1
|
Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis. Intensive Crit Care Nurs 2019; 56:102753. [PMID: 31445794 DOI: 10.1016/j.iccn.2019.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units. RESEARCH METHODOLOGY PUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English. RESULTS Eight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16-1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16-9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07-0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis. CONCLUSION This meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results.
Collapse
|
2
|
Profound Neuromuscular Blockade: Advantages and Challenges for Patients, Anesthesiologists, and Surgeons. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Donmez T, Uzman S, Yildirim D, Hut A, Avaroglu HI, Erdem DA, Cekic E, Erozgen F. Is there any effect of pneumoperitoneum pressure on coagulation and fibrinolysis during laparoscopic cholecystectomy? PeerJ 2016; 4:e2375. [PMID: 27651988 PMCID: PMC5018660 DOI: 10.7717/peerj.2375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 07/28/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomies (LC) are generally performed in a 12 mmHg-pressured pneumoperitoneum in a slight sitting position. Considerable thromboembolism risk arises in this operation due to pneumoperitoneum, operation position and risk factors of patients. We aim to investigate the effect of pneumoperitoneum pressure on coagulation and fibrinolysis under general anesthesia. MATERIAL AND METHODS Fifty American Society of Anesthesiologist (ASA) I-III patients who underwent elective LC without thromboprophlaxis were enrolled in this prospective study. The patients were randomly divided into two groups according to the pneumoperitoneum pressure during LC: the 10 mmHg group (n = 25) and the 14 mmHg group. Prothrombin time (PT), thrombin time (TT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) and blood levels of d-dimer and fibrinogen were measured preoperatively (pre), one hour (post1) and 24 h (post24) after the surgery. Moreover, alanine amino transferase, aspartate amino transferase and lactate dehydrogenase were measured before and after the surgery. These parameters were compared between and within the groups. RESULTS PT, TT, aPTT, INR, and D-dimer and fibrinogen levels significantly increased after the surgery in both of the groups. D-dimer level was significantly higher in 14-mmHg group at post24. CONCLUSION Both the 10-mmHg and 14-mmHg pressure of pneumoperitoneum may lead to affect coagulation tests and fibrinogen and D-dimer levels without any occurrence of deep vein thrombosis, but 14-mmHg pressure of pneumoperitoneum has a greater effect on D-dimer. However, lower pneumoperitoneum pressure may be useful for the prevention of deep vein thrombosis.
Collapse
Affiliation(s)
- Turgut Donmez
- Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Sinan Uzman
- Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Dogan Yildirim
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Adnan Hut
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| | | | - Duygu Ayfer Erdem
- Department of Anesthesiology and Reanimation, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Erdinc Cekic
- Department of Ear Nose Throat Surgery, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey
| | - Fazilet Erozgen
- Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e429. [PMID: 26180730 PMCID: PMC4494499 DOI: 10.1097/gox.0000000000000167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
Background: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE. Methods: We reviewed the 2005–2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair. Preoperative variables and postoperative outcomes were compared between a component separation group and a non–component separation group. The χ2 tests and Fisher’s exact test were used for categorical variables and t tests for continuous variables. Logistic regression analysis was performed to determine preoperative predictors for complications in both groups. Results: Thirty-four thousand five hundred forty-one patients were included in our study; 501 patients underwent a component separation procedure. A higher rate of wound complications, minor/major morbidity, mortality, and return to the operating room occurred in the component separation group. However, there was no statistically significant difference in deep vein thrombosis/thrombophlebitis and pulmonary embolism rates between the 2 groups (P = 0.780 and P = 0.591, respectively). Several risk factors were significantly associated with postoperative complications in both groups. Conclusions: Component separation is used for large and complex incisional/ventral hernia repairs to achieve tension-free midline closure. Although component separation hernia repair is associated with higher incidence of wound complication, morbidity, and mortality, perhaps because of the complexity of the defects, it does not seem to be associated with increased VTE rates.
