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The Right Ventricle-You May Forget it, but It Will Not Forget You. J Clin Med 2020; 9:jcm9020432. [PMID: 32033368 PMCID: PMC7074056 DOI: 10.3390/jcm9020432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023] Open
Abstract
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
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102
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Aditianingsih D, Mochtar CA, Lydia A, Siregar NC, Margyaningsih NI, Madjid AS, Suwarto S. Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study. BMC Anesthesiol 2020; 20:37. [PMID: 32019488 PMCID: PMC7001365 DOI: 10.1186/s12871-020-0956-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background Laparoscopic nephrectomy is a preferred technique for living kidney donation. However, positive-pressure pneumoperitoneum may have an unfavorable effect on the remaining kidney and other distant organs due to inflamed vascular endothelium and renal tubular cell injury in response to increased systemic inflammation. Early detection of vascular endothelial and renal tubular response is needed to prevent further kidney injury due to increased intraabdominal pressure induced by pneumoperitoneum. Transperitoneal laparoscopic living donor nephrectomy represented a human model of mild increasing intraabdominal pressure. This study aimed to assess the effect of increased intraabdominal pressure on vascular endothelium and renal tubular cells by comparing the effects of low and standard pressure pneumoperitoneum on vascular endothelial growth factor receptor-2 (VEGFR-2) expression and the shedding of syndecan-1 as the early markers to a systemic inflammation. Methods We conducted a prospective randomized study on 44 patients undergoing laparoscopic donor nephrectomy. Subjects were assigned to standard (12 mmHg) or low pressure (8 mmHg) groups. Baseline, intraoperative, and postoperative plasma interleukin-6, syndecan-1, and sVEGFR-2 were quantified by ELISA. Syndecan-1 and VEGFR-2 expression were assessed immunohistochemically in renal cortex tissue. Renal tubule and peritubular capillary ultrastructures were examined using electron microscopy. Perioperative hemodynamic changes, end-tidal CO2, serum creatinine, blood urea nitrogen, and urinary KIM-1 were recorded. Results The low pressure group showed lower intra- and postoperative heart rate, intraoperative plasma IL-6, sVEGFR-2 levels and plasma syndecan-1 than standard pressure group. Proximal tubule syndecan-1 expression was higher in the low pressure group. Proximal-distal tubules and peritubular capillary endothelium VEGFR-2 expression were lower in low pressure group. The low pressure group showed renal tubule and peritubular capillary ultrastructure with intact cell membranes, clear cell boundaries, and intact brush borders, while standard pressure group showed swollen nuclei, tenuous cell membrane, distant boundaries, vacuolizations, and detached brush borders. Conclusion The low pressure pneumoperitoneum attenuated the inflammatory response and resulted in reduction of syndecan-1 shedding and VEGFR-2 expression as the renal tubular and vascular endothelial proinflammatory markers to injury due to a systemic inflammation in laparoscopic nephrectomy. Trial registration ClinicalTrials.gov NCT:03219398, prospectively registered on July 17th, 2017.
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Affiliation(s)
- Dita Aditianingsih
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia. .,Department of Anesthesiology, Cipto Mangunkusumo Hospital, Salemba Raya 6th, Jakarta, 10430, Indonesia.
| | - Chaidir Arif Mochtar
- Department of Urology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Aida Lydia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Nuryati Chairani Siregar
- Department of Anatomical Pathology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.,Eijkman Institute of Molecular Biology, Jakarta, Indonesia
| | | | - Amir Sjarifuddin Madjid
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Suhendro Suwarto
- Department of Internal Medicine, Division of Tropical and Infectious Disease, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
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103
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Carron M, Safaee Fakhr B, Ieppariello G, Foletto M. Perioperative care of the obese patient. Br J Surg 2020; 107:e39-e55. [DOI: 10.1002/bjs.11447] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients.
Methods
A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta-analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non-obese populations were used.
Results and conclusion
Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.
