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English K, Frise C, Trinder J, Cauldwell M, Simpson M, Adamson D, Elton C, Burns G, Choudhary M, Nathanson M, Robert L, Moore J, O'Brien P, Pundir J. Best practice recommendations for medically assisted reproduction in patients with known cardiovascular disease or at high risk of cardiovascular disease. HUM FERTIL 2024; 27:2278295. [PMID: 38196173 DOI: 10.1080/14647273.2023.2278295] [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: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
Increasing numbers of people are seeking assisted conception. In people with known cardiac disease or risk factors for cardiac disease, assisted conception may carry increased risks during treatment and any subsequent pregnancy. These risks should be assessed, considered and minimized prior to treatment.
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Affiliation(s)
- Kate English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Charlotte Frise
- Department of Obstetrics, Queen Charlotte's and Chelsea Hospital, London, UK
| | | | | | | | - Dawn Adamson
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chris Elton
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | | | - Meenakshi Choudhary
- Newcastle Fertility Centre at Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mike Nathanson
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Jim Moore
- Department of Primary Care, NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Pat O'Brien
- Department of Obstetrics, University College London, London, UK
| | - Jyotsna Pundir
- Reproductive Medicine, St Bartholomew's Hospital, London, UK
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2
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Ng AJT, Tiwari RV, Ho VK, Lee LS. Perioperative management of phaeochromocytoma with stress cardiomyopathy and aberrant vascular drainage. BMJ Case Rep 2024; 17:e260479. [PMID: 38862185 DOI: 10.1136/bcr-2024-260479] [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] [Indexed: 06/13/2024] Open
Abstract
The following case discusses the surgical considerations for a patient presenting with cardiogenic shock secondary to a phaeochromocytoma crisis with stress cardiomyopathy. The patient underwent an interval laparoscopic adrenalectomy. Pneumoperitoneum insufflation was performed at lower pressures; manipulation of the adrenal tumour was minimised, and the adrenal vein was ligated early. However, as intraoperative blood pressure (BP) remained elevated and rising, further gentle dissection revealed an aberrant inferior phrenic vein draining the adrenal nodule. BP was finally reduced following ligation of the inferior phrenic vein, demonstrating the clinical significance of an unusual dual venous drainage from the adrenal nodule in this patient.
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Affiliation(s)
| | | | - Vui Kian Ho
- Department of Anaesthesiology, Sengkang General Hospital, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore
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3
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Sanchez K, Tollinche L, Reece-Nguyen T. Anesthesia for gender-affirming surgery: a practical review. Curr Opin Anaesthesiol 2024; 37:292-298. [PMID: 38390936 DOI: 10.1097/aco.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW Gender-affirming surgery (GAS) is an effective, well studied, and often necessary component of gender-affirming care and mitigation of gender dysphoria for transgender and gender-diverse (TGD) individuals. GAS is categorized as chest surgeries, genitourinary surgeries, facial feminization/masculinization, and vocal phonosurgery. Despite increased incidence of GAS during recent years, there is a gap in knowledge and training on perioperative care for TGD patients. RECENT FINDINGS Our review discusses the relevant anesthetic considerations for the most common GAS, which often involve highly specialized surgical techniques that have unique implications for the anesthesia professional. SUMMARY Anesthesiology professionals must attend to the surgical and anesthetic nuances of various GAS procedures. However, as many considerations are based on common practice, research is warranted on anesthetic implications and outcomes of GAS.
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Affiliation(s)
- Kyle Sanchez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Luis Tollinche
- Department of Anesthesiology and Pain Medicine, MetroHealth Medical System of Case Western Reserve University, Cleveland, Ohio
| | - Travis Reece-Nguyen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford Medicine, Stanford, California, USA
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Zhang D, Xu R, Huo T, Liu Y, Hao Z, Sun Y, Xi X, Du X, Wang L, Du J. Perioperative management of a patient with unexpectedly detected early-stage ovarian mucinous carcinoma combined with progressive bulbar paralysis: a case report and literature review. BMC Womens Health 2024; 24:274. [PMID: 38704534 PMCID: PMC11069129 DOI: 10.1186/s12905-024-03117-9] [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: 11/19/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Giant ovarian cysts (GOCs)complicated with progressive bulbar paralysis (PBP) are very rare, and no such literature about these cases have been reported. Through the diagnosis and treatment of this case, the perioperative related treatment of such patients was analyzed in detail, and early-stage ovarian mucinous carcinoma was unexpectedly found during the treatment, which provided reference for clinical diagnosis and treatment of this kind of diseases. CASE PRESENTATION In this article, we reported a 38-year-old female patient. The patient was diagnosed with PBP 2 years ago. Examination revealed a large fluid-dominated cystic solid mass in the pelvis measuring approximately 28.6×14.2×8.0 cm. Carbohydrate antigen19-9(CA19-9) 29.20 IU/mL and no other significant abnormalities were observed. The patient eventually underwent transabdominal right adnexal resection under regional anesthesia, epidural block. Postoperative pathology showed mucinous carcinoma in some areas of the right ovary. The patient was staged as stage IA, and surveillance was chosen. With postoperative follow-up 1 month later, her CA19-9 decreased to 14.50 IU/ml. CONCLUSIONS GOCs combined with PBP patients require a multi-disciplinary treatment. Preoperative evaluation of the patient's PBP progression, selection of the surgical approach in relation to the patient's fertility requirements, the nature of the ovarian cyst and systemic condition are required. Early mucinous ovarian cancer accidentally discovered after operation and needs individualized treatment according to the guidelines and the patient's situation. The patient's dysphagia and respiratory function should be closely monitored during the perioperative period. In addition, moral support from the family is also very important.
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Affiliation(s)
- Dingbei Zhang
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Ruibo Xu
- Department of Gynecology, Handan first hospital, Handan, 056000, Hebei, China
| | - Tingting Huo
- Department of Anaesthesiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300072, China
| | - Ying Liu
- Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Zengfang Hao
- Department of Pathology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Yao Sun
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Xiaoyu Xi
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Xiaoli Du
- Department of Gynecology, Traditional Chinese Medicine Hospital of Shijiazhuang, Hebei, 050000, China
| | - Lili Wang
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Jiexian Du
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.
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5
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Wildey B, Berman D, Borahay MA. Cardiovascular collapse during laparoscopy: a brief overview. Arch Gynecol Obstet 2024; 309:2253-2256. [PMID: 38015208 DOI: 10.1007/s00404-023-07274-4] [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: 05/03/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
This review article considers the physiology, differential diagnosis and immediate management of vasovagal response, vascular injury and carbon dioxide embolism caused during the creation of the laparoscopic pneumoperitoneum. These pathologies account for over half of all laparoscopic complications and therefore, by taking a systematic approach to these possibly life-threatening events, laparoscopy can become even safer.
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Affiliation(s)
- Brian Wildey
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue Room A121, Baltimore, MD, 21224-2780, USA.
| | - David Berman
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue Room A121, Baltimore, MD, 21224-2780, USA
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6
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Chandramohan D, Konda R, Pujari A, Avula S, Palleti SK, Jena N, Naik R, Bali A. Acute kidney injury after robot-assisted laparoscopic prostatectomy: A meta-analysis. Int J Med Robot 2024; 20:e2630. [PMID: 38567745 DOI: 10.1002/rcs.2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND We investigated the rates of acute kidney injury (AKI) post robot-assisted laparoscopic prostatectomy (RALP). METHODS A comprehensive search was conducted to identify studies that reported the rates of AKI post-RALP. A random effects model was used, and the pooled rates of AKI were calculated. RESULTS We identified 10 studies with 60,937 patients to be included. The mean age was 65.1 years. The mean anaesthesia time was 234.3 min (95% CI: 177.8-290.9). The mean operation time was 212.2 min (95% CI: 188.7-235.6). The mean estimated blood loss was 314.1 mL (95% CI: 153-475.3). The mean intraoperative IV fluids administered were 1985 mL (95% CI: 1516.3-2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19-23.9). CONCLUSIONS The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post-RALP.
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Affiliation(s)
- Deepak Chandramohan
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Raghunandan Konda
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashwini Pujari
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sreekant Avula
- Department of Internal Medicine/Endocrinology, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Sujith Kumar Palleti
- Department of Internal Medicine/Nephrology, Louisiana State University, Shreveport, Louisiana, USA
| | - Nihar Jena
- Department of Internal Medicine/Cardiovascular Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
| | - Roopa Naik
- Department of Medicine, Geisinger Health, Wilkes-Barre, Pennsylvania, USA
| | - Atul Bali
- Department of Medicine, Geisinger Health, Wilkes-Barre, Pennsylvania, USA
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Chaba A, Hacking D, Slifirski H, Cogan R, Spano S, Maeda A, Eastwood G, Bellomo R. Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management-a pilot randomized controlled trial. J Clin Monit Comput 2024; 38:337-345. [PMID: 37831377 DOI: 10.1007/s10877-023-01079-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
The impact of blood pressure targets and surgical approach (laparoscopic or open) on continuous urinary oxygenation (PuO2), a validated surrogate of renal medullary PO2, during general surgery, is unclear. We aimed to assess the effects of different blood pressure targets and surgical procedures on PuO2. We randomized patients receiving either laparoscopic or open surgery into two mean arterial pressure (MAP) target groups: usual MAP or a high MAP. We measured PuO2 in real-time and analyzed it according to the type of surgery and blood pressure target. The study was retrospectively registered on the 5th of July 2023 (ACTRN12623000726651). We included 43 participants who underwent either laparoscopic (n = 20) or open surgery (n = 23). We found that PuO2 significantly decreased during both laparoscopic and open surgery under a usual blood pressure target (- 51% and - 49%, respectively). However, there was a sharper fall with laparoscopic surgery resulting in a higher PuO2 with open surgery (mean difference: 11 ± 1 mmHg higher; p < 0.001). Targeting a higher MAP resulted in a higher PuO2 over time during laparoscopic surgery (mean difference: 7 ± 1 mmHg, p < 0.001). In contrast, targeting a usual MAP resulted in a higher PuO2 during open surgery (mean difference: 7 ± 1 mmHg, p < 0.001). Surgical approach and intraoperative blood pressure targets significantly impact urinary oxygenation. Further studies with larger sample sizes are needed to confirm these findings and understand their potential clinical implications.Registration number: ACTRN12623000726651; Date of registration: 05/07/2023 (retrospectively registered).