Collapse
|
5
|
Kisa P, Ting J, Callejas A, Osiovich H, Butterworth SA. Major thrombotic complications with lower limb PICCs in surgical neonates. J Pediatr Surg 2015; 50:786-9. [PMID: 25783362 DOI: 10.1016/j.jpedsurg.2015.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/13/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND PICC lines are now used routinely to provide central access for neonatal intensive care unit (NICU) patients. Neonates are known to be at risk for venous thromboembolism (VTE) related to central catheters. No literature exists about VTE PICC-related morbidity in the NICU abdominal surgery subgroup. METHODS With REB approval, a retrospective review of a NICU database of PICC insertions performed at a tertiary children's hospital was conducted (January 2010-June 2013). Information about PICCs and complications was recorded. For patients with a major thrombotic complication, charts were reviewed. A major thrombotic complication was defined as a thrombosis which required medical and/or surgical intervention. RESULTS 692 PICCs were inserted (485 in the upper extremity, 142 in the lower extremity, and 65 in the scalp). Seventy-four patients had significant intraabdominal pathology, and 5 had a major thrombotic complication. All patients with a major thrombotic complication had a lower extremity PICC which was at or below L1 (L1-S1) running parenteral nutrition. CONCLUSIONS In the current study, only neonates with abdominal pathology and a lower extremity insertion site suffered major thrombotic complications from PICC lines. Given all patients' PICC tips were below the recommended location, more rigorous surveillance (with repositioning if required) may avoid these complications for future patients.
Collapse
Affiliation(s)
- Phyllis Kisa
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Ting
- Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Allison Callejas
- Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Horacio Osiovich
- Division of Neonatatology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Neonatology, Children's & Women's Health Centre of BC, Vancouver, BC, Canada
| | - Sonia A Butterworth
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
6
|
Abstract
It has been hypothesized that providing deep neuromuscular block (a posttetanic count of 1 or more, but a train-of-four [TOF] count of zero) when compared with moderate block (TOF counts of 1-3) for laparoscopic surgery would allow for the use of lower inflation pressures while optimizing surgical space and enhancing patient safety. We conducted a literature search on 6 different medical databases using 3 search strategies in each database in an attempt to find data substantiating this proposition. In addition, we studied the reference lists of the articles retrieved in the search and of other relevant articles known to the authors. There is some evidence that maintaining low inflation pressures during intra-abdominal laparoscopic surgery may reduce postoperative pain. Unfortunately most of the studies that come to these conclusions give few if any details as to the anesthetic protocol or the management of neuromuscular block. Performing laparoscopic surgery under low versus standard pressure pneumoperitoneum is associated with no difference in outcome with respect to surgical morbidity, conversion to open cholecystectomy, hemodynamic effects, length of hospital stay, or patient satisfaction. There is a limit to what deep neuromuscular block can achieve. Attempts to perform laparoscopic cholecystectomy at an inflation pressure of 8 mm Hg are associated with a 40% failure rate even at posttetanic counts of 1 or less. Well-designed studies that ask the question "is deep block superior to moderate block vis-à-vis surgical operating conditions" are essentially nonexistent. Without exception, all the peer-reviewed studies we uncovered which state that they investigated this issue have such serious flaws in their protocols that the authors' conclusions are suspect. However, there is evidence that abdominal compliance was not increased by a significant amount when deep block was established when compared with moderate neuromuscular block. Maintenance of deep block for the duration of the pneumoperitoneum presents a problem for clinicians who do not have access to sugammadex. Reversal of block with neostigmine at a time when no response to TOF stimulation can be elicited is slow and incomplete and increases the potential for postoperative residual neuromuscular block. The obligatory addition of sugammadex to any anesthetic protocol based on the continuous maintenance of deep block is not without associated caveats. First, monitoring of neuromuscular function is still essential and second, antagonism of deep block necessitates doses of sugammadex of ≥4.0 mg/kg. Thus, maintenance of deep block has substantial economic repercussions. There are little objective data to support the proposition that deep neuromuscular block (when compared with less intense block; TOF counts of 1-3) contributes to better patient outcome or improves surgical operating conditions.
