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Wang BB, Hu L, Hu XY, Han D, Wu J. Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients: A Propensity Score Matching Study. Curr Med Sci 2024; 44:441-449. [PMID: 38561592 DOI: 10.1007/s11596-024-2848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population. METHODS This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022. Data were collected for each patient, including demographics, disease status, surgical data, and clinical information. Preoperative bowel preparation, postoperative gastrointestinal function, and electrolyte levels were compared between the two groups using propensity score matching (PSM). RESULTS The incidence of hypokalemia (serum potassium level <3.5 mmol/L) during the recovery period from anesthesia was approximately 43.75%. After PSM, oral laxative use (96.4% vs. 82.4%, P=0.005), the number of general enemas (P=0.014), and the rate of ≥2 general enemas (92.9% vs. 77.8%, P=0.004) were identified as risk factors for hypokalemia, which was accompanied by decreased PaCO2 and hypocalcemia. There were no significant differences in postoperative gastrointestinal outcomes, such as the time to first flatus or feces, the I-FEED score (a scoring system was created to evaluate impaired postoperative gastrointestinal function), or postoperative recovery outcomes, between the hypokalemia group and the normal serum potassium group. CONCLUSION Hypokalemia during postanesthesia recovery period occurred in 43.75% of gynecological patients, which resulted from preoperative mechanical bowel preparation; however, it did not directly affect clinical outcomes, including postoperative gastrointestinal function, postoperative complications, and length of hospital stay.
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Affiliation(s)
- Bei-Bei Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Li Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Xin-Yue Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Dong Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China
| | - Jing Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, 430022, China.
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Lin C, Wang D, Yan Y, Zhong R, Li C, Zhang J. Transnasal humidified rapid-insufflation ventilator exchange compared with laryngeal mask airway for endoscopic thoracic sympathectomy: a randomized controlled trial. Front Med (Lausanne) 2023; 10:1252586. [PMID: 38116036 PMCID: PMC10728469 DOI: 10.3389/fmed.2023.1252586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023] Open
Abstract
Background Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has the characteristics of operating easily and maintaining oxygenation and eliminating CO2, which makes it possible to be used in endoscopic thoracic sympathectomy (ETS). The application of THRIVE in ETS remains undefined. The purpose of this randomized controlled study is to assess the efficacy between THRIVE and laryngeal mask airway (LMA) for ETS. Methods In total, 34 patients from May 2022 to May 2023 in Huazhong University of Science and Technology Union Shenzhen Hospital undergoing ETS were randomly divided into a THRIVE group (n = 17) and an LMA group (n = 17). A serial arterial blood gas analysis was conducted during the perioperative period. The primary outcome was the arterial partial pressure of carbon dioxide (PaCO2) during the perioperative period. The secondary outcome was arterial partial pressure of oxygen (PaO2) during the perioperative period. Results The mean (SD) highest PaCO2 in the THRIVE group and LMA group were 99.0 (9.0) mmHg and 51.7 (5.2) mmHg, respectively (p < 0.001). The median (inter-quartile range) time to PaCO2 ≥ 60 mmHg in the THRIVE group was 26.0 min (23.2-28.8). The mean (SD) PaO2 was 268.8 (89.0) mmHg in the THRIVE group and 209.8 (55.8) mmHg in the LMA group during surgery (p = 0.027). Conclusion CO2 accumulation in the THRIVE group was higher than that of the LMA group during ETS, but THRIVE exhibited greater oxygenation capability compared to LMA. We preliminarily testified that THRIVE would be a feasible non-intubated ventilation technique during ETS under monitoring PaCO2.
