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Cao J, Luo XL, Lin Q. Remazolam combined with transversus abdominis plane block in gastrointestinal tumor surgery: Have we achieved better anesthetic effects? World J Gastrointest Oncol 2024; 16:3368-3371. [PMID: 39171186 PMCID: PMC11334034 DOI: 10.4251/wjgo.v16.i8.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 08/07/2024] Open
Abstract
Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors. Although laparoscopic surgery is minimally invasive, its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients. On the other hand, gastrointestinal surgery can cause stronger pain in patients, compared to other surgeries. Transversus abdominis plane block (TAPB) can effectively inhibit the transmission of nerve impulses caused by surgical stimulation, alleviate patient pain, and thus alleviate stress reactions. Remazolam is an acting, safe, and effective sedative, which has little effect on hemodynamics and is suitable for most patients. TAPB combined with remazolam can reduce the dosage of total anesthetic drugs, reduce adverse reactions, reduce stress reactions, and facilitate the rapid postoperative recovery of patients.
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Affiliation(s)
- Jing Cao
- Department of Anesthesiology, North China Petroleum Bureau General Hospital, Renqiu 062552, Hebei Province, China
| | - Xing-Liao Luo
- Department of Anesthesiology, North China Petroleum Bureau General Hospital, Renqiu 062552, Hebei Province, China
| | - Qiang Lin
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu 062552, Hebei Province, China
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Chen L, Dasgupta P, Vasdev N. Use of mixed gas pneumoperitoneum during minimally invasive surgery: a systematic review of human and mouse modelled laparoscopic interventions. J Robot Surg 2024; 18:215. [PMID: 38758349 PMCID: PMC11101563 DOI: 10.1007/s11701-024-01971-1] [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: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024]
Abstract
The formation of pneumoperitoneum involves the process of inflating the peritoneal cavity during laparoscopic and typically uses CO2 as the insufflation gas. This review aims to identify ideal gas mixtures for establishing the pneumoperitoneum with animal and human studies undertaken up to the writing of this review. A systematic search of PubMed, OVID, and clinicaltrials.gov was performed to identify studies on the utilisation of mixed gases in laparoscopic surgery, including non-randomised/randomised trials, animal and human studies, and studies with inflating pressures between 12 and 16 mmHg. ROBINS-I and RoB2 tool was used to assess the risk of bias. A narrative synthesis of results was performed due to the heterogeneity of the studies. 5 studies from the database search and 5 studies from citation search comprising 128 animal subjects and 61 human patients were found. These studies collated results based on adhesion formation (6 studies), pain scores (2 studies) and other outcomes, with results favouring the use of carbon dioxide + 10% nitrous oxide + 4% oxygen. This has shown a significant reduction in adhesion formation, pain scores and inflammation. The use of this gas mixture provides promising results for future practice. Several of the studies available require larger sample sizes to develop a more definitive answer on the effects of different gas mixtures. Furthermore, the number of confounding factors in randomised trials should be reduced so that each component of the current suggested gas mixture can be tested for safety and efficacy.
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Affiliation(s)
- Leon Chen
- Faculty of Life Sciences & Medicine, King's College London, London, UK.
| | - Prokar Dasgupta
- Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK
- MRC Centre for Transplantation, King's College London, London, UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Sampurno S, Chittleborough T, Dean M, Flood M, Carpinteri S, Roth S, Millen RM, Cain H, Kong JCH, MacKay J, Warrier SK, McCormick J, Hiller JG, Heriot AG, Ramsay RG, Lynch AC. Effect of Surgical Humidification on Inflammation and Peritoneal Trauma in Colorectal Cancer Surgery: A Randomized Controlled Trial. Ann Surg Oncol 2022; 29:7911-7920. [PMID: 35794366 PMCID: PMC9261208 DOI: 10.1245/s10434-022-12057-3] [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: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pre-clinical studies indicate that dry-cold-carbon-dioxide (DC-CO2) insufflation leads to more peritoneal damage, inflammation and hypothermia compared with humidified-warm-CO2 (HW-CO2). Peritoneum and core temperature in patients undergoing colorectal cancer (CRC) surgery were compared. METHODS Sixty-six patients were randomized into laparoscopic groups; those insufflated with DC-CO2 or HW-CO2. A separate group of nineteen patients undergoing laparotomy were randomised to conventional surgery or with the insertion of a device delivering HW-CO2. Temperatures were monitored and peritoneal biopsies and bloods were taken at the start of surgery, at 1 and 3 h. Further bloods were taken depending upon hospital length-of-stay (LOS). Peritoneal samples were subjected to scanning electron microscopy to evaluate mesothelial damage. RESULTS Laparoscopic cases experienced a temperature drop despite Bair-HuggerTM use. HW-CO2 restored normothermia (≥ 36.5 °C) by 3 h, DC-CO2 did not. LOS was shorter for colon compared with rectal cancer cases and if insufflated with HW-CO2 compared with DC-CO2; 5.0 vs 7.2 days, colon and 11.6 vs 15.4 days rectum, respectively. Unexpectedly, one third of patients had pre-existing damage. Damage increased at 1 and 3 h to a greater extent in the DC-CO2 compared with the HW-CO2 laparoscopic cohort. C-reactive protein levels were higher in open than laparoscopic cases and lower in both matched HW-CO2 groups. CONCLUSIONS This prospective RCT is in accord with animal studies while highlighting pre-existing damage in some patients. Peritoneal mesothelium protection, reduced inflammation and restoration of core-body temperature data suggest benefit with the use of HW-CO2 in patients undergoing CRC surgery.
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Affiliation(s)
- Shienny Sampurno
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Timothy Chittleborough
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Meara Dean
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Michael Flood
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sandra Carpinteri
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Sara Roth
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Rosemary M Millen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Helen Cain
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - Joseph C H Kong
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
| | - John MacKay
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Satish K Warrier
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jacob McCormick
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Jonathon G Hiller
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Alexander G Heriot
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.,Epworth Healthcare, Richmond Victoria, Richmond, Australia
| | - Robert G Ramsay
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia. .,Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia. .,Epworth Healthcare, Richmond Victoria, Richmond, Australia.
| | - Andrew C Lynch
- Epworth Healthcare, Richmond Victoria, Richmond, Australia
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