Collapse
Affiliation(s)
- Aaron F Kopman
- From the *Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
7
|
Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis. Hernia 2015; 19:901-8. [PMID: 25662843 DOI: 10.1007/s10029-015-1353-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prosthetic material (mesh) is commonly used to repair inguinal hernias. Its implantation close to the common femoral vein (CFV) can induce slow flow and favor the appearance of venous thromboembolism (VTE) events. AIM To investigate the speed of flow, diameter and area of the CFV after inguinal hernioplasty. METHODS Two hundred and fifty patients receiving open hernioplasty with a non-resorbable mesh for the repair of a unilateral, primary, simple inguinal hernia were prospectively investigated. Patients were stratified, by consensus, into a low or a moderate risk of VTE group. The moderate-risk group (n = 163) received low molecular weight heparin. On day 10 post-operation a blinded Echo-Doppler was carried out, and repeated 7 days later in patients with a venous flow of <15 cm/s. The speed of flow (cm/s), diameter (cm), and area (cm(2)) of the ipsilateral and contralateral CFV of the groin operated upon were measured. RESULTS No event symptomatic of VTE was documented. One case of asymptomatic deep vein thrombosis (1/163, 0.6%) was found in the moderate-risk group. In 29 patients (2 and 27 in the low- and moderate-risk groups, respectively; p < 0.001) a maximum blood flow velocity of <15 cm/s was found in the ipsilateral CFV; these flows were close to normal in the second measurement. Taking the entire sample into account, the maximum venous blood flow found in the ipsilateral CFV of the operated groin was less than that measured in the contralateral CFV (20.88 vs. 24.01 cm/s; p < 0.001); this difference was significant in both VTE risk groups. The diameter and area of the CFV were both greater in the ipsilateral than the contralateral CFV (p < 0.01); this finding proved to be significant only in hernias of the left groin (p < 0.001). CONCLUSIONS In the immediate postoperative period, inguinal hernioplasty with mesh induces a temporarily slow venous flow in the ipsilateral CFV. However, this does not lead to an increase in the incidence of VTE.
Collapse
|
8
|
Hopkins L, Carrier M, Plante M, Luna V, Gotlieb W, Rambout L. Surgical venous thromboprophylaxis: a cross-sectional survey of canadian gynaecologic oncologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 34:673-7. [PMID: 22742487 DOI: 10.1016/s1701-2163(16)35321-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a significant cause of morbidity and mortality following gynaecologic cancer surgery. The objective of this study was to assess the current practice for VTE prophylaxis among Canadian gynaecologic oncologists for both open and minimally invasive surgical techniques and to assess interest in participation in a clinical trial to examine this issue. METHODS Assessment of national thromboprophylaxis practices was achieved through an online survey technique, "Zoomerang." An invitation to complete the survey was sent out via email to members of the Society of Gynecologic Oncology of Canada. RESULTS The majority of respondents (78%) believed surgical thromboprophylaxis to be indicated for all gynaecologic oncology patients, irrespective of an open versus minimally invasive approach. Current thromboprophylaxis practice patterns are variable, reflecting centre-specific challenges. CONCLUSION Venous thromboembolism is an important and preventable complication of major gynaecologic surgery. A demonstrated lack of evidence and consensus regarding VTE prophylaxis following minimally invasive procedures for gynaecologic oncology patients necessitates further prospective study to evaluate the incidence, risk, treatment, and cost-effectiveness of prophylaxis.