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Affiliation(s)
- M Carron
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - B Safaee Fakhr
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - G Ieppariello
- Department of Medicine – DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy
| | - M Foletto
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padua, Padua, Italy
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104
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Kamhawy GA, Khamis FM, El-Said GH, Hassan NT. Can optic nerve sheath diameter assess increased intracranial pressure in pneumoperitoneum and trendelenburg position? EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1080/11101849.2019.1678296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Ghada A. Kamhawy
- Department of Anesthesia, Intensive Care & Pain management, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Fatma M. Khamis
- Department of Anesthesia, Intensive Care & Pain management, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Galal H. El-Said
- Department of Anesthesia, Intensive Care & Pain management, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nada T. Hassan
- Department of Anesthesia, Intensive Care & Pain management, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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105
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Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial. J Clin Monit Comput 2019; 34:943-953. [DOI: 10.1007/s10877-019-00406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/19/2019] [Indexed: 12/26/2022]
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106
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Almufti T, Eversheim F, Johnson B, Akra GA. Platypnoea-orthodeoxia after left total knee replacement. BMJ Case Rep 2019; 12:12/10/e230771. [PMID: 31645396 PMCID: PMC6827959 DOI: 10.1136/bcr-2019-230771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Platypnoea–orthodeoxia syndrome (POS) is a rare disorder characterised by both dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position, with improvement in the supine position. We report an unusual case in which an 82-year-old woman developed severe hypoxaemia with POS after left total knee replacement. A significant difference in alveolar–arterial blood gas oxygen tension was demonstrated, and hypoxaemia failed to respond to 100% oxygen supply. A patent foramen ovale with a right-to-left shunt was evident on transoesophageal echocardiogram employing colour Doppler and agitated normal saline studies. Interestingly, the patient’s symptoms resolved within 6 months with ongoing chest physiotherapy, without surgical or medical intervention.
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Affiliation(s)
- Taha Almufti
- Medicine, Albury Wodonga Health, Wodonga, Victoria, Australia
| | - Franz Eversheim
- Medicine, Albury Wodonga Health, Wodonga, Victoria, Australia
| | - Brett Johnson
- Medicine, Albury Wodonga Health, Wodonga, Victoria, Australia
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107
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Besthadi Sukmono R, Rahendra, Sari A, Aditianingsih D, Rosita Tantri A. Comparison of intraoperative hemodynamic stability between quadratus lumborum and epidural block in patients who underwent laparoscopic nephrectomy. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1246/1/012064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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108
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Montandrau O, Mascitti P, Boucau C, Cosserat J, Denet C, Beaussier M, Philip I. Laparoscopic Rectopexy in a Patient With Pulmonary Hypertension Associated With Scleroderma: A Case Report. A A Pract 2019; 12:313-316. [PMID: 30371524 DOI: 10.1213/xaa.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the perioperative management of a patient with pulmonary hypertension under new-generation treatments who underwent laparoscopic surgery. Preoperatively, arterial catheter, central venous line, and transesophageal echocardiography probe were inserted in addition to standard monitoring. Intraoperatively, inhaled nitric oxide was used because of increasing pressure in the right heart chambers related to the Trendelenburg position and the pneumoperitoneum. The operation finally lasted <2 hours without complication. The prognosis of patients with pulmonary hypertension has evolved since the advent of new management strategies. Thorough preoperative assessment and multidisciplinary discussion in a referral center are essential for medical optimization.
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Affiliation(s)
| | | | | | | | - Christine Denet
- Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
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109
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Di Bella C, Lacitignola L, Fracassi L, Skouropoulou D, Crovace A, Staffieri F. Pulse Pressure Variation Can Predict the Hemodynamic Response to Pneumoperitoneum in Dogs: A Retrospective Study. Vet Sci 2019; 6:vetsci6010017. [PMID: 30791578 PMCID: PMC6466147 DOI: 10.3390/vetsci6010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/25/2022] Open
Abstract
Pneumoperitoneum may induce important hemodynamic alterations in healthy subjects. Pulse pressure variation (PPV) is a hemodynamic parameter able to discriminate preload dependent subjects. Anesthesia records of dogs undergoing laparoscopy were retrospectively evaluated. The anesthetic protocol included acepromazine, methadone, propofol and isoflurane administered with oxygen under mechanical ventilation. The hemodynamic parameters were considered five minutes before (BASE) and ten minutes after (P10) the pneumoperitoneum. Based on the cardiac index (CI) variation, at P10, dogs were classified as sensitive (S group, CI ≤ 15%) and non-sensitive (NO-S group). Data were analyzed with the ANOVA test and the ROC curve (p < 0.05). Fifty-five percent of dogs (S) had a reduction of CI ≥ 15% at P10 (2.97 ± 1.4 L/min/m2) compared to BASE (4.32 ± 1.62 L/min/m2) and at P10 in the NO-S group (4.51 ± 1.41 L/min/m2). PPV at BASE was significantly higher in the S group (22.4% ± 6.1%) compared to the NO-S group (10.9% ± 3.3%). The ROC curve showed a threshold of PPV > 16% to distinguish the S and NO-S groups. PPV may be a valid predictor of the hemodynamic response to pneumoperitoneum in dogs. A PPV > 16% can identify patients that may require fluid administration before the creation of pneumoperitoneum.