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Affiliation(s)
- Anis Chaba
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.
| | - Doug Hacking
- Department of Anesthesia, Austin Hospital, Melbourne, Australia
| | - Hugh Slifirski
- Department of Anesthesia, Austin Hospital, Melbourne, Australia
| | - Rebecca Cogan
- Department of Anesthesia, Austin Hospital, Melbourne, Australia
| | - Sofia Spano
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Akinori Maeda
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
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8
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Peták F, Südy R, Diaper J, Fontao F, Bizzotto D, Dellacà RL, Habre W, Schranc Á. Benefits of intratracheal and extrathoracic high-frequency percussive ventilation in a model of capnoperitoneum. J Appl Physiol (1985) 2024; 136:928-937. [PMID: 38420682 DOI: 10.1152/japplphysiol.00881.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Abdominal inflation with CO2 is used to facilitate laparoscopic surgeries, however, providing adequate mechanical ventilation in this scenario is of major importance during anesthesia management. We characterized high-frequency percussive ventilation (HFPV) in protecting from the gas exchange and respiratory mechanical impairments during capnoperitoneum. In addition, we aimed to assess the difference between conventional pressure-controlled mechanical ventilation (CMV) and HFPV modalities generating the high-frequency signal intratracheally (HFPVi) or extrathoracally (HFPVe). Anesthetized rabbits (n = 16) were mechanically ventilated by random sequences of CMV, HFPVi, and HFPVe. The ventilator superimposed the conventional waveform with two high-frequency signals (5 Hz and 10 Hz) during intratracheal HFPV (HFPVi) and HFPV with extrathoracic application of oscillatory signals through a sealed chest cuirass (HFPVe). Lung oxygenation index ([Formula: see text]/[Formula: see text]), arterial partial pressure of carbon dioxide ([Formula: see text]), intrapulmonary shunt (Qs/Qt), and respiratory mechanics were assessed before abdominal inflation, during capnoperitoneum, and after abdominal deflation. Compared with CMV, HFPVi with additional 5-Hz oscillations during capnoperitoneum resulted in higher [Formula: see text]/[Formula: see text], lower [Formula: see text], and decreased Qs/Qt. These improvements were smaller but remained significant during HFPVi with 10 Hz and HFPVe with either 5 or 10 Hz. The ventilation modes did not protect against capnoperitoneum-induced deteriorations in respiratory tissue mechanics. These findings suggest that high-frequency oscillations combined with conventional pressure-controlled ventilation improved lung oxygenation and CO2 removal in a model of capnoperitoneum. Compared with extrathoracic pressure oscillations, intratracheal generation of oscillatory pressure bursts appeared more effective. These findings may contribute to the optimization of mechanical ventilation during laparoscopic surgery.NEW & NOTEWORTHY The present study examines an alternative and innovative mechanical ventilation modality in improving oxygen delivery, CO2 clearance, and respiratory mechanical abnormalities in a clinically relevant experimental model of capnoperitoneum. Our data reveal that high-frequency oscillations combined with conventional ventilation improve gas exchange, with intratracheal oscillations being more effective than extrathoracic oscillations in this clinically relevant translational model.
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Affiliation(s)
- Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Roberta Südy
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - John Diaper
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Fabienne Fontao
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Davide Bizzotto
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Walid Habre
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
| | - Álmos Schranc
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Unit for Anesthesiological Investigations, Department of Acute Medicine, University of Geneva, Geneva, Switzerland
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9
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Maeda Y, Kakuta N, Kasai A, Yonezawa H, Kawanishi R, Tanaka K. Successful intraoperative management of laparoscopic hysterectomy in a patient with Eisenmenger syndrome: a case report. JA Clin Rep 2024; 10:17. [PMID: 38433128 PMCID: PMC10909790 DOI: 10.1186/s40981-024-00700-9] [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: 12/04/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Patients with Eisenmenger syndrome (ES) requiring noncardiac surgery are at a significantly high risk of perioperative morbidity and mortality. However, perioperative management of patients with ES requiring laparoscopic surgery remains unclear. CASE PRESENTATION We describe the case of a patient with ES who underwent laparoscopic hysterectomy under general anesthesia with a peripheral nerve block. The objectives of the perioperative management included the following: (1) maintaining systemic vascular resistance and cardiac output through euvolemia, facilitated by the infusion of noradrenaline, and (2) preventing a reduction in oxygen-carrying capacity and factors that elevate pulmonary vascular resistance, such as pain, hypoxia, and decreased body temperature. Although laparoscopic procedures involved an increased risk in patients with ES, they are less invasive than open surgeries. CONCLUSION This report describes the successful anesthetic management of a patient with ES, ensuring a balance between systemic and pulmonary vascular resistance.
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Affiliation(s)
- Yuki Maeda
- Department of Anesthesiology, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
| | - Nami Kakuta
- Department of Anesthesiology, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Asuka Kasai
- Division of Surgical Center, Tokushima University Hospital, Tokushima, Japan
| | - Hiroki Yonezawa
- Department of Anesthesiology, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Ryosuke Kawanishi
- Division of Surgical Center, Tokushima University Hospital, Tokushima, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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10
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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11
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Dai ZC, Gui XW, Yang FH, Zhang HY, Zhang WF. Perforated gastric ulcer causing mediastinal emphysema: A case report. World J Clin Cases 2024; 12:859-864. [PMID: 38322697 PMCID: PMC10841121 DOI: 10.12998/wjcc.v12.i4.859] [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: 12/03/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons. It can be spontaneous or secondary to chest trauma, esophageal perforation, medically induced factors, etc. Its common symptoms are chest pain, tightness in the chest, and respiratory distress. Most mediastinal emphysema patients have mild symptoms, but severe mediastinal emphysema can cause respiratory and circulatory failure, resulting in serious consequences. CASE SUMMARY A 75-year-old man, living alone, presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol. Due to the remoteness of his residence and lack of neighbors, the patient was found by his nephew and brought to the hospital the next morning after the disease onset. Computed tomography (CT) showed free gas in the abdominal cavity, mediastinal emphysema, and subcutaneous pneumothorax. Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated. Therefore, we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia. An operative incision of the muscle layer of the patient's abdominal wall was made, and a large amount of subperitoneal gas was revealed. And a continued incision of the peritoneum revealed the presence of a perforation of approximately 0.5 cm in the gastric antrum, which we repaired after pathological examination. Postoperatively, the patient received high-flow oxygen and cough exercises. Chest CT was performed on the first and sixth postoperative days, and the mediastinal and subcutaneous gas was gradually reduced. CONCLUSION After gastric perforation, a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm, and upper gastrointestinal angiography can clarify the site of perforation. In patients with mediastinal emphysema, open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure. In addition, thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.
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Affiliation(s)
- Zhi-Cheng Dai
- Department of General Surgery, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
| | - Xun-Wu Gui
- Department of General Surgery, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
| | - Feng-He Yang
- Department of General Surgery, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
| | - Hao-Yuan Zhang
- Department of Medical Imaging, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
| | - Wen-Feng Zhang
- Department of General Surgery, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
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12
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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13
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Condliffe R, Newton R, Bauchmuller K, Bonnett T, Kerry R, Mannings A, Nair A, Selby K, Skinner PP, Wilson VJ, Kiely DG. Surgery and Anesthesia in Patients with Pulmonary Hypertension. Semin Respir Crit Care Med 2023; 44:797-809. [PMID: 37729924 DOI: 10.1055/s-0043-1772753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Pulmonary hypertension is characterized by right ventricular impairment and a reduced ability to compensate for hemodynamic insults. Consequently, surgery can be challenging but is increasingly considered in view of available specific therapies and improved longer term survival. Optimal management requires a multidisciplinary patient-centered approach involving surgeons, anesthetists, pulmonary hypertension clinicians, and intensivists. The optimal pathway involves risk:benefit assessment for the proposed operation, optimization of pulmonary hypertension and any comorbidities, the appropriate anesthetic approach for the specific procedure and patient, and careful monitoring and management in the postoperative period. Where patients are carefully selected and meticulously managed, good outcomes can be achieved.
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Affiliation(s)
- Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ruth Newton
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Kris Bauchmuller
- Department of Critical Care, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Tessa Bonnett
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Robert Kerry
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Alexa Mannings
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Amanda Nair
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Karen Selby
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Paul P Skinner
- Department of Surgery, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Victoria J Wilson
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - David G Kiely
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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14
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de Jonge SW, Hulskes RH, Zokaei Nikoo M, Weenink RP, Meyhoff CS, Leslie K, Myles P, Forbes A, Greif R, Akca O, Kurz A, Sessler DI, Martin J, Dijkgraaf MG, Pryor K, Belda FJ, Ferrando C, Gurman GM, Scifres CM, McKenna DS, Chan MT, Thibon P, Mellin-Olsen J, Allegranzi B, Boermeester M, Hollmann MW. Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials. BMJ Open 2023; 13:e067243. [PMID: 37899157 PMCID: PMC10619062 DOI: 10.1136/bmjopen-2022-067243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 07/27/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION The use of high fraction of inspired oxygen (FiO2) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO2compared with regular (0.21-0.40) FiO2 and its potential effect modifiers. METHODS AND ANALYSIS Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO2 (0.60-1.00) to regular FiO2 (0.21-0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (<15 mL/kg/hour) and procedure duration (>2.5 hour). ETHICS AND DISSEMINATION Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42018090261.