Collapse
Affiliation(s)
- Laura Hopkins
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON
| | | | | | | | | | | |
Collapse
|
9
|
Senoglu N, Yuzbasioglu MF, Oksuz H, Yildiz H, Dogan Z, Bulbuloglu E, Goksu M, Gisi G. Effects of epidural-and-general anesthesia combined versus general anesthesia alone on femoral venous flow during laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2010; 20:219-23. [PMID: 20218940 DOI: 10.1089/lap.2009.0404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The pneumoperitoneum has been shown to decrease femoral blood flow, resulting in venous stasis. We analyzed the effects of the pneumoperitoneum and epidural analgesia on femoral vein diameter and the peak flow rate of femoral vein during laparoscopic cholecystectomy. PATIENTS AND METHODS Forty patients were randomly allocated to receive either combined epidural analgesia (EA) and general anesthesia (GA) (group EA/GA) or GA alone (group GA). Laparoscopic cholecystectomy was the standard operation for the selected patients. Then, 10 mL of 1% lidocaine in group EA/GA or physiologic serum in group GA was injected via epidural catheter. Peak flow rates (PFRs) of femoral vein cross-sectional areas (CSAs) were measured from the right femoral vein at three different times: after induction of anesthesia, during the pneumoperitoneum, and after abdominal deflation, but prior to reversal of anesthesia. RESULTS The two groups were similar in age, sex, body mass index, and duration of operation. The CSA slightly increased after the induction of anesthesia, compared with the previous measurements, although there was no statistical significance between them for both groups (P > 0.05). The PFR decreased, whereas the CSA increased during the pneumoperitoneum in each group. The PFR values after basal measurements were significantly higher in the EA/GA than in the GA group (P < 0.05). Group EA/GA had significantly lower heart-rate and blood-pressure levels during surgery than those in group GA (P < 0.05). CONCLUSIONS Abdominal insufflation during laparoscopic cholecystectomy results in dilation and decreased flow in the common femoral vein. Epidural analgesia added to the GA partially compensated for the reduction in femoral PFR.
Collapse
Affiliation(s)
- Nimet Senoglu
- Department of Anesthesiology and Reanimation, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Lee SD, Park JW, Park SC, Kim HJ, Choi HS, Oh JH. The Prophylactic Impact of Low Molecular Weight Heparin on Occurrence of Venous Thromboembolism after Colorectal Cancer Resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Seung Duk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hak Jin Kim
- Cardiology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyo Seong Choi
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| |
Collapse
|
11
|
Cheung HYS, Chung CC, Yau KKK, Siu WT, Wong SKH, Chiu E, Li MKW. Risk of deep vein thrombosis following laparoscopic rectosigmoid cancer resection in chinese patients. Asian J Surg 2008; 31:63-8. [PMID: 18490217 DOI: 10.1016/s1015-9584(08)60060-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the incidence of postoperative deep vein thrombosis (DVT) in Chinese patients who underwent laparoscopic resection of rectal or sigmoid cancer in the absence of thromboprophylaxis. METHODS Patients with adenocarcinoma of the sigmoid colon or rectum scheduled for laparoscopic resection were recruited. Neither chemoprophylaxis nor mechanical methods against DVT were employed. They were scheduled to have routine duplex ultrasound of both lower limbs perioperatively. RESULTS In a 12-month period, 50 patients were recruited. Postoperative DVT occurred in 19 (38%) patients. None needed anticoagulation. Complete resolution of the thrombus was noted in 10 (53%) patients 12 weeks after operation, and in six patients 36 weeks after operation. Female sex was identified as being associated with a higher incidence of DVT. Age, smoking, preoperative neoadjuvant chemoirradiation, preoperative metastasis, duration of operation, conversion and postoperative complications did not appear to be risk factors for DVT. CONCLUSION The incidence of asymptomatic calf vein DVT is relatively high after laparoscopic resection for rectosigmoid cancers in the Chinese population. However, complete resolution occurred without the use of anticoagulant therapy in the majority of cases. It is thus difficult to advocate the routine use of anticoagulant prophylaxis.