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Affiliation(s)
| | | | | | | | - Chaoyang Li
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Jie Zhang
- Department of Anesthesiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Pan Y, Shao Y, Chi Z, Jin S, Wang J. Transcutaneous Electrical Acupoint Stimulation Accelerates the Recovery of Patients Undergoing Laparoscopic Myomectomy: A Randomized Controlled Trial. J Pain Res 2023; 16:809-819. [PMID: 36925621 PMCID: PMC10013582 DOI: 10.2147/jpr.s399249] [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: 12/13/2022] [Accepted: 03/04/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose To evaluate transcutaneous electrical acupoint stimulation (TEAS) on the perioperative rehabilitation of patients undergoing laparoscopic myomectomy. Patients and Methods One hundred and five women undergoing laparoscopic hysteromyomectomy were randomly divided into TEAS group (Group T) and control group (Group C). Propofol and remifentanil were used to stabilize patient blood pressure and keep BIS between 40 and 60. Group T patients received TEAS at LI4/PC6 30 minutes before the operation and lasting until the end of anesthesia, followed by TEAS at ST36/SP6 for 30 minutes in PACU. All required indicators were recorded. Results Group T patients required lower dosages of remifentanil and vasoactive drugs, and had a reduced incidence of propofol injection pain and intraoperative hypotension compared to Group C. Group T also had a lower maximum NRS score in PACU, lower NRS scores at 1 hour and 24 hours, and a lower incidence of vomiting within 24 hours. In addition, the QoR-40 score for Group T at 24 hours after operation was higher in terms of physical comfort, emotional state, pain and total score. Conclusion TEAS can reduce the amount of anesthetic, maintain hemodynamic stability, reduce postoperative pain, reduce postoperative vomiting, enhance the recovery of gastrointestinal function, increase the quality of postoperative recovery and thus accelerate overall patient recovery.
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Affiliation(s)
- Yuanyuan Pan
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yifan Shao
- Department of Anesthesia, Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Zhanghuan Chi
- Department of Anesthesia, Wenzhou People's Hospital, Wenzhou, People's Republic of China
| | - Shenhui Jin
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Junlu Wang
- Department of Anesthesia, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
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Hwang JH, Kim BW. Comparative study on gasless laparoscopy using a new device versus conventional laparoscopy for surgical management of postmenopausal patients. J Minim Access Surg 2022; 18:346-352. [PMID: 35708378 PMCID: PMC9306136 DOI: 10.4103/jmas.jmas_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To compare gasless laparoscopy with conventional laparoscopy for the surgical management of postmenopausal patients. Methods: The medical records of 80 postmenopausal patients who underwent laparoscopic surgeries between February 2016 and February 2020 were reviewed. Forty patients underwent gasless laparoscopy and 40 patients underwent conventional single-port access (SPA) laparoscopy. The two groups were compared in terms of surgical outcomes. Results: Of 80 patients, 42 underwent adnexal surgeries and 38 underwent uterine surgeries such as total hysterectomy or myomectomy. Between the gasless SPA and conventional SPA laparoscopic groups, no significant differences were observed in terms of age, body mass index, parity or history of previous abdominal surgery. The mean retraction setup time from skin incision was 6.8 ± 1.2 min with gasless laparoscopic surgery. There was no significant difference in mean total operation times for the gasless (71.3 ± 31.4 min) and conventional (82.5 ± 36.4 min) groups. There was also no significant difference between the groups in terms of operation type, laparotomy conversion rate or duration of hospitalisation. There were no major complications in either group. Conclusions: Gasless laparoscopy is a safe and feasible alternative to conventional laparoscopy for postmenopausal women.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon Metropolitan City, South Korea
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon Metropolitan City, South Korea
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Petran J, Ansems K, Rossaint R, Marx G, Kalvelage C, Kopp R, Benstoem C, Brülls C. Effects of hypercapnia versus normocapnia during general anesthesia on outcomes: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 72:398-406. [PMID: 35644204 PMCID: PMC9373272 DOI: 10.1016/j.bjane.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The effect of mild changes in CO2 levels to organ perfusion and tissue inflammation are well known, whereas an influence of hypercapnia under general anesthesia on adverse events as nausea and vomiting, or length of hospital stay is barely examined. The goal of our meta-analysis was to identify possibly positive effects of hypercapnia versus normocapnia in general anesthesia in adult patients. METHODS We conducted a systematic review of parallel-arm randomised controlled trials comparing hypercapnia versus normocapnia in adult patients undergoing general anesthesia. In July 2018 and September 2019 we searched "CENTRAL‿, "MEDLINE‿, and "Embase‿, checked reference lists of all included studies and relevant systematic reviews for additional references to trials. Two review authors independently assessed trials for inclusion, extracted data, and completed a "Risk of bias‿ assessment for all included studies. RESULTS Our search identified 297 records after abstract screening 30 full-text papers remained for further examination. Ten publications met our inclusion criteria and were used for narrative description of this systematic review. Three studies were eligible for the meta-analysis normocapnia versus hypercapnia with the outcomes: time to extubation and adverse events. On average, time to extubation was significantly reduced in the hypercapnia group with a mean difference 3.78 (95% CI 0.85 to 6.71). No difference was found regarding adverse events. CONCLUSIONS The findings of our study do not enable us to produce evidence of a positive influence of increased CO2 partial pressure levels during general anesthesia. A well-planned, adequately powered randomized controlled trial would be desirable in the future.
