Effect of CO(2) pneumoperitoneum on early cellular markers of retinal ischemia in rabbits with alpha-chymotrypsin-induced glaucoma

Intraocular Pressure Changes With Positioning During Laparoscopy

Background and Objectives:

Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning.

Methods:

We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1–T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO₂) measurements were taken at each time point.

Results:

Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO₂, and airway pressures in both groups.

Conclusions:

IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

Background

Laparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum.

Methods

A systematic review of all randomized controlled clinical trials and observational studies comparing low- versus standard-pressure pneumoperitoneum.

Results and conclusions

Quality assessment showed that the overall quality of evidence was moderate to low. Postoperative pain scores were reduced by the use of low-pressure pneumoperitoneum. With appropriate perioperative measures, the use of low-pressure pneumoperitoneum does not seem to have clinical advantages as compared to standard pressure on cardiac and pulmonary function. Although there are indications that low-pressure pneumoperitoneum is associated with less liver and kidney injury when compared to standard-pressure pneumoperitoneum, this does not seem to have clinical implications for healthy individuals. The influence of low-pressure pneumoperitoneum on adhesion formation, anastomosis healing, tumor metastasis, intraocular and intracerebral pressure, and thromboembolic complications remains uncertain, as no human clinical trials have been performed. The influence of pressure on surgical conditions and safety has not been established to date. In conclusion, the most important benefit of low-pressure pneumoperitoneum is lower postoperative pain scores, supported by a moderate quality of evidence. However, the quality of surgical conditions and safety of the use of low-pressure pneumoperitoneum need to be established, as are the values and preferences of physicians and patients regarding the potential benefits and risks. Therefore, the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak, and more studies are required.

[Survey of office space and computer availability offered to full time practitioners in departments of anaesthesia and intensive care of French university hospitals]

INTRODUCTION

Office space and computer facilities offered to medical practitioners in departments of anaesthesia (DA) belonging to university hospitals in metropolitan France in 2002 were surveyed.

METHOD

A questionnaire was mailed to the 72 heads of DA belonging to university hospitals in metropolitan France in order to assess: (1) the number of full time anaesthesiologists sharing each office; (2) whether a computer was provided to all full time anaesthetists who required one; (3) the adequacy of the offices in terms of the DA's needs; (4) the subjective appreciation of the comfort level of the DA office space when compared to other departments within the institution; (5) whether an office space with a computer was specifically reserved for fellows.

RESULTS

Sixty-two replies were received (86.1%). Among full time anaesthesiologists surveyed:only 21.8% occupied an office alone; 1.2% had no office; 36.5, 21.7, 8.2, 3.4, 3.9, 3.2% shared one office with 1, 2, 3, 4, 5, more than 5 colleagues, respectively; 25.8% had a personal computer. Fifty percent of DA surveyed did not reserve a specific office for fellow's need; 75.8% of the offices surveyed were evaluated as being of inadequate comfort level; 64.5% of the offices surveyed were evaluated at a lower comfort level when compared to the office space of other departments within the institution.

CONCLUSION

A high response rate was obtained. DA were found to be insufficiently provided with offices and computer facilities in french university hospitals. Such a situation, which is both surprising and questionable in an industrialised country, warrants a debate.