Collapse
Affiliation(s)
- Hester Yui-Shan Cheung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR.
| | | | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Kurukahvecioglu O, Sare M, Karamercan A, Gunaydin B, Anadol Z, Tezel E. Intermittent pneumatic sequential compression of the lower extremities restores the cerebral oxygen saturation during laparoscopic cholecystectomy. Surg Endosc 2007; 22:907-11. [PMID: 17704866 DOI: 10.1007/s00464-007-9505-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 02/16/2007] [Accepted: 03/03/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pneumoperitoneum causes intracranial pressure elevation and blood stasis at lower extremities. This study investigates cerebral oxygen saturation changes during laparoscopy and the effects of intermittent sequential compression (ISC) of the lower extremities in patients during elective laparoscopic cholecystectomy. PATIENTS AND METHOD Sixty patients were randomly divided into two groups according to the application of ISC to the lower extremities. Group I served as control group whereas ISC was applied to group II. Cerebral oxygen saturation, peripheral blood oxygen saturation, heart rate, mean blood pressure, and associated changes have been recorded during the operation. RESULTS Peripheral blood oxygen saturation and mean blood pressure values did not change significantly after pneumoperitoneum. Cerebral oxygen saturation levels of the group II patients were higher in than the group I patients and the difference between the groups was statistically significant (p = 0.0001). The difference became more prominent following the 35(th) minute of the operation. Mean heart rate of the patients in group II was lower than the patients in group I and the difference was also statistically significant (p = 0.0001). CONCLUSION In this study, it was found that the decrease in cerebral oxygen saturation was recovered with ISC application. This simple and reliable technique helps to restore cerebral oxygen saturation levels while increasing blood return from the lower extremities.
Collapse
|
14
|
Svensson M, Wirén M, Kimby E, Hägglund H. Portal vein thrombosis is a common complication following splenectomy in patients with malignant haematological diseases. Eur J Haematol 2006; 77:203-9. [PMID: 16923107 DOI: 10.1111/j.1600-0609.2006.00696.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elective laparoscopic splenectomy (LS) is performed with increasing frequency rather than open splenectomy (OS) because of reduced morbidity. LS is feasible also in patients with haematological diseases with splenomegaly, a group that is subject to more postoperative complications, such as bleeding, infections and portal vein thrombosis (PVT). METHOD We retrospectively reviewed the medical records of 69 patients splenectomised for haematological diseases during a 5-yr period at a single centre with the aim of comparing the results and complications after LS and OS. RESULTS Thirty-nine patients underwent LS and 30 OS. The median durations of surgery were 138 and 115 min (ns) in the LS and OS groups respectively. Three conversions (7.7%) from laparoscopic surgery to open surgery were necessary because of bleeding and/or splenomegaly. Thromboembolic complications occurred in totally seven of 69 patients. PVT was diagnosed in five of 37 (13.5%) patients with haematological malignancies (three with indolent lymphoma and two with myeloproliferative disease), one after LS and four after OS. All patients with PVT had splenomegaly and had received thromboembolic prophylaxis with low-molecular-weight heparin of short duration. Two patients were diagnosed with deep vein thromboses in the lower leg. Both had idiopathic thrombocytopenic purpura (ITP) and LS. CONCLUSIONS Patients with malignant haematological diseases and splenomegaly seem to have a high risk of developing PVT after splenectomy why careful observation and prolonged thromboprophylaxis is recommended for these patients. Ultrasonography or computerised tomography should be considered in all patients with abdominal symptoms after splenectomy.
Collapse
Affiliation(s)
- Magnus Svensson
- Department of Haematology Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
15
|
Bouldin MJ, Ross LA, Sumrall CD, Loustalot FV, Low AK, Land KK. The effect of obesity surgery on obesity comorbidity. Am J Med Sci 2006; 331:183-93. [PMID: 16617233 DOI: 10.1097/00000441-200604000-00004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Obesity is epidemic in the modern world. It is becoming increasingly clear that obesity is a major cause of cardiovascular disease, diabetes, and renal disease, as well as a host of other comorbidities. There are at present no generally effective long-term medical therapies for obesity. Surgical therapy for morbid obesity is not only effective in producing long-term weight loss but is also effective in ameliorating or resolving several of the most significant complications of obesity, including diabetes, hypertension, dyslipidemia, sleep apnea, gastroesophageal reflux disease, degenerative joint disease, venous stasis, pseudotumor cerebri, nonalcoholic steatohepatitis, urinary incontinence, fertility problems, and others. The degree of benefit and the rates of morbidity and mortality of the various surgical procedures vary according to the procedure.