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Affiliation(s)
- Jan Petran
- RWTH Aachen University, Medical Faculty, Department of Anaesthesiology, Aachen, Germany; RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany.
| | - Kelly Ansems
- RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Rolf Rossaint
- RWTH Aachen University, Medical Faculty, Department of Anaesthesiology, Aachen, Germany
| | - Gernot Marx
- RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Christina Kalvelage
- RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Rüdger Kopp
- RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Carina Benstoem
- RWTH Aachen University, Medical Faculty, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Christian Brülls
- RWTH Aachen University, Medical Faculty, Department of Anaesthesiology, Aachen, Germany
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Dong L, Takeda C, Yamazaki H, Hamada M, Hirotsu A, Yamamoto Y, Mizota T. Association between intraoperative end-tidal carbon dioxide and postoperative nausea and vomiting in gynecologic laparoscopic surgery. Sci Rep 2022; 12:6865. [PMID: 35477978 PMCID: PMC9046149 DOI: 10.1038/s41598-022-10727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Gynecologic laparoscopic surgery has a high incidence of postoperative nausea and vomiting (PONV). Studies suggest that low intraoperative end-tidal carbon dioxide (EtCO2) is associated with an increased incidence of PONV, but the results have not been consistent among studies. This study investigated the association between intraoperative EtCO2 and PONV in patients undergoing gynecologic laparoscopic surgeries under general anesthesia. This retrospective cohort study involved patients who underwent gynecologic laparoscopic surgeries under general anesthesia at Kyoto University Hospital. We defined low EtCO2 as a mean EtCO2 of < 35 mmHg. Multivariable modified Poisson regression analysis examined the association between low EtCO2 and PONV during postoperative two days and the postoperative length of hospital stay (PLOS). Of the 739 patients, 120 (16%) had low EtCO2, and 430 (58%) developed PONV during postoperative two days. There was no substantial association between low EtCO2 and increased incidence of PONV (adjusted risk ratio: 0.96; 95% confidence interval [CI] 0.80–1.14; p = 0.658). Furthermore, there was no substantial association between low EtCO2 and prolonged PLOS (adjusted difference in PLOS: 0.13; 95% CI − 1.00 to 1.28; p = 0.816). Intraoperative low EtCO2, specifically a mean intraoperative EtCO2 below 35 mmHg, was not substantially associated with either increased incidence of PONV or prolonged PLOS.
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Affiliation(s)
- Li Dong
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Anaesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan
| | - Chikashi Takeda
- Department of Anaesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto-shi, Kyoto, 606-8501, Japan
| | - Miho Hamada
- Department of Anaesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan
| | - Akiko Hirotsu
- Department of Anaesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiyuki Mizota
- Department of Anaesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Kyoto, 606-8507, Japan.