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Affiliation(s)
- Caterina Di Bella
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Luca Lacitignola
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
| | - Laura Fracassi
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Despoina Skouropoulou
- PhD Course in Tissues and Organs Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70010 Bari, Italy.
| | - Antonio Crovace
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
| | - Francesco Staffieri
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari, Italy.
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110
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Majedi MA, Sarlak S, Sadeghi Y, Ahsan B. Comparison of the Effects of Thoracic Epidural Anesthesia with General Anesthesia on Hemodynamic Changes and its Complications in Patients Undergoing Laparoscopic Cholecystectomy. Adv Biomed Res 2019; 8:7. [PMID: 30820428 PMCID: PMC6385560 DOI: 10.4103/abr.abr_193_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy. Materials and Methods: This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests. Results: The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups (P > 0.05). Conclusion: The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach.
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Affiliation(s)
- Mohammad Azad Majedi
- Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shahab Sarlak
- Department of Medicine, General Physician, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yasaman Sadeghi
- Department of Medicine, General Physician, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Ahsan
- Department of Anesthesiology, Kurdistan University of Medical Sciences, Sanandaj, Iran
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111
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Bellon M, Skhiri A, Julien-Marsollier F, Malbezin S, Thierno D, Hilly J, ElGhoneimi A, Bonnard A, Michelet D, Dahmani S. Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management. Anaesth Crit Care Pain Med 2018; 37:453-457. [DOI: 10.1016/j.accpm.2017.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/14/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022]
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112
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The effect of pulmonary hypertension on inpatient outcomes of laparoscopic procedures. Updates Surg 2018; 70:521-528. [PMID: 29951840 DOI: 10.1007/s13304-018-0556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
The purpose of our analysis was to assess the effects of pulmonary hypertension (PH) on clinical outcomes of patients undergoing laparoscopic procedures. Pulmonary hypertension alters physiologic patterns that has the potential to complicate laparoscopic procedures, however, an in-depth analysis evaluating survival outcomes, complications, and associated comorbidities has not been done before. Data from the National Inpatient Survey were used to identify 179,663 patients without PH and 1453 patients with PH undergoing laparoscopic procedures from the years 2003-2013. In patients with pulmonary hypertension, the presence of the following comorbidities, congestive heart failure (OR 3.56) diabetes with chronic complications (OR 3.74) fluid and electrolyte disorders (OR 7.34) metastatic cancer (OR 14.42) and peripheral vascular disease (OR 3.12) increased in-patient mortality. In regards to post-operative complications, patients with PH were more likely to have cardiac complications defined as cardiac arrest, cardiac insufficiency, cardiorespiratory failure, or heart failure (OR 3.74). Patients with PH were also more likely to develop iatrogenic pneumothorax (OR 4.13) iatrogenic pulmonary embolism (OR 7.65) and post-operative urinary complications (OR 1.92). Overall, the comorbidity with the highest association with in-patient mortality was metastatic cancer and of all complications, patients with PH were most likely to develop iatrogenic pulmonary embolism. Preparing for these adversities, notably in patients with certain associated conditions has the potential to improve patient outcome.