Collapse
Affiliation(s)
- Marshall J Bouldin
- University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Rahr HB, Bendix J, Ahlburg P, Gjedsted J, Funch-Jensen P, Tønnesen E. Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia. Surg Endosc 2006; 20:468-72. [PMID: 16437269 DOI: 10.1007/s00464-005-0305-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 08/31/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant. METHODS Patients with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2. RESULTS Leukocyte counts and interleukin-6 and CRP levels increased in both groups, with the CRP increase being significantly greater in the OR group. The other markers did not increase significantly. CONCLUSION The acute phase response was more pronounced after OR, even when this was done under local anesthesia. Both techniques seemed rather atraumatic.
Collapse
Affiliation(s)
- H B Rahr
- Department of Surgery, Aarhus University Hospital, Aarhus C, DK-8000, Denmark.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVE To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. SUMMARY BACKGROUND DATA The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. METHODS A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. RESULTS Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. CONCLUSIONS Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes.
Collapse
Affiliation(s)
- Ninh T Nguyen
- Department of Surgery, University of California, Irvine, Medical Center, Orange, CA 92868, USA.
| | | |
Collapse
|
18
|
Isoda N, Suzuki T, Ido K, Kawamoto C, Nagamine N, Sohara H, Ono K, Kumagai M, Hirayama Y, Sugano K. Femoral Vein Stasis During Laparoscopic Cholecystectomy Effect of an Intermittent Sequential Pneumatic Compression Device. Dig Endosc 2001. [DOI: 10.1046/j.1443-1661.2000.00047.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Norio Isoda
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Takanori Suzuki
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Kenichi Ido
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Chiaki Kawamoto
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Nobuhiko Nagamine
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Hiromitsu Sohara
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Kazunori Ono
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Machio Kumagai
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Yoshimi Hirayama
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| | - Kentaro Sugano
- *Department of Gastroenterology, Jichi Medical School, Yakushiji, † Department of Surgery, Imaichi Hospital, Imaichi and ‡Toshiba Medical Company, Omiya, Japan
| |
Collapse
|
19
|
Larsen JF, Ejstrud P, Svendsen F, Redke F, Pedersen V, Rahr HB. Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy. Br J Surg 2001; 88:1001-5. [PMID: 11442535 DOI: 10.1046/j.0007-1323.2001.01783.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Carbon dioxide pneumoperitoneum may be an important pathophysiological factor stimulating the coagulation system during conventional laparoscopic cholecystectomy. The aim of this study was to test the hypothesis that gasless laparoscopy produces smaller changes in the coagulation and fibrinolytic system than carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. METHODS Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia, after insufflation or traction, 30 min after introduction of the laparoscope, 10 min after exsufflation of carbon dioxide or traction, 4 h after extubation and 24 h after operation. RESULTS The two groups were comparable with respect to age, sex, body mass index and duration of operation. Plasma levels of prothrombin fragment 1 and 2 (F1 + 2), soluble fibrin and D-dimer did not differ between the two groups. F1 + 2 levels varied significantly in both groups during and after operation (P < 0.001). Soluble fibrin and D-dimer levels did not change during operation in either group, but after operation the levels increased significantly in both groups (P < 0.001). CONCLUSION Carbon dioxide pneumoperitoneum does not enhance the activation of coagulation and fibrinolysis associated with laparoscopic cholecystectomy. The coagulation and fibrinolytic systems are activated during and after gasless as well as conventional laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- J F Larsen
- Department of Surgical Gastroenterology, Aalborg Hospital, Aalborg, Denmark.