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Affiliation(s)
- Stijn W de Jonge
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Rick H Hulskes
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robert P Weenink
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kate Leslie
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ozan Akca
- Department of Anaesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrea Kurz
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Janet Martin
- Department of Anaesthesiology and Perioperative Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Marcel Gw Dijkgraaf
- Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Kane Pryor
- Department of Anaesthesiology, Weil Medical College of Cornell University, New York City, New York, USA
| | - F Javier Belda
- Department of Surgery, Hospital Clinico Universitario de Valencia, Valencia, Valenciana, Spain
- Department of Anaesthesia and Critical Care, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Carlos Ferrando
- Department of Anaesthesiology and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel M Gurman
- Department of Anaesthesiology and Critical Care Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Christina M Scifres
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David S McKenna
- Department of Obstetrics and Gynaecology, Wright State University and Miami Valley Hospital, Dayton, Ohio, USA
| | - Matthew Tv Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Pascal Thibon
- Centre d'appui pour la Prévention des Infections Associées aux Soins, CPias Normandie, Centre Hospitalo-Universitaire, Caen, Normandy, France
| | | | | | - Marja Boermeester
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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15
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Koldova K, Rara A, Muller M, Tyll T, Roubik K. Cranial Electrode Belt Position Improves Diagnostic Possibilities of Electrical Impedance Tomography during Laparoscopic Surgery with Capnoperitoneum. SENSORS (BASEL, SWITZERLAND) 2023; 23:8644. [PMID: 37896737 PMCID: PMC10611224 DOI: 10.3390/s23208644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
Laparoscopic surgery with capnoperitoneum brings many advantages to patients, but also emphasizes the negative impact of anesthesia and mechanical ventilation on the lungs. Even though many studies use electrical impedance tomography (EIT) for lung monitoring during these surgeries, it is not clear what the best position of the electrode belt on the patient's thorax is, considering the cranial shift of the diaphragm. We monitored 16 patients undergoing a laparoscopic surgery with capnoperitoneum using EIT with two independent electrode belts at different tomographic levels: in the standard position of the 4th-6th intercostal space, as recommended by the manufacturer, and in a more cranial position at the level of the axilla. Functional residual capacity (FRC) was measured, and a recruitment maneuver was performed at the end of the procedure by raising the positive end-expiratory pressure (PEEP) by 5 cmH2O. The results based on the spectral analysis of the EIT signal show that the ventilation-related impedance changes are not detectable by the belt in the standard position. In general, the cranial belt position might be more suitable for the lung monitoring during the capnoperitoneum since the ventilation signal remains dominant in the obtained impedance waveform. FRC was significantly decreased by the capnoperitoneum and remained lower also after desufflation.
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Affiliation(s)
- Kristyna Koldova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic;
| | - Ales Rara
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine First Faculty of Medicine, The Military University Hospital Prague, Charles University, 121 08 Prague, Czech Republic; (A.R.); (T.T.)
| | - Martin Muller
- Clinic of Anesthesiology, Critical Care 1st Faculty of Medicine, Thomayer University Hospital Prague, Charles University, 140 59 Prague, Czech Republic;
| | - Tomas Tyll
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine First Faculty of Medicine, The Military University Hospital Prague, Charles University, 121 08 Prague, Czech Republic; (A.R.); (T.T.)
| | - Karel Roubik
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic;
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16
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Hany TS, Jadav AM, Parkin E, Bhowmick AK. Extraperitoneal approach to left-sided colorectal resections (EXPERTS procedure). Br J Surg 2023; 110:1348-1354. [PMID: 37535960 DOI: 10.1093/bjs/znad173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/14/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Tarek S Hany
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
| | - Alka M Jadav
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
| | - Edward Parkin
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
- Division of Cancer Services, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Arnab K Bhowmick
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
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17
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Efetov SK, Zubayraeva AA, Panova PD. The retroperitoneal approach to vessel-sparing D3 lymph node dissection in left-sided colorectal cancer resections: a video vignette. Colorectal Dis 2023; 25:1940-1941. [PMID: 37553825 DOI: 10.1111/codi.16705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Sergey K Efetov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Albina A Zubayraeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Polina D Panova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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18
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Hernandez-Meza G, Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update. Minerva Anestesiol 2023; 89:812-823. [PMID: 37158629 DOI: 10.23736/s0375-9393.23.17284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, ocular, respiratory, and hemodynamic homeostasis. Possible non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. The anesthetic management of RALP patients involves a thorough preoperative evaluation, careful positioning on the operative table, managing ventilation issues, and appropriate fluid management. Close coordination between the anesthesia and surgical teams is required for a successful surgery. This updated review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.
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Affiliation(s)
- Gabriela Hernandez-Meza
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA
| | - Daniel M Gainsburg
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA -
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA
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19
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Hiraoka E, Tanabe K, Izuta S, Kubota T, Kohsaka S, Kozuki A, Satomi K, Shiomi H, Shinke T, Nagai T, Manabe S, Mochizuki Y, Inohara T, Ota M, Kawaji T, Kondo Y, Shimada Y, Sotomi Y, Takaya T, Tada A, Taniguchi T, Nagao K, Nakazono K, Nakano Y, Nakayama K, Matsuo Y, Miyamoto T, Yazaki Y, Yahagi K, Yoshida T, Wakabayashi K, Ishii H, Ono M, Kishida A, Kimura T, Sakai T, Morino Y. JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery. Circ J 2023; 87:1253-1337. [PMID: 37558469 DOI: 10.1253/circj.cj-22-0609] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital
| | | | - Tadao Kubota
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Amane Kozuki
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | | | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, International University of Health and Welfare Narita Hospital
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Taku Inohara
- Department of Cardiovascular Medicine, Keio University Graduate School of Medicine
| | - Mitsuhiko Ota
- Department of Cardiovascular Center, Toranomon Hospital
| | | | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital
| | - Yumiko Shimada
- JADECOM Academy NP·NDC Training Center, Japan Association for Development of Community Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomofumi Takaya
- Department of Cardiovascular Medicine, Hyogo Prefectural Himeji Cardiovascular Center
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital
| | - Kenichi Nakazono
- Department of Pharmacy, St. Marianna University Yokohama Seibu Hospital
| | | | | | - Yuichiro Matsuo
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | | | | | | | | | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
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20
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Kan CFK, Rich B, Brown N, Janes S, Grudziak J. Takotsubo Cardiomyopathy (TCM) After Uncomplicated Paraesophageal Hernia Repair: A Case Report and Review on Postoperative TCM. Cureus 2023; 15:e41770. [PMID: 37575796 PMCID: PMC10416749 DOI: 10.7759/cureus.41770] [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] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Takotsubo cardiomyopathy (TCM) is a rare stress-induced condition that appears rarely in suspected acute myocardial infarction cases. It causes unexplained left ventricular failure, but most cases are reversible with supportive treatment. In this report, we present the case of a 70-year-old female who developed acute hypotension after a laparoscopic Toupet fundoplication on postoperative day one, requiring care in the surgical intensive care unit. Following consultation with the cardiology service and further imaging and tests, she was diagnosed with TCM. This report outlines the potential mechanisms and management of TCM in the intensive care unit, emphasizing the importance of prompt diagnosis and treatment.
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Affiliation(s)
| | - Bianca Rich
- Anesthesiology, University of Utah School of Medicine, Salt Lake City, USA
| | - Noah Brown
- General Surgery, University of Utah School of Medicine, Salt Lake City, USA
| | - Sophia Janes
- Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA
| | - Joanna Grudziak
- General Surgery, University of Utah School of Medicine, Salt Lake City, USA
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21
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Zadey S, Leraas H, Gupta A, Biswas A, Hollier P, Vissoci JRN, Mugaga J, Ssekitoleko RT, Everitt JI, Loh AHP, Lee YT, Saterbak A, Mueller JL, Fitzgerald TN. KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model. Surg Endosc 2023:10.1007/s00464-023-10054-5. [PMID: 37074419 PMCID: PMC10338623 DOI: 10.1007/s00464-023-10054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Many surgeons in low- and middle-income countries have described performing surgery using gasless (lift) laparoscopy due to inaccessibility of carbon dioxide and reliable electricity, but the safety and feasibility of the technique has not been well documented. We describe preclinical testing of the in vivo safety and utility of KeyLoop, a laparoscopic retractor system to enable gasless laparoscopy. METHODS Experienced laparoscopic surgeons completed a series of four laparoscopic tasks in a porcine model: laparoscopic exposure, small bowel resection, intracorporeal suturing with knot tying, and cholecystectomy. For each participating surgeon, the four tasks were completed in a practice animal using KeyLoop. Surgeons then completed these tasks using standard-of-care (SOC) gas laparoscopy and KeyLoop in block randomized order to minimize learning curve effect. Vital signs, task completion time, blood loss and surgical complications were compared between SOC and KeyLoop using paired nonparametric tests. Surgeons completed a survey on use of KeyLoop compared to gas laparoscopy. Abdominal wall tissue was evaluated for injury by a blinded pathologist. RESULTS Five surgeons performed 60 tasks in 15 pigs. There were no significant differences in times to complete the tasks between KeyLoop and SOC. For all tasks, there was a learning curve with task completion times related to learning the porcine model. There were no significant differences in blood loss, vital signs or surgical complications between KeyLoop and SOC. Eleven surgeons from the United States and Singapore felt that KeyLoop could be used to safely perform several common surgical procedures. No abdominal wall tissue injury was observed for either KeyLoop or SOC. CONCLUSIONS Procedure times, blood loss, abdominal wall tissue injury and surgical complications were similar between KeyLoop and SOC gas laparoscopy for basic surgical procedures. This data supports KeyLoop as a useful tool to increase access to laparoscopy in low- and middle-income countries.
