthesia is superior in the reversibility, and the blood gas analyses showed also better records, but clinically the adverse effects were negligible in epidural anesthesia. For patients of ASAⅠgrade undergoing minor operations like LV less than 40 min and pneumoperitoneum pressure of 1.6 kPa（12 mmHg）, epidural anesthesia is definitely safe and feasible.

Key words: laparoscopic varicocelectomy, epidural anesthesia, general anesthesia