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Effects of intra-operative end-tidal carbon dioxide levels on postoperative nausea and vomiting after thyroidectomy: A pilot randomised controlled study. Eur J Anaesthesiol 2022; 39:399-401. [PMID: 35232941 DOI: 10.1097/eja.0000000000001604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gin E, Lowen D, Tacey M, Hodgson R. Reduced Laparoscopic Intra-abdominal Pressure During Laparoscopic Cholecystectomy and Its Effect on Post-operative Pain: a Double-Blinded Randomised Control Trial. J Gastrointest Surg 2021; 25:2806-2813. [PMID: 33565010 DOI: 10.1007/s11605-021-04919-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic surgery is regarded as the gold standard for the surgical management of cholelithiasis. To improve post-operative pain, low-pressure laparoscopic cholecystectomies (LPLC) have been trialed. A recent systematic review found that LPLC reduced pain; however, many of the randomised control trials were at a high risk of bias and the overall quality of evidence was low. METHODS One hundred patients undergoing elective laparoscopic cholecystectomy were randomised to a LPLC (8 mmHg) or a standard pressure laparoscopic cholecystectomy (12 mmHg) (SPLC) with surgeons and anaesthetists blinded to the pressure. Pressures were increased if vision was compromised. Primary outcomes were post-operative pain and analgesia requirements at 4-6 h and 24 h. RESULTS Intra-operative visibility was significantly reduced in LPLC (p<0.01) resulting in a higher number of operations requiring the pressure to be increased (29% vs 8%, p=0.010); however, there were no differences in length of operation or post-operative outcomes. Pain scores were comparable at all time points across all pressures; however, recovery room fentanyl requirement was more than four times higher when comparing 8 to 12 mmHg (12.5mcg vs 60mcg, p=0.047). Nausea and vomiting was also higher when comparing these pressures (0/36 vs 7/60, p=0.033). Interestingly, when surgeons estimated the operating pressure, they were correct in only 69% of cases. CONCLUSION Although pain scores were similar, there was a significant reduction in fentanyl requirement and nausea/vomiting in LPLC. Although LPLC compromised intra-operative visibility requiring increased pressure in some cases, there was no difference in complications, suggesting LPLC is safe and beneficial to attempt in all patients. TRIAL REGISTRATION Registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12619000205134).
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Affiliation(s)
- Elliot Gin
- Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, Australia
| | - Darren Lowen
- Department of Anaesthetics, Northern Health, Epping, Australia
| | - Mark Tacey
- Department of Research, Northern Health, Epping, Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Russell Hodgson
- Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, Australia. .,Department of Surgery, University of Melbourne, Epping, Australia.
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Bataineh AM, Qudaisat IY, Banihani M, Obeidat R, Hamasha HS. Use of intraoperative mild hyperventilation to decrease the incidence of postoperative shoulder pain after laparoscopic gastric sleeve surgery: A prospective randomised controlled study. Indian J Anaesth 2021; 65:806-812. [PMID: 35001953 PMCID: PMC8680420 DOI: 10.4103/ija.ija_576_21] [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] [Received: 06/23/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Post-laparoscopic shoulder pain (PLSP) is a common problem. It is a referred type of pain resulting from irritation of phrenic nerve endings. Multiple manoeuvres were used to decrease its incidence with varying success rates. In this study, we tested the use of mild intraoperative hyperventilation to reduce PLSP in patients undergoing laparoscopic sleeve gastrectomy surgery (LSG). METHODS Consenting American Society of Anesthesiologists-I and II patients undergoing LSG under general anaesthesia were randomly assigned to two groups. Group A (53 patients) received intraoperative mild hyperventilation with target end-tidal carbon dioxide (ETCO2) of 30-32 mmHg. Group B (51 patients) received conventional ventilation (ETCO2 of 35-40 mmHg). Incidence and severity of PLSP, cumulative analgesic requirements and incidence of nausea and vomiting were recorded at 12 and 24 hours postoperatively and then followed up after discharge over the phone at 48 hours, 1 week, 1 month and 3 months. Statistical significance of differences between the two groups was defined at P < 0.05. RESULTS Incidence of PLSP was comparable between the two groups in the first 24 hours. The intervention group had a significantly lower incidence of PLSP throughout the remaining assessment points (56.6% vs. 80.4%, 30.2% vs. 78.4%, 15.1% vs. 70.6%, 3.8% vs. 35.3% at 36 hours, 48 hours, 1 week and 1 month, respectively, P < 0.05). The average PLSP pain score was significantly lower in the mild hyperventilation group at all assessment time points. Nausea and vomiting were non-significantly lower in the mild hyperventilation group. CONCLUSION Mild intraoperative hyperventilation could be beneficial in reducing the incidence and severity of PLSP after LSG surgery.