| | | | | | | | | | | |
Collapse
|
20
|
Alishahi S, Francis N, Crofts S, Duncan L, Bickel A, Cuschieri A. Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device. Ann Surg 2001; 233:176-82. [PMID: 11176122 PMCID: PMC1421198 DOI: 10.1097/00000658-200102000-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To study the influence of a novel intermittent sequential pneumatic compression device (Lympha-press) on the adverse cardiac and peripheral hemodynamic changes induced by positive-pressure pneumoperitoneum (PPPn) in laparoscopic surgery. SUMMARY BACKGROUND DATA Creation of PPPn is known to cause adverse central and peripheral hemodynamic changes. An intrasubject observational study was undertaken to quantitate these adverse changes and to assess the influence of an intermittent sequential pneumatic compression system on these adverse hemodynamic changes during laparoscopic surgery with PPPn. METHODS The study involved 16 consecutive patients undergoing laparoscopic surgery with PPPn of 12 mmHg and 30 degrees head-up tilt position. The following peripheral hemodynamic recordings were made using Doppler ultrasound: peak systolic velocity (PSV), end diastolic velocity (EDV), and cross-sectional area of the femoral vein. Central monitoring included cardiac output and stroke volume by transesophageal Doppler, blood pressure, and pulse. The hemodynamic state based on these parameters was assessed before induction of PPPn with the anesthetized patient in the supine position, after induction of PPPn and head-up tilt position with Lympha-press off, and during PPPn and head-up tilt position with Lympha-press on, and after desufflation with the patient in the supine position under general anesthesia. RESULTS Positive-pressure pneumoperitoneum and the head-up tilt position resulted in a 33% reduction in PSV, a 21% reduction in EDV, and a 29% increase in cross-sectional area of the femoral vein. This was associated with a 20% reduction in cardiac output and an 18% reduction in stroke volume. Activation of Lympha-press during PPPn and the head-up tilt position resulted in a 129% increase in PSV and a 55% increase in EDV by 55%. It also increased the cardiac output by 27% and stroke volume by 16%, with no effect on cross-sectional area. Compared with the pre-PPPn stage, there was no difference in cardiac output or stroke volume, but the PSV was higher by 78% and the EDV by 32%. After abdominal desufflation in the supine position, the cardiac output and stroke volume were restored to the pre-PPPn level, but persistent and significant elevations were observed during the period of study in PSV, EDV, and cross-sectional area. CONCLUSIONS Significant and individually variable central and peripheral hemodynamic changes are encountered during laparoscopic surgery with PPPn and the head-up tilt position. These are reversed by intermittent sequential pneumatic compression using Lympha-press.
Collapse
Affiliation(s)
- S Alishahi
- Departments of Surgery & Molecular Oncology and Anaesthesia, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
| | | | | | | | | | | |
Collapse
|
21
|
Rahr HB, Fabrin K, Larsen JF, Thorlacius-Ussing O. Coagulation and fibrinolysis during laparoscopic cholecystectomy. Thromb Res 1999; 93:121-7. [PMID: 10030828 DOI: 10.1016/s0049-3848(98)00177-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Laparoscopic surgery appears to be less traumatic to the patient than open surgery, but its influence upon coagulation and fibrinolysis is incompletely elucidated. Our aim was to measure markers of coagulation and fibrinolysis before, during. and after laparoscopic cholecystectomy (LC). Blood samples drawn on admission, on four occasions during operation as well as 2 hours after operation and on the first postoperative day in 50 patients undergoing elective LC were analyzed for prothrombin fragment 1+2 (F1+2), soluble fibrin (SF), D-dimer (DD), fibrin degradation products (FbDP), tissue-type plasminogen activator (tPA) activity and antigen, and plasminogen activator inhibitor (PAI) activity and antigen. F1+2, SF, DD, and FbDP levels increased significantly after LC. Differences between pre- and postoperative PAI and tPA levels were not significant apart from a transient increase in tPA antigen levels. tPA activity was significantly increased during operation.
Collapse
Affiliation(s)
- H B Rahr
- Department of Gastrointestinal Surgery, Aalborg Hospital, Denmark.
| | | | | | | |
Collapse
|