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Affiliation(s)
- Siddhesh Zadey
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
- Association for Socially Applicable Research (ASAR), Pune, MH, India.
| | - Harold Leraas
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Aryaman Gupta
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Arushi Biswas
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Julius Mugaga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Jeffrey I Everitt
- Department of Pathology, Duke University of School of Medicine, Durham, NC, USA
| | - Amos H P Loh
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ann Saterbak
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Jenna L Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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22
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Tang Y, Li B, Ouyang W, Jiang G, Tang H, Liu X. Intraoperative Hypertension Is Associated with Postoperative Acute Kidney Injury after Laparoscopic Surgery. J Pers Med 2023; 13:jpm13030541. [PMID: 36983722 PMCID: PMC10058414 DOI: 10.3390/jpm13030541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2023] Open
Abstract
Background: It is well demonstrated that intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); however, the association between severity and duration of abnormal intraoperative blood pressure (BP) with AKI in patients undergoing laparoscopic surgery remains unknown. Methods: This retrospective cohort study included 12,414 patients aged ≥ 18 years who underwent a single elective laparoscopic abdominal surgery during hospitalization between October 2011 and April 2017. Multivariate stepwise logistic regressions were applied to determine the correlation between the severity and duration of intraoperative mean arterial pressure (MAP, (systolic BP + 2 × diastolic BP)/3), acute intraoperative hypertension (IOTH) and postoperative AKI, in different periods of surgery. Results: A total of 482 hospitalized patients (3.9%) developed surgery-related AKI. Compared with those without IOTH or with preoperative mean MAP (80–85 mmHg), acute elevated IOTH (odds ratio, OR, 1.4, 95% CI, 1.1 to 1.7), mean MAP 95–100 mmHg (OR, 1.8; 95% CI, 1.3 to 2.7), MAP 100–105 mmHg (OR, 2.4; 95% CI, 1.6 to 3.8), and more than 105 mmHg (OR, 1.9; 95% CI, 1.1 to 3.3) were independent of other risk factors in a diverse cohort undergoing laparoscopic surgery. In addition, the risk of postoperative AKI appeared to result from long exposure (≥20 min) to IOTH (OR, 1.9; 95% CI, 1.5 to 2.5) and MAP ≥ 115 mmHg (OR, 2.2; 95% CI, 1.6 to 3.0). Intraoperative hypotension was not found to be associated with AKI in laparoscopic surgery patients. Conclusions: Postoperative AKI correlates positively with intraoperative hypertension in patients undergoing laparoscopic surgery. These findings provide an intraoperative evaluation criterion to predict the occurrence of postoperative AKI.
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Affiliation(s)
- Yongzhong Tang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Bo Li
- Operation Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Guiping Jiang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Hongjia Tang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xing Liu
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China
- Correspondence: ; Tel.: +86-186-8497-0921
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23
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Hany TS, Jadav AM, Parkin E, McAleer J, Barrow P, Bhowmick AK. The Extraperitoneal Approach to Left-Sided Colorectal Resections: A Human Cadaveric Study. J Surg Res 2023; 283:172-178. [PMID: 36410233 DOI: 10.1016/j.jss.2022.10.038] [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: 07/09/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Technical challenges during laparoscopic and robotic anterior resection include identification of key retroperitoneal structures and obtaining clear views of the inferior mesenteric artery (IMA) pedicle and total mesorectal excision (TME) plane. Steep head-down position improves surgical exposure but is associated with cerebral oedema, high intrapulmonary pressures, and rare neurological complications. In this article we describe the key steps of an anterior resection performed via the extra-peritoneal (XP) space in the supine position. METHODS The technique of same-side lateral-to-medial XP dissection has been developed and refined in serial cadaveric workshops. A standard periumbilical port is inserted for initial laparoscopic exploration. Dissection is then performed in the left XP space via a 5 cm skin incision (later used as the extraction site) to allow for insertion of four (latterly three) working ports. The colon is mobilized along its lateral attachments, reflecting retroperitoneal structures down and away. The IMA pedicle is taken proximally, next to the duodenum. If required, TME dissection can be continued in the same plane. A short intraperitoneal phase is then required to complete the procedure. RESULTS Eight cadavers were studied (seven males; median 78 y). Four operations were performed laparoscopically and four robotically. Excellent views of the key retroperitoneal structures were achieved early in the procedure. Anatomical identification was performed sequentially for left-sided structures-psoas tendon, gonadal vessel, ureter, common iliac artery, IMA, and duodenum before ligation of the IMA pedicle. High ligation of IMA on the aorta and splenic flexure mobilization were performed in all eight procedures. CONCLUSIONS This novel study shows it is feasible to perform the key steps of an anterior resection using the XP space in the supine position. This will reduce the need for steep head-down positioning which may have meaningful clinical benefits. Prospective clinical studies are required to validate the technique within a patient population.
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Affiliation(s)
- Tarek S Hany
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK.
| | - Alka M Jadav
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
| | - Edward Parkin
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Joseph McAleer
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
| | - Paul Barrow
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
| | - Arnab K Bhowmick
- Department of Colorectal Surgery, Lancashire Teaching NHS Foundation Trust, Preston, UK
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24
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Hickey T, Jayakumar S, Perrino AC. Severe Pulmonary Hypertension Meets Intraperitoneal Surgery: No Place to Inflate? Cureus 2023; 15:e35318. [PMID: 36968928 PMCID: PMC10038649 DOI: 10.7759/cureus.35318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Severe pulmonary hypertension (PH) is associated with poor operative outcomes; however, guidance for perioperative management of this population is lacking. Mechanical ventilation has known deleterious effects on right ventricular preload and cardiac output. Meanwhile, pneumoperitoneum results in further cardiopulmonary insults. We report the successful case management of a patient with severe PH scheduled for elective cholecystectomy. While patients undergoing this surgery typically benefit from the less invasive, laparoscopic approach, the risk-benefit ratio may tilt towards risk in the setting of severe PH. A multidisciplinary approach to optimize outcome included the decision to perform an open rather than laparoscopic procedure, which resulted in a favorable outcome.
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25
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Abstract
An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.
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26
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Jo YY, Chang YJ, Lee D, Kim YB, Jung J, Kwak HJ. Comparisons of Mechanical Power and Respiratory Mechanics in Pressure-Controlled Ventilation and Volume-Controlled Ventilation during Laparoscopic Cholecystectomy in Elderly Patients. J Pers Med 2023; 13:jpm13020201. [PMID: 36836435 PMCID: PMC9967818 DOI: 10.3390/jpm13020201] [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: 12/18/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
We compared the effects of pressure-controlled volume-guaranteed ventilation (PCV) and volume-controlled ventilation (VCV) on respiratory mechanics and mechanical power (MP) in elderly patients undergoing laparoscopy. Fifty patients aged 65-80 years scheduled for laparoscopic cholecystectomy were randomly assigned to either the VCV group (n = 25) or the PCV group (n = 25). The ventilator had the same settings in both modes. The change in MP over time was insignificant between the groups (p = 0.911). MP significantly increased during pneumoperitoneum in both groups compared with anesthesia induction (IND). The increase in MP from IND to 30 min after pneumoperitoneum (PP30) was not different between the VCV and PCV groups. The change in driving pressure (DP) over time were significantly different between the groups during surgery, and the increase in DP from IND to PP30 was significantly higher in the VCV group than in the PCV group (both p = 0.001). Changes in MP during PCV and VCV were similar in elderly patients, and MP increased significantly during pneumoperitoneum in both groups. However, MP did not reach clinical significance (≥12 J/min). In contrast, the PCV group had a significantly lower increase in DP after pneumoperitoneum than the VCV group.
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Affiliation(s)
| | | | | | | | | | - Hyun Jeong Kwak
- Correspondence: ; Tel.: +82-32-460-3637; Fax: +82-32-469-6319
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27
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van Weteringen W, Sterke F, Vlot J, Wijnen RMH, Dankelman J. Automated control for investigation of the insufflation-ventilation interaction in experimental laparoscopy. PLoS One 2023; 18:e0285108. [PMID: 37146021 PMCID: PMC10162516 DOI: 10.1371/journal.pone.0285108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/15/2023] [Indexed: 05/07/2023] Open
Abstract
In laparoscopic surgery the abdominal cavity is insufflated with pressurized carbon dioxide gas to create workspace. This pressure is exerted through the diaphragm onto the lungs, competing with ventilation and hampering it. In clinical practice the difficulty of optimizing this balance can lead to the application of harmfully high pressures. This study set out to create a research platform for the investigation of the complex interaction between insufflation and ventilation in an animal model. The research platform was constructed to incorporate insufflation, ventilation and relevant hemodynamic monitoring devices, controlling insufflation and ventilation from a central computer. The core of the applied methodology is the fixation of physiological parameters by applying closed-loop control of specific ventilation parameters. For accurate volumetric measurements the research platform can be used in a CT scanner. An algorithm was designed to keep blood carbon dioxide and oxygen values stable, minimizing the effect of fluctuations on vascular tone and hemodynamics. This design allowed stepwise adjustment of insufflation pressure to measure the effects on ventilation and circulation. A pilot experiment in a porcine model demonstrated adequate platform performance. The developed research platform and protocol automation have the potential to increase translatability and repeatability of animal experiments on the biomechanical interactions between insufflation and ventilation.