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Affiliation(s)
- Adel M. Bataineh
- Department of Anaesthesia and Recovery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibraheem Y Qudaisat
- Department of Anaesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed Banihani
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rawan Obeidat
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba S Hamasha
- Department of Anaesthesia and Recovery, Jordan University of Science and Technology, Irbid, Jordan
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Robleda G, Baños JE. Health Care Professionals' Assessment of Patient Discomfort After Abdominal Surgery. J Perianesth Nurs 2021; 36:553-558. [PMID: 33966992 DOI: 10.1016/j.jopan.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to classify elements of patients' discomfort in the resuscitation room after open or laparoscopic abdominal surgery as per health care professionals' perceptions. DESIGN A prospective cross-sectional study at a tertiary hospital in Spain. METHODS Resuscitation room nurses administered the Postoperative Discomfort Inventory to physicians and nurses with >1 year experience working closely with patients who had undergone abdominal surgery, asking them to score nine items related to patients' discomfort in the first 8 hours after surgery on an 11-point scale (0 = absent to 10 = very severe). Interobserver agreement among proxy reporters was measured with the Spearman's ρ; correlations >0.35 was considered adequate agreement. FINDINGS Of 125 eligible professionals, 116 (93%) participated (63 [54%] nurses and 53 [46%] physicians; mean age, 38 ± 12 years; 86 [74%] women). Professionals' perception of discomfort differed significantly between patients undergoing open surgery and those undergoing laparoscopic surgery; after open surgery, the most common types were pain (7.1 ± 1.8), movement restriction (7 ± 1.75), and dry mouth (6.6 ± 2.6), whereas after laparoscopic surgery, the most common types were dry mouth (5.85 ± 2.8), abdominal bloating (5.3 ± 2.5), and pain (5 ± 2.2). The Spearman's ρ correlations were inadequate for all items except for dry mouth in open surgery (r = 0.40). CONCLUSIONS Pain, movement restriction, abdominal bloating, and dry mouth were the main causes of discomfort. Our findings highlight the need to be vigilant for all manifestations of discomfort after abdominal surgery to enable timely treatment.
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Affiliation(s)
- Gemma Robleda
- Campus Docent, Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain; Ibero-American Cochrane Center, Department of Epidemiology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
| | - Josep-E Baños
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; School of Medicine, Universitat de Vic -Universitat Central de Catalunya, Vic, Spain
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Kim MK, Hwang JH, Kim JH, Kim SR, Lee SB, Kim BW. Gasless Total Laparoscopic Hysterectomy with New Abdominal-Wall Retraction System. JSLS 2020; 24:JSLS.2019.00061. [PMID: 32161436 PMCID: PMC7056266 DOI: 10.4293/jsls.2019.00061] [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] [Indexed: 02/03/2023] Open
Abstract
Background and Objectives Gasless laparoscopy is an alternative method to reduce the number of carbon dioxide (CO2)-insufflated, pneumoperitoneum-related problems including shoulder pain, postoperative nausea/vomiting, and decreased cardiopulmonary function. In this study, we investigated the feasibility of gasless total laparoscopic hysterectomy (TLH) with a newly developed abdominal-wall retraction system. Methods Abdominal-wall retraction for gasless laparoscopy was performed using the newly developed J-shape retractor and the Thompson surgical retractor. Surgical outcomes between gasless TLH and conventional CO2-based TLH were compared for each of 40 patients for the period from January 2017 to October 2019. Results Between gasless TLH and conventional CO2-based TLH, no significant differences were observed for age, body mass index, parity, or surgical indications. The mean retraction setup time from skin incision was 7.4 min (range: 4-12 min) with gasless TLH. The mean total operation times were 87.9 min (range: 65-170) with gasless TLH and 90 min (range: 45-180) with conventional TLH, which showed no significant difference. Estimated blood loss and uterus weight also showed no significant intergroup difference. No major complications related to the ureter, bladder, or bowel were encountered. Conclusion Our new abdominal-wall retraction system for gasless TLH allowed for easy setup and a proper operation field in the performance of laparoscopic hysterectomy.