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113
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Effect of Clonidine on Hemodynamic Responses During Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2018; 27:335-340. [PMID: 28708771 DOI: 10.1097/sle.0000000000000449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clonidine might be beneficial to the patients undergoing laparoscopic cholecystectomy. This meta-analysis focused on the influence of clonidine on hemodynamic responses in patients undergoing laparoscopic cholecystectomy. METHODS We searched several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. This meta-analysis included randomized controlled trials regarding the influence of clonidine versus placebo on laparoscopic cholecystectomy. The primary outcomes were mean arterial pressure (MAP) and heart rate (HR) at pneumoperitoneum. The random-effect model was applied for this study. RESULTS Compared with control intervention, clonidine intervention was found to significantly reduce the MAP at pneumoperitoneum [standard mean difference=-2.58; 95% confidence interval (CI),-4.63 to -0.53; P=0.01), HR at pneumoperitoneum (standard mean difference=-3.67; 95% CI, -6.57 to -0.76; P=0.01), MAP at intubation (standard mean difference=-2.40; 95% CI, -4.75 to -0.06; P=0.04), HR at intubation (standard mean difference=-3.39; 95% CI, -5.75 to -1.02; P=0.005), propofol requirement (standard mean difference=-2.25; 95% CI, -4.01 to -0.48; P=0.01), as well as postoperative nausea and vomiting (risk ratio, 0.35; 95% CI, 0.19-0.63; P=0.0005). CONCLUSIONS Compared with control intervention, clonidine intervention was found to significantly reduce MAP and HR at pneumoperitoneum and intubation, propofol requirement, as well as postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
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114
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Riddles T, Brown J, Judge D. A case of platypnoea orthodeoxia following Laproscopic Cholecystectomy. BMJ Case Rep 2018; 2018:bcr-2017-221714. [PMID: 29735491 DOI: 10.1136/bcr-2017-221714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Platypnoea Orthodeoxia syndrome is defined by dyspnoea and hypoxaemia exacerbated by orthostatic positioning and alleviated in recumbency. This condition has been reported in association with pulmonary, hepatic and cardiac disease. We describe a case herein of a 79 year old female who developed severe hypoxaemia and dyspnoea post laparoscopic cholecystectomy. A difference in arterial blood gas oxygen tension was demonstrated in the supine and erect positions on arterial blood gas analysis. A Patent Foramen Ovale (PFO) with a right to left shunt was evident on echocardiogram employing colour doppler and agitated normal saline studies. Definitive management, with closure of the patent foramen ovale lead to a complete resolution of symptoms and normalisation of arterial blood gas parameters in both the supine and erect positions.
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Affiliation(s)
- Timothy Riddles
- Department of Thoracics, Cairns Hospital, Cairns, Queensland, Australia
| | - James Brown
- Department of Thoracic Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Daniel Judge
- Cairns and Hinterland Hospital and Health Service, Respiratory department, Cairns, Queensland, Australia
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115
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Hur M, Yoo S, Choi JY, Park SK, Jung DE, Kim WH, Kim JT, Bahk JH. Positive end-expiratory pressure-induced increase in external jugular venous pressure does not predict fluid responsiveness in laparoscopic prostatectomy. J Anesth 2018; 32:316-325. [DOI: 10.1007/s00540-018-2475-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/22/2018] [Indexed: 01/31/2023]
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116
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Fan CJ, Chien HL, Weiss MJ, He J, Wolfgang CL, Cameron JL, Pawlik TM, Makary MA. Minimally invasive versus open surgery in the Medicare population: a comparison of post-operative and economic outcomes. Surg Endosc 2018; 32:3874-3880. [PMID: 29484556 DOI: 10.1007/s00464-018-6126-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite strong evidence demonstrating the clinical and economic benefits of minimally invasive surgery (MIS), utilization of MIS in the Medicare population is highly variable and tends to be lower than in the general population. We sought to compare the post-operative and economic outcomes of MIS versus open surgery for seven common surgical procedures in the Medicare population. METHODS Using the 2014 Medicare Provider Analysis and Review Inpatient Limited Data Set, patients undergoing bariatric, cholecystectomy, colectomy, hysterectomy, inguinal hernia, thoracic, and ventral hernia procedures were identified using DRG and ICD-9 codes. Adjusting for patient demographics and comorbidities, the odds of complication and all-cause 30-day re-admission were compared among patients undergoing MIS versus open surgery stratified by operation type. A generalized linear model was used to calculate the estimated difference in length of stay (LOS), Medicare claim cost, and Medicare reimbursement. RESULTS Among 233,984 patients, 102,729 patients underwent an open procedure versus 131,255 who underwent an MIS procedure. The incidence of complication after MIS was lower for 5 out of the 7 procedures examined (OR 0.36-0.69). Re-admission was lower for MIS for 6 out of 7 procedures (OR 0.43-0.87). MIS was associated with shorter LOS for 6 procedures (point estimate range 0.35-2.47 days shorter). Medicare claim costs for MIS were lower for 4 (range $3010.23-$4832.74 less per procedure) and Medicare reimbursements were lower for 3 (range $841.10-$939.69 less per procedure). CONCLUSIONS MIS benefited Medicare patients undergoing a range of surgical procedures. MIS was associated with fewer complications and re-admissions as well as shorter LOS and lower Medicare costs and reimbursements versus open surgery. MIS may represent a better quality and cost proposition in the Medicare population.
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Affiliation(s)
- Caleb J Fan
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Hung-Lun Chien
- Minimally Invasive Therapies Group, Medtronic Inc., Mansfield, MA, USA
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - John L Cameron
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Martin A Makary
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
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