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Affiliation(s)
- Willem van Weteringen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank Sterke
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - John Vlot
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Peng C, Shen H, Cao S, Wu S, Huang Q, Li S, Li H, Zhang X, Wang B, Cao J, Ma X. Effects of Retroperitoneal or Transperitoneal Pneumoperitoneum on Inferior Vena Cava Hemodynamics and Cardiopulmonary Function: A Prospective Real-Time Comparison. J Endourol 2023; 37:28-34. [PMID: 36106602 DOI: 10.1089/end.2022.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: To evaluate the effects of CO2 pneumoperitoneum on venous hemodynamics and cardiopulmonary function during transperitoneal or retroperitoneal laparoscopic surgery. Materials and Methods: A single-institution prospective study. Forty-three patients with renal-cell carcinoma undergoing retroperitoneal (22) or transperitoneal (21) laparoscopic partial nephrectomy were enrolled. Hemodynamic functions were monitored by minimally invasive FloTrac/Vigileo system. Transesophageal echocardiography was used to measure the diameter and blood flow of the inferior vena cava (IVC). Measured parameters were recorded at baseline, 10, 30, 60 minutes following insufflation to 14 mm Hg and 10 minutes following desufflation. Results: For hemodynamic changes in the transperitoneal laparoscopic surgery (TPL) and retroperitoneal laparoscopic surgery (RPL), transperitoneal CO2 insufflation resulted in a rapid parallel increase in central intravenous pressure (CVP), peak airway pressure (AWP), and IVC blood flow velocity after the first 30 minutes of pneumoperitoneum (p < 0.05). In contrast, CVP, AWP, and IVC blood flow velocity increased progressively in RPL. The variation of those parameters was significantly lower than that of TRL (p < 0.001; p = 0.002; p = 0.004). The mean maximum CVP in the two groups was 20 and 16 mm Hg, respectively. The IVC diameter at the cavoatrial junction was significantly reduced in TPL after 10 minutes of insufflation, but it remained unchanged in RPL throughout the surgery. For cardiopulmonary function changes, heart output decreased after a short period of pneumoperitoneum, but no statistical differences were observed between the two groups. The increments of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide tension were significantly higher in RPL than TPL (p < 0.001; p < 0.001). Conclusions: Compared with retroperitoneal pneumoperitoneum, transperitoneal pneumoperitoneum has significant effects on IVC hemodynamics. Elevated intra-abdominal pressure (IAP) causes higher AWP and venous return resistance, which lead to the significant increase of CVP during transperitoneal approach. Adjusting the balance between IAP and CVP might be an effective way to control intravenous bleeding. Clinical Trial Registry: Registration number: ChiCTR2000038291.
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Affiliation(s)
- Cheng Peng
- Medical School of Chinese PLA, Beijing, China.,Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Hao Shen
- Department of Anesthesiology, The First Medical Centre of PLA General Hospital, Beijing, China
| | - Senming Cao
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Shengpan Wu
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Qingbo Huang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Shichao Li
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Hongzhao Li
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
| | - Jiangbei Cao
- Department of Anesthesiology, The First Medical Centre of PLA General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre of PLA General Hospital, Beijing, China
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29
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Muacevic A, Adler JR, Preethi A. Comparison of Different Carbon Dioxide Insufflation Rates on Hemodynamic Changes in Laparoscopic Surgeries: A Randomized Controlled Trial. Cureus 2023; 15:e34071. [PMID: 36843757 PMCID: PMC9944635 DOI: 10.7759/cureus.34071] [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] [Accepted: 01/22/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction The injury and detrimental effects of carbon dioxide (CO2) insufflation during laparoscopic surgeries may be due to the higher flow rates used during insufflation. The aim of our study was to study the effects of different CO2 insufflation flow rates on hemodynamic parameters in laparoscopic surgeries. The secondary objectives were to compare the patient and surgeon satisfaction scores, postoperative shoulder scores, and surgical site pain scores. Methods This prospective, randomized, double-blinded trial was commenced after institutional ethical committee approval and The Clinical Trials Registry- India (CTRI) registration (CTRI 2021/10/037595). Ninety patients scheduled for laparoscopic cholecystectomy were randomly divided into three groups based on CO2 insufflation flow rate by computer-generated random numbers and the sealed envelope method: Group-A: 5 L/min; Group-B: 10 L/min; and Group-C: 15 L/min. General anesthesia was standardized in all three groups. Mean arterial pressure (MAP) and heart rate were recorded at different timelines, which included the arrival in the operating room (T0), just before the induction of anesthesia (T1), at the beginning of pneumoperitoneum (T2), 10 minutes (T3), 20 minutes (T4), 30 minutes (T5), and 60 minutes (T6) after the pneumoperitoneum, at the end of the operation (T7), five minutes (T8), and 15 minutes (T9) after arriving at the recovery room. The patient and surgeon satisfaction scores were assessed on a 5-point Likert scale. The visual analog score (VAS) was used to assess the surgical site pain and shoulder pain every four hours for 24 hours. The continuous data were assessed by one-way analysis of variance (ANOVA), and the categorical data were assessed by the Chi-square test. The sample size was estimated based on a pilot study and using the G Power 3.1.9.2 Program (Universitat Kiel, Germany) calculator. Results There was an increase in the mean arterial pressure (MAP) between the groups 60 min after pneumoperitoneum creation with higher flow rates. The baseline MAP was 85.76± 10.11 in group A, 86.03± 9.79 in group B, and 88.13± 8.46 in group C. At 60 min from the creation of the pneumoperitoneum, the MAP increased significantly from 99.17 ± 9.35 in group A, 102.43 ± 8.24 in group B, to 106.83 ± 8.31 in group C. This was statistically significant with a p-value of 0.004. There was a statistically significant difference in heart rate between the groups 10 minutes after pneumoperitoneum creation. No complications were reported in any of the groups. The postoperative shoulder pain was more severe when higher flows were used at 20 and 24 hours. The surgical site pain was also significantly more for up to 12 hours following surgery with higher flows. Conclusion We conclude that low-flow CO2 insufflation during laparoscopic surgeries is associated with fewer hemodynamic changes, better patient satisfaction scores, and lower postoperative pain scores.
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30
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Popescu M, Olita MR, Stefan MO, Mihaila M, Sima RM, Tomescu D. Lung mechanics during video-assisted abdominal surgery in Trendelenburg position: a cross-sectional propensity-matched comparison between classic laparoscopy and robotic-assisted surgery. BMC Anesthesiol 2022; 22:356. [PMID: 36411445 PMCID: PMC9677621 DOI: 10.1186/s12871-022-01900-5] [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: 09/15/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. METHODS Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO2) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO2 values were noted and arterial to end-tidal CO2 gradient was calculated. RESULTS We observed a statistically significant difference in plateau pressure between RAS and LAS at one-hour (26.2 ± 4.5 cmH2O vs. 20.2 ± 3.5 cmH2O, p = 0.05) and two-hour intervals (25.2 ± 5.7 cmH2O vs. 17.9 ± 3.1 cmH2O, p = 0.01) during surgery and at the end of surgery (19.9 ± 5.0 cmH2O vs. 17.0 ± 2.7 cmH2O, p = 0.02). Significant changes in lung compliance were also observed between groups at one-hour (28.2 ± 8.5 mL/cmH2O vs. 40.5 ± 13.9 mL/cmH2O, p = 0.01) and two-hour intervals (26.2 ± 7.8 mL/cmH2O vs. 54.6 ± 16.9 mL/cmH2O, p = 0.01) and at the end of surgery (36.3 ± 9.9 mL/cmH2O vs. 58.2 ± 21.3 mL/cmH2O, p = 0.01). At the end of surgery, plateau pressures remained higher than preoperative values in both groups, but lung compliance remained significantly lower than preoperative values only in patients undergoing RAS with a mean 24% change compared to 1.7% change in the LAS group (p = 0.01). We also noted a more significant arterial to end-tidal CO2 gradient in the RAS group compared to LAS group at one-hour (12.9 ± 4.5 mmHg vs. 7.4 ± 4.4 mmHg, p = 0.02) and two-hours interval (15.2 ± 4.5 mmHg vs. 7.7 ± 4.9 mmHg, p = 0.02), as well as at the end of surgery (11.0 ± 6.6 mmHg vs. 7.0 ± 4.6 mmHg, p = 0.03). CONCLUSION Video-assisted surgery is associated with significant changes in lung mechanics after induction of pneumoperitoneum. The observed changes are more severe and longer-lasting in patients undergoing robotic-assisted surgery compared to classic laparoscopy.
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Affiliation(s)
- Mihai Popescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Roxana Olita
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mara Oana Stefan
- grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
| | - Mariana Mihaila
- grid.415180.90000 0004 0540 9980Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Romina-Marina Sima
- grid.8194.40000 0000 9828 7548Department of Obstetrics and Gynecology, Bucur Maternity, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dana Tomescu
- grid.8194.40000 0000 9828 7548Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Street, 2nddistrict, 022328 Bucharest, Romania ,grid.415180.90000 0004 0540 9980Department of Anaesthesia and Critical Care III, Fundeni Clinical Institute, Bucharest, Romania
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31
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Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It’s effects on hemodynamic parameters and respiratory mechanics. J Robot Surg 2022; 17:933-940. [DOI: 10.1007/s11701-022-01482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022]
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Cheng M, Ni L, Huang L, Zhou Y, Wang K. Effect of positive end-expiratory pressure on pulmonary compliance and pulmonary complications in patients undergoing robot-assisted laparoscopic radical prostatectomy: a randomized control trial. BMC Anesthesiol 2022; 22:347. [DOI: 10.1186/s12871-022-01869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To observe the effects of different positive end-expiratory pressure (PEEP) ventilation strategies on pulmonary compliance and complications in patients undergoing robotic-assisted laparoscopic prostate surgery.
Methods
A total of 120 patients with the American Society of Anesthesiologists Physical Status Class I or II who underwent elective robotic-assisted laparoscopic prostatectomy were enrolled. We randomized the patients divided into divided into three groups of 40 patients each: PEEP0, PEEP5, or PEEP10. Master Anesthetist used volume control ventilation intraoperatively with an intraoperative deep muscle relaxation strategy. Respiratory mechanics indexes were recorded at six time-points: 10 mimuts after anaesthesia induction, immediately after pneumoperitoneum establishment, 30 min, 60 min, 90 min, and at the end of pneumoperitoneum. Arterial blood gas analysis and oxygenation index calculation were performed 10 mimuts after anaesthesia induction, 60 mimuts after pneumoperitoneum, and after tracheal extubation. Postoperative pulmonary complications were also recorded.