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Affiliation(s)
- Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA University, CHA Gangnam Medical Center
| | | | - Jang-Heub Kim
- Department of Obstetrics and Gynecology, Catholic Kwandong University, International Saint Mary's Hospital
| | - Soo Rim Kim
- Department of Obstetrics and Gynecology, Catholic Kwandong University, International Saint Mary's Hospital
| | - Sae Bom Lee
- Department of Obstetrics and Gynecology, Catholic Kwandong University, International Saint Mary's Hospital
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, Catholic Kwandong University, International Saint Mary's Hospital
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Hwang JH, Kim SR, Kim JH, Kim BW. Gasless single-port access laparoscopy using a J-shaped retractor in patients undergoing adnexal surgery. Surg Endosc 2020; 35:2457-2464. [PMID: 32444972 DOI: 10.1007/s00464-020-07654-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare gasless single-port access (SPA) laparoscopy using a J-shaped retractor and conventional SPA laparoscopy in patients undergoing adnexal surgery. Study design The medical records of 80 patients who underwent laparoscopic adnexal surgery between May 2017 and April 2019 were reviewed. Of the 80 patients, 40 patients underwent gasless SPA laparoscopy using a J-shaped retractor and 40 underwent conventional SPA laparoscopy. All surgeries were performed by one laparoscopic surgeon. Surgical outcomes were compared between the two groups. RESULTS There are no significant differences in age, body mass index, parity, previous abdominal surgery, tumor marker, and tumor diameter between the gasless and conventional groups. The median retraction setup time from skin incision was 7 min (range 5-12 min) in gasless SPA laparoscopic adnexal surgery. The median total operation times were 55.5 min (range 30-155 min) in the gasless group and 55 min (range 30-165 min) in the conventional group without a significant difference. Additionally, there were no differences in operation type, conversion rate of laparotomy, use of an additional trocar, and pathological outcomes between the two groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSIONS Gasless SPA laparoscopy using a J-shaped retractor appears to offer a better alternative to conventional SPA laparoscopy that avoids the potential negative effects of carbon dioxide gas in selected cases.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Soo Rim Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Jang Heub Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Simgokro 100 gil 25 Seo-gu, Incheon, 22711, South Korea.
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The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting. J Anesth 2019; 34:195-201. [PMID: 31776779 DOI: 10.1007/s00540-019-02715-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Patients undergoing gynecological surgery are considered to be a high-risk cohort for postoperative nausea and vomiting (PONV). The purpose of this study was to assess the association of intraoperative end-tidal carbon dioxide (EtCO2) with risk of PONV in patients underwent gynecological open surgery. METHODS In this single-center retrospective observational study, we included patients aged 20-60 years who underwent elective gynecological open surgery. We obtained data for the incidence of PONV within 24 h after operation. We collected EtCO2 every minute during the operation, and determined the lowest value of EtCO2. We compared the lowest EtCO2 between patients with and without PONV. Multivariate logistic regression analysis was performed to assess the independent association of EtCO2 with the risk of PONV. RESULTS A total of 146 patients were included in the current study. There were 81 patients with PONV within 24 h after the operation. The median lowest value of EtCO2 in patients with PONV was significantly lower than that in patients without PONV (31 vs 33 mmHg, p = 0.02). In the multivariate logistic regression model, we found that lowest EtCO2 ≤ 31 mmHg was independently associated with increase in the risk of PONV (adjusted odds ratio = 3.37, p = 0.02). CONCLUSION In this retrospective observational study, low intraoperative EtCO2 was shown to be independently associated with increased risk of PONV. However, this result may be skewed by uncollected information including previous PONV, motion sickness or other unknown bias, so future studies should be conducted to refute or confirm our findings.
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