Effect of Retroperitoneal Lavage with Normal Saline Containing Adrenaline on Carbon Dioxide Absorption in Patients Undergoing Retroperitoneal Laparoscopic Surgery

Bronchoalveolar lavage with pediatric flexible fibreoptic bronchoscope in pediatric haematopoietic stem cell transplant patients: Nursing considerations for operative complications

PURPOSE

Bronchoalveolar lavage (BAL) with pediatric flexible fibreoptic bronchoscopy (FB) is used for diagnostic and therapeutic purposes in pediatric haematopoietic stem cell transplant (HSCT) patients with pulmonary complications. The aim of our study was to evaluate complications in pediatric HSCT patients undergoing BAL/FB and to explore the nursing emphases on complications.

DESIGN AND METHODS

We performed a retrospective, case-controlled study to evaluate perioperative complications of HSCT children. BAL/FB was conducted for 42 children with HSCT who experienced pulmonary complications between January 2017 and January 2018 within a tertiary hospital. Forty patients diagnosed with general pneumonia were randomly selected during the same period and served as the control group. We analyzed the signs and symptoms of all patients and compared the operative complications between the two groups. Furthermore, we presented the methods used to manage complications.

RESULTS

The presence of cough, lung rales, and imaging findings in the HSCT patients was significantly different from that of the control group (p < 0.0001). The complication rate was 66.67% (28/42) in the HSCT group and 22.5% (9/40) in the control group, and the difference was significant (p < 0.0001). Twelve out of 42 HSCT patients experienced airway mucosal bleeding (28.57%), and six had transient fever (14.29%). The topical use of epinephrine diluted saline (1:10,000) was highly effective for controlling airway mucosal bleeding without causing fluctuations in blood pressure.

PRACTICE IMPLICATIONS

There were more perioperative complications in the HSCT patients than in the general pneumonia patients who underwent BAL/FB. Airway mucosal bleeding was a key focus of perioperative nursing in HSCT patients undergoing bronchoscopy as main complication. BAL with the use of epinephrine diluted saline (1:10,000) effectively decreased airway mucosal bleeding.

Carbon dioxide absorption during retroperitoneoscopic adrenalectomy: comparison between monolateral and synchronous bilateral approaches

Synchronous posterior retroperitoneoscopic bilateral adrenalectomy (PR-BilA) is a novel technique proposed for the definitive cure of hypercortisolism when a surgical approach is indicated. The aim of the present prospective cohort study was to compare the carbon dioxide (CO₂) absorption in patients undergoing PR-BilA with those undergoing single posterior retroperitoneoscopic adrenalectomy (PRA). Twenty-nine patients undergoing PR-BilA or PRA were consecutively enrolled. Anaesthesia was standardised. In both groups, CO₂ elimination (VCO₂), CO₂ dissolved in arterial blood (PaCO₂), end-tidal CO₂ (EtCO₂), and volume per minute (VM) were measured at the following time points: after anaesthesia induction and before CO₂ insufflation (T1), 5 min after CO₂ insufflation (T2), at the time of maximum VCO₂ (T3), and at desufflation (T4). VCO₂ was continuously measured using a metabolic monitor. ANOVA for repeated measures was used for statistical analysis. With respect to VCO₂, a significant group × time interaction was found (p = 0.03). Post hoc analysis revealed that VCO₂ was significantly increased at T4 compared with T1 in both groups (p = 0.02 and p = 0.0001 in the PRA and PR-BilA groups, respectively). Regarding PaCO₂, ANOVA analysis showed a significant group effect (p = 0.01), with higher values in the PR-BilA group. EtCO₂ and VM did not differ between the two groups. We found that the CO₂ absorption was increased in both groups at the end of surgery, in the presence of a higher trend in PaCO₂ values during PR-BilA. Therefore, PR-BilA may be considered a safe surgical approach with respect to CO₂ absorption, when a mild degree of hypercapnia may be accepted.