Results
After pneumoperitoneum, peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean pressure (Pmean), driving pressure (ΔP), and airway resistance (Raw) increased significantly, and pulmonary compliance (Crs) decreased, persisting during pneumoperitoneum in all groups. Between immediately after pneumoperitoneum establishment, 30 min, 60 min, and 90 min, pulmonary compliance in the 10cmH2OPEEP group was higher than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups(P < 0.05). The driving pressure (ΔP) immediately after pneumoperitoneum establishment, at 30 min, 60 min, and 90 min in the 10cmH2OPEEP group was lower than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups (P < 0.05). Sixty min after pneumoperitoneum and tracheal extubation, the PaCO2 did not differ significantly among the three groups (P > 0.05). The oxygenation index (PaO2/FiO2) was higher in the PEEP5 group than in the PEEP0 and PEEP10 groups 60 min after pneumoperitoneum and after tracheal extubation, with a statistically significant difference (P < 0.05). In postoperative pulmonary complications, the incidence of atelectasis was higher in the PEEP0 group than in the PEEP5 and PEEP10 groups, with a statistically significant difference (p < 0.05).
Conclusion
The use of PEEP at 5cmH2O during RARP increases lung compliance, improves intraoperative oxygenation index and reduces postoperative atelectasis.
Trial registration
This study was registered in the China Clinical Trials Registry on May 30, 2020 (Registration No. ChiCTR2000033380).
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do Nascimento PRL, de Gouvêa LV, Leite TRS, Teixeira ALDS, da Silva PCAR, Filho JADF, Helayel MJSA, Júnior AN, da Cunha IM, Mendonça JDS, Silva PL, Lessa DAB. Cardiorespiratory effects of different intraabdominal pressures in sheep: An experimental study. Physiol Rep 2022; 10:e15506. [PMID: 36353885 PMCID: PMC9647340 DOI: 10.14814/phy2.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023] Open
Abstract
Increased intraabdominal pressure (IAP) during laparoscopy can reduce venous return, but changes in respiratory system mechanics and their effect in left cardiac function are not well documented. This study evaluated the effects of different IAPs on respiratory mechanics and cardiac function in 10 healthy nonpregnant adult Santa Ines ewes randomly submitted to a crossover study using different IAPs: 0 mm Hg (G1), 10 mm Hg (G2), 12 mmHg (G3), and 15 mmHg (G4). Animals were anesthetized and mechanically ventilated (VT = 15 ml/kg; positive end-expiratory pressure = 3 cmH2 O; FiO2 = 1.0). Pneumoperitoneum was induced by Hasson's trocar cannula. Variables were measured at INITIAL (IAP, 0 mmHg) and FINAL time points for each IAP after 1 h. At FINAL, driving airway pressure (ΔP,RS ), and percentage fraction of dead space (Vd/Vt) were higher in G3 and G4 than G1 (p = 0.002, difference in means [MD] 4.60, 95% CI: 7.91-1.28, and p < 0.001, MD 5.4, 95% CI: 8.7-2.0; p = 0.016, MD -9.5, 95% CI: -17.9 to -1.2; and p = 0.027, MD -8.7, 95% CI: -17.1 to -0.4). The ejection fraction and fractional shortening were lower in G3 (p = 0.039, MD -11.38, 95% CI: -0.07--22.68; p = 0.015, MD -13.05, 95% CI: -1.74--24.36) and G4 (p = 0.039, MD -9.94, 95% CI: -0.07 to -19.80; p = 0.015, MD -11.43, 95%CI: -1.57 to -21.30, respectively) than G2. In G3, the maximum pulmonary flow velocity correlated negatively with ΔP,RS (r = -0.740; p = 0.018), and Vd/Vt correlated positively with ΔP,RS (r = 0.738, p = 0.046). At IAP of 12 and 15 mm Hg impaired respiratory system mechanics, reduced left cardiac function and no change in maximum pulmonary artery flow velocity were detected. Therefore, respiratory mechanics should be monitored as an interplay to reduce left cardiac function.
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Affiliation(s)
- Paulo R. L. do Nascimento
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Liana V. de Gouvêa
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Thiago R. S. Leite
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - André L. de Sousa Teixeira
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Paulo C. A. R. da Silva
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - José A. D. F. Filho
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Michel J. S. A. Helayel
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Amary N. Júnior
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Isabelle M. da Cunha
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Júlia de Souza Mendonça
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
| | - Pedro L. Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics InstituteFederal University of Rio de JaneiroRio de JaneiroRJBrazil
| | - Daniel A. B. Lessa
- Department of Pathology and Veterinary Clinic, Faculty of Veterinary MedicineFluminense Federal UniversityNiteróiRJBrazil
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Sandeep B, Xiao Z, Zhao F, Feng Q, Gao K. Role of Platelets in Acute Lung Injury After Extracorporeal Circulation in Cardiac Surgery Patients: A Systemic Review. Curr Probl Cardiol 2022; 47:101088. [PMID: 34936908 DOI: 10.1016/j.cpcardiol.2021.101088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
In vitro circulation (cardiopulmonary bypass, CPB) has been widely used in heart surgery. In the past, it was believed that the reduction of platelet count and impaired platelet function during cardiac surgery were the main causes of acute lung injury (ALI). ALI is a life-threatening clinical syndrome in critically ill patients due to an uncontrolled systemic inflammatory response resulting from direct injury to the lung or indirect injury in the setting of a systemic process. Platelets have an emerging and incompletely understood role in a myriad of ALI after extracorporeal circulation in cardiac surgery patients. An electronic literature search was performed using Pubmed, Scopus and Cinahl investigating ALI, pathogenesis, and role of platelets, treatment and management for ALI patients. Many studies have shown that in vitro circulation is a nonphysiological process that can lead to a decrease in the number of platelets and impaired platelet function, as well as varying degrees of lung damage. The relationship between the effects of in vitro circulation on platelets and acute lung injury is still controversial. This review article discusses the role of platelets in lung injury after cardiopulmonary bypass and resent development in the management of ALI.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Zongwei Xiao
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Fengying Zhao
- Department of Intensive Care Unit, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Qianru Feng
- Department of Intensive Care Unit, Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Ke Gao
- Department of Cardiothoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
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Li Y, Lu Y, Tan X, Zhang Z, Feng F, Li R. Effect of endotracheal tube size on airway resistance and dynamic lung compliance. Medicine (Baltimore) 2022; 101:e31410. [PMID: 36316839 PMCID: PMC9622621 DOI: 10.1097/md.0000000000031410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There are different results on the effect of endotracheal tube (ETT) size on respiratory mechanics in patients undergoing mechanical ventilation, and there are few reports in adult laparoscopic surgery. The aim of this study was to investigate the effect of ETT size on airway resistance (RAW) and dynamic lung compliance (COMPL) in patients undergoing laparoscopic colorectal surgery. Seventy-two patients undergoing laparoscopic radical surgery for colorectal cancer under general anesthesia with endotracheal intubation were selected and divided into 3 groups (n = 24) using the random number table method Group A (ETT ID 7.0), Group B (ETT ID 7.5), and Group C (ETT ID 8.0). After mechanical ventilation, intraoperative RAW and COMPL were monitored in each of the 3 groups. In the non-pneumoperitoneal state, RAW in group ID7.0 is significantly higher than this in group ID7.5 and group ID8.0 (P < .05); the RAW between the 2 groups with ID7.5 and ID8.0 was not statistically significant (P > .05). The difference of COMPL between the 3 groups was statistically significant (P < .05); the COMPL of Group ID7.0 is lower than Group ID7.5, and Group ID7.5 is lower than Group ID8.0. In the pneumoperitoneal state, the RAW between ID7.0 group and ID8.0 group was statistically significant, the RAW difference between ID7.0 group and ID7.5 group, ID7.5 group and ID8.0 group not statistically significant (P > .05);the COMPL between the 3 groups was not statistically significant (P > .05). In the non-pneumoperitoneal state, the smaller the ETT internal diameter within a certain range, the higher RAW and the lower COMPL; in the pneumoperitoneal state, the RAW with the ID7.0 ETT was higher than that with the ID8.0 ETT, and the ETT size within a certain range had no effect on COMPL.
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Affiliation(s)
- Yiming Li
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan Lu
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xinmin Tan
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zilong Zhang
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Feng Feng
- Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Ruhong Li
- Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
- * Correspondence: Ruhong Li, Department of Anesthesiology, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi St, Chengde, Hebei 067000, China (e-mail: )
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Granton J, Teijeiro-Paradis R. Management of the Critically Ill Patient with Pulmonary Arterial Hypertension and Right Heart Failure. Clin Chest Med 2022; 43:425-439. [PMID: 36116812 DOI: 10.1016/j.ccm.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Right ventricular (RV) failure is a recognized complication of pulmonary hypertension (PH). Pregnancy and surgery represent unique challenges to the patient with PH and require input from an interprofessional team. Approach to treatment must embrace sound physiologic principles that are based on optimization of RV preload, contractility, and afterload to improve cardiac function and tissue perfusion before the onset of multiorgan dysfunction. Failure of medical therapy needs to be recognized before the onset of irreversible shock. When appropriate, eligible patients should be considered for mechanical circulatory support as a bridge to recovery or transplantation.
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Affiliation(s)
- John Granton
- University of Toronto, Pulmonary and Critical Care Medicine, University Health Network, 9-9023 MARS Building, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
| | - Ricardo Teijeiro-Paradis
- Interdepartmental Division of Critical Care, University of Toronto, University Health Network, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
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Di Bella C, Vicenti C, Araos J, Lacitignola L, Fracassi L, Stabile M, Grasso S, Crovace A, Staffieri F. Effects of two alveolar recruitment maneuvers in an “open-lung” approach during laparoscopy in dogs. Front Vet Sci 2022; 9:904673. [PMID: 36061108 PMCID: PMC9435385 DOI: 10.3389/fvets.2022.904673] [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: 03/25/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study was to compare the effects of a sustained inflation alveolar recruiting maneuver (ARM) followed by 5 cmH2O of PEEP and a stepwise ARM, in dogs undergoing laparoscopic surgery. Materials and methods Twenty adult dogs were enrolled in this prospective randomized clinical study. Dogs were premedicated with methadone intramuscularly (IM); anesthesia was induced with propofol intravenously (IV) and maintained with inhaled isoflurane in pure oxygen. The baseline ventilatory setting (BVS) was as follows: tidal volume of 15 mL/kg, inspiratory pause of 25%, inspiratory to expiratory ratio of 1:2, and the respiratory rate to maintain the end-tidal carbon dioxide between 45 and 55 mmHg. 10 min after pneumoperitoneum, randomly, 10 dogs underwent sustained inflation ARM followed by 5 cmH2O of PEEP (ARMi), while 10 dogs underwent a stepwise recruitment maneuver followed by the setting of the “best PEEP” (ARMc). Gas exchange, respiratory system mechanics, and hemodynamic were evaluated before the pneumoperitoneum induction (BASE), 10 min after the pneumoperitoneum (PP), 10 min after the recruitment (ARM), and 10 min after the pneumoperitoneum resolution (PostPP). Statistical analysis was performed with the ANOVA test (p < 0.05). Results Static compliance decreased in both groups at PP (ARMc = 1.35 ± 0.21; ARMi = 1.16 ± 0.26 mL/cmH2O/kg) compared to BASE (ARMc = 1.78 ± 0.60; ARMi = 1.66 ± 0.66 mL/cmH2O/kg) and at ARM (ARMc = 1.71 ± 0.41; ARMi = 1.44 ± 0.84 mL/cmH2O/kg) and PostPP (ARMc = 1.75 ± 0.45; ARMi = 1.89 ± 0.59 mL/cmH2O/kg), and it was higher compared to PP and similar to BASE. The PaO2/FiO2, in both groups, was higher at ARM (ARMc = 455.11 ± 85.90; ARMi = 505.40 ± 31.70) and PostPP (ARMc = 521.30 ± 66.20; ARMi = 450.90 ± 70.60) compared to PP (ARMc = 369.53 ± 49.31; ARMi = 394.32 ± 37.72). Conclusion and clinical relevance The two ARMs improve lung function in dogs undergoing laparoscopic surgery similarly. Application of PEEP at the end of the ARMs prolonged the effects of the open-lung strategy.
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Affiliation(s)
- Caterina Di Bella
- School of Bioscience and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Caterina Vicenti
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Laura Fracassi
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Alberto Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantations, University of Bari, Bari, Italy
- *Correspondence: Francesco Staffieri
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Luo W, Wu M, Chen Y. Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta-analysis of matched studies. ANZ J Surg 2022; 92:2003-2017. [PMID: 35969025 DOI: 10.1111/ans.17972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To compare clinical and survival outcomes between laparoscopic versus open surgery in elderly colorectal cancer patients. METHODS PubMed, Embase and Scopus databases were systematically searched. The review included studies that were either randomized controlled trials (RCTs) or observational in design. STATA was used for statistical analysis. RESULTS The meta-analysis was conducted with 24 studies. Compared with elderly subjects with open surgery, those undergoing laparoscopic surgery had a lower risk of mortality (within 3 months postoperatively) (RR 0.70, 95% CI: 0.53, 0.94). The long-term overall survival (HR 0.96, 95% CI: 0.89, 1.04), disease-free survival (HR 1.02, 95% CI: 0.93, 1.13), risk of recurrence (RR 1.44, 95% CI: 0.90, 2.30) and readmission (RR 1.11, 95% CI: 0.88, 1.40) rates were statistically similar in both the groups. The operative time (in minutes) was higher (WMD 30.37, 95% CI: 17.75, 43.0) and the blood loss (in ml) was lower (WMD -78.85, 95% CI: -101.96, -55.75) in those undergoing laparoscopic surgery. The length of hospital stay (in days) (WMD -2.53, 95% CI: -3.11, -1.95) and the time of return of bowel movements (in days) (WMD -1.06, 95% CI: -1.20, -0.93) was lower in those with laparoscopic surgery. The pooled risk of complications was lower in those with laparoscopic surgery (RR 0.66, 95% CI: 0.60, 0.74), compared with open surgery. CONCLUSIONS Findings suggest that in elderly subjects with colorectal cancer, laparoscopic surgery appears to be more beneficial than open surgery and should be prioritized, subject to the availability of required technical skills and facilities.
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Affiliation(s)
- Weimin Luo
- Department of Proctology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengyuan Wu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanling Chen
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Marinari G, Foletto M, Nagliati C, Navarra G, Borrelli V, Bruni V, Fantola G, Moroni R, Tritapepe L, Monzani R, Sanna D, Carron M, Cataldo R. Enhanced recovery after bariatric surgery: an Italian consensus statement. Surg Endosc 2022; 36:7171-7186. [PMID: 35953683 PMCID: PMC9485178 DOI: 10.1007/s00464-022-09498-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
Background Enhanced recovery after bariatric surgery (ERABS) is an approach developed to improve outcomes in obese surgical patients. Unfortunately, it is not evenly implemented in Italy. The Italian Society for the Surgery of Obesity and Metabolic Diseases and the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care joined in drafting an official statement on ERABS. Methods To assess the effectiveness and safety of ERABS and to develop evidence-based recommendations with regard to pre-, intra-, and post-operative care for obese patients undergoing ERABS, a 13-member expert task force of surgeons and anesthesiologists from Italian certified IFSO center of excellence in bariatric surgery was established and a review of English-language papers conducted. Oxford 2011 Levels of Evidence and U.S. Preventive Services Task Force Grade Definitions were used to grade the level of evidence and the strength of recommendations, respectively. The supporting evidence and recommendations were reviewed and discussed by the entire group at meetings to achieve a final consensus. Results Compared to the conventional approach, ERABS reduces the length of hospital stay and does not heighten the risk of major post-operative complications, re-operations, and hospital re-admissions, nor does it increase the overall surgical costs. A total of 25 recommendations were proposed, covering pre-operative evaluation and care (7 items), intra-operative management (1 item, 11 sub-items), and post-operative care and discharge (6 items). Conclusions ERABS is an effective and safe approach. The recommendations allow the proper management of obese patients undergoing ERABS for a better outcome.
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Affiliation(s)
- Giuseppe Marinari
- Bariatric Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedale Università Padova, Padua, Italy
| | - Carlo Nagliati
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Vincenzo Bruni
- Bariatric Surgery Unit, Campus Bio Medico University of Rome, Rome, Italy
| | - Giovanni Fantola
- Bariatric Surgery Unit, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Roberto Moroni
- Bariatric Surgery Unit, Policlinico Sassarese, Sassari, Italy
| | - Luigi Tritapepe
- Department of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Sapienza University of Rome, Rome, Italy
| | - Roberta Monzani
- Department of Anesthesia and Intensive Care Units, Humanitas Research Hospital, Humanitas University Milan, Rozzano, Milan, Italy
| | - Daniela Sanna
- Emergency Department, Section of Anesthesiology and Intensive Care, ARNAS, G. Brotzu Hospital, Cagliari, Italy
| | - Michele Carron
- Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care, University of Padua, Via V. Gallucci, 13, 35121, Padua, Italy.
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio Medico University of Rome, Rome, Italy
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Omar I, Miller K, Madhok B, Amr B, Singhal R, Graham Y, Pouwels S, Abu Hilal M, Aggarwal S, Ahmed I, Aminian A, Ammori BJ, Arulampalam T, Awan A, Balibrea JM, Bhangu A, Brady RR, Brown W, Chand M, Darzi A, Gill TS, Goel R, Gopinath BR, Henegouwen MVB, Himpens JM, Kerrigan DD, Luyer M, Macutkiewicz C, Mayol J, Purkayastha S, Rosenthal RJ, Shikora SA, Small PK, Smart NJ, Taylor MA, Udwadia TE, Underwood T, Viswanath YK, Welch NT, Wexner SD, Wilson MSJ, Winter DC, Mahawar KK. The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery. Int J Surg 2022; 104:106766. [PMID: 35842089 DOI: 10.1016/j.ijsu.2022.106766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. METHODS A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. RESULTS A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. CONCLUSION Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.
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Affiliation(s)
- Islam Omar
- Wirral University Teaching Hospital NHS Foundation Trust, UK.
| | - Karl Miller
- King's College Hospital London, Dubai, United Arab Emirates
| | - Brijesh Madhok
- University Hospitals of Derby & Burton NHS Foundation Trust, UK
| | - Bassem Amr
- Taunton & Somerset NHS Foundation Trust, UK
| | - Rishi Singhal
- University Hospital Birmingham NHS Foundation Trust, UK
| | - Yitka Graham
- University of Sunderland, Sunderland, UK; Universidad Anahuac, Anahuac, Mexico
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Hospital Brescia, Italy; Southampton University Hospitals NHS Trust, UK
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Altaf Awan
- University Hospitals of Derby & Burton NHS Foundation Trust, UK
| | - José María Balibrea
- Department of Gastrointestinal Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | | | - Wendy Brown
- Monash University Department of Surgery, Alfred Health, Australia
| | | | | | | | | | | | - Mark van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | - Julio Mayol
- Hospital Clinico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Des C Winter
- St Vincent's University Hospital, Dublin, Ireland
| | - Kamal K Mahawar
- University of Sunderland, Sunderland, UK; Bariatric Unit, South Tyneside and Sunderland Foundation Trust, UK
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Liu Y, Tan X, Cheng Y, Wang B, Zhang H, Zhang L, Liu D, Qi X. Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery. Front Surg 2022; 9:896452. [PMID: 35747433 PMCID: PMC9209646 DOI: 10.3389/fsurg.2022.896452] [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: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
The randomized controlled study investigated the impacts of immediate peri-operative Intermittent pneumatic compression (IPC) on hemodynamic indicators in patients undergoing laparoscopic gynecologic surgery. Patients scheduled for elective laparoscopic gynecologic surgery were randomized to control (IPC not used), pre-operative IPC, post-operative IPC, and peri-operative IPC (performed both before and after surgery) groups. Systolic blood pressure (SBP), mean blood pressure (MBP) cardiac output (CO), heart rate (HR) and systemic vascular resistance (SVR) were measured at different time points. The results showed that SBP changes not obviously over time in the control and peri-operative IPC group. Compared with values before surgery, the pre-operative IPC group had a lower SBP (P < 0.01) at the end of PACU stay, whereas the post-operative IPC group had a higher SBP (P < 0.01) after surgery. All groups exhibited little or no variation in HR, CO and SVR. Conclusion is peri-operative IPC has no major adverse effects on hemodynamic parameters.
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Affiliation(s)
- Yanchang Liu
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xuhong Tan
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Yujin Cheng
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Baojun Wang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Hanyu Zhang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Lili Zhang
- Operation Room, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Danyong Liu
- Department of Anesthesiology, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Xiaofei Qi
- Department of Anesthesiology, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, China
- Correspondence: Xiaofei Qi
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Chung YH, Jeong YS, Martin GL, Choi MS, Kang YJ, Lee M, Cho A, Koo BS, Cho SH, Kim SH. Prediction of blood pressure changes associated with abdominal pressure changes during robotic laparoscopic low abdominal surgery using deep learning. PLoS One 2022; 17:e0269468. [PMID: 35666742 PMCID: PMC9200233 DOI: 10.1371/journal.pone.0269468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Intraoperative hypertension and blood pressure (BP) fluctuation are known to
be associated with negative patient outcomes. During robotic lower abdominal
surgery, the patient’s abdominal cavity is filled with CO2, and
the patient’s head is steeply positioned toward the floor (Trendelenburg
position). Pneumoperitoneum and the Trendelenburg position together with
physiological alterations during anesthesia, interfere with predicting BP
changes. Recently, deep learning using recurrent neural networks (RNN) was
shown to be effective in predicting intraoperative BP. A model for
predicting BP rise was designed using RNN under special scenarios during
robotic laparoscopic surgery and its accuracy was tested. Methods Databases that included adult patients (over 19 years old) undergoing low
abdominal da Vinci robotic surgery (ovarian cystectomy, hysterectomy,
myomectomy, prostatectomy, and salpingo-oophorectomy) at Soonchunhyang
University Bucheon Hospital from October 2018 to March 2021 were used. An
RNN-based model was designed using Python3 language with the PyTorch
packages. The model was trained to predict whether hypertension (20%
increase in the mean BP from baseline) would develop within 10 minutes after
pneumoperitoneum. Results Eight distinct datasets were generated and the predictive power was compared.
The macro-average F1 scores of the datasets ranged from 68.18% to 72.33%. It
took only 3.472 milliseconds to obtain 39 prediction outputs. Conclusions A prediction model using the RNN may predict BP rises during robotic
laparoscopic surgery.
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Affiliation(s)
- Yang-Hoon Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Young-Seob Jeong
- Department of Computer Engineering, Chungbuk National University,
Cheongju, Republic of Korea
| | - Gati Lother Martin
- Department of ICT Convergence, Soonchunhyang University, Asan-si,
Republic of Korea
| | - Min Seo Choi
- Industry-Academy Cooperation Foundation, Soonchunhyang University,
Asan-si, Republic of Korea
| | - You Jin Kang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Misoon Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Ana Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Bon Sung Koo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Sung Hwan Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Sang Hyun Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
- * E-mail:
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Fernández-Martín S, Valiño-Cultelli V, González-Cantalapiedra A. Laparoscopic versus Open Ovariectomy in Bitches: Changes in Cardiorespiratory Values, Blood Parameters, and Sevoflurane Requirements Associated with the Surgical Technique. Animals (Basel) 2022; 12:ani12111438. [PMID: 35681900 PMCID: PMC9179476 DOI: 10.3390/ani12111438] [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: 05/07/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to examine the cardiorespiratory and blood changes associated with pneumoperitoneum (PNP) in laparoscopic ovariectomy (LAP Ove), as well as sevoflurane requirements, comparing them to those determined in open surgery (LPT Ove). The study was performed in 16 bitches submitted to LAP or LPT Ove. The cardiorespiratory and end-tidal sevoflurane concentration values were recorded as follows: at the beginning of surgery (T1), after the right ovary resection (T2), after the left ovary resection (T3), and after surgical closure (T4). Blood samples were taken before and after PNP. Among the cardiorespiratory parameters, no differences were observed in the values of end-tidal CO2, minute volume, and heart rate. In the LAP Ove group, a significant increase in inspiratory pressures and a decreased compliance were identified at T2 and T3. Significant higher arterial pressure values were observed in both groups at T2 and T3, with this increase especially marked at T2 in the LPT Ove group. Sevoflurane requirements were significantly higher in the LPT group during ovarian resection. Finally, in terms of the hematochemical parameters, statistical differences were recorded between pre- and post-operative assessments, but not between both surgical groups. The pathophysiological effects associated with PNP seemed to be transient and well-tolerated by healthy dogs.
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Affiliation(s)
- Silvia Fernández-Martín
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
- Correspondence:
| | - Victoria Valiño-Cultelli
- Department of Anatomy, Animal Production and Veterinary Clinical Sciences, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
| | - Antonio González-Cantalapiedra
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
- Department of Anatomy, Animal Production and Veterinary Clinical Sciences, Faculty of Veterinary, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
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Wu Y, Cai Z, Li Y, Kang Y, Fu B, Wang J. Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair. Medicine (Baltimore) 2022; 101:e29320. [PMID: 35608433 PMCID: PMC9276157 DOI: 10.1097/md.0000000000029320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To observe the effect of Ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative sedation in patients undergoing laparoscopic hernia repair. METHODS 100 male patients aged 60 to 80 years old, a line to elective laparoscopic inguinal hernia repair, were randomly divided into four groups: control group (Group A) and dezocine group (Group B), ketorolac tromethamine group (Group C), ketorolac tromethamine combined with dezocine group (Group D). Patients were administrated with 0.1 mg/kg dezocine in Group B, 0.5 mg/kg ketorolac in Group C, 0.1 mg/kg dezocine, and 0.5 mg/kg ketorolac in Group D, and with an equal dose of normal saline in group A. The heart rate (HR) and mean arterial pressure (MAP) of patients in 4 groups were recorded at each time point as follows, T0 (enter the operating room), T1 (before skin resection), 10 min after pneumoperitoneum (T2), mesh placement (T3), and laryngeal mask extraction (T4). Operation time, awakening time (time from drug withdrawal to consciousness recovery), the dosage of propofol, sufentanil, remifentanil, and intraoperative vasoactive drug dosage were recorded to compare. Visual analog scale score and sedation Ramsay score were evaluated 1, 6, 12, and 24 hours after extubation. RESULTS There was no significant difference in operation time, anesthesia recovery time, sufentanil dosage, and vasoactive drugs among all groups. The amount of propofol in Group B and D was less than that in Group A and C (P < .05), and there was no difference between Group B and D, A and C (P > .05). The amount of remifentanil in Group B, C, and D was less than that in Group A (P < .05), and Group D was less than B and C (P < .05). After extubation, HR and MAP were significantly higher than before (P < .05). Compared with T0, HR and MAP increased in each group at T4, but MAP and HR in Group D increased the least (P < .05). There were significant differences between Group B, C, D, and A, MAP and HR fluctuated little during extubation (P < .05), but there was a significant difference between Group D and B, C (P < .05). Visual analog scale scores of Group B, C, and D were lower than those of A at 1, 6, and 12 hours after surgery (P < .05), and there was a significant difference between Group D, and B, C (P < .05). Ramsay scores in Group B and D were higher than those in A and C at 1 and 6 hours after the operation (P < .05). There was no difference in the incidence of adverse reactions among groups. CONCLUSION The prophylactic use of ketorolac tromethamine and dezocine before laparoscopic inguinal hernia repair can reduce hemodynamic disorder during anesthesia recovery, increase postoperative sedative and analgesic effects.
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Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:jcm11092643. [PMID: 35566769 PMCID: PMC9102266 DOI: 10.3390/jcm11092643] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023] Open
Abstract
Remimazolam has been suggested to improve the maintenance of hemodynamic stability when compared with other agents used for general anesthesia. This study aimed to compare the effects of remimazolam and sevoflurane anesthesia on hemodynamic stability in patients undergoing robotic gastrectomy. We retrospectively reviewed the electronic medical records of 199 patients who underwent robotic gastrectomy with sevoflurane (n = 135) or remimazolam (n = 64) anesthesia from January to November 2021. Propensity scores were used for 1:1 matching between the groups. The primary outcome was the difference in use of intraoperative vasopressors between groups. Secondary outcomes included differences in incidence and dose of vasopressors, as well as intraoperative hemodynamic variables, between groups. Remimazolam anesthesia was associated with a significantly less frequent use of ephedrine (odds ratio (OR): 0.13; 95% confidence interval (CI): 0.05−0.38, p < 0.001), phenylephrine (OR: 0.12; 95% CI: 0.04−0.40, p < 0.001), and any vasopressor (OR: 0.06; 95% CI: 0.02−0.25, p < 0.001) compared with sevoflurane anesthesia. Remimazolam anesthesia enables better maintenance of hemodynamic stability than sevoflurane anesthesia. Thus, remimazolam anesthesia may be beneficial for patients who are expected to experience hypotension due to the combined effects of CO2 pneumoperitoneum and the head-up position utilized during robotic gastrectomy.
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Hara M, Hyodo A, Kimura H, Hiraki T. Transfenestration Doppler Assessment During Laparoscopic Pheochromocytoma Resection in a Patient With Fontan Circulation. J Cardiothorac Vasc Anesth 2022; 36:3655-3661. [PMID: 35659830 DOI: 10.1053/j.jvca.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Masato Hara
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan.
| | - Ayako Hyodo
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroko Kimura
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
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Leech MM, Herrick MD, Parnell KE, Rosenkranz KM. Dysautonomia following breast surgery: Disproportionate response to post-operative hematoma. Surg Open Sci 2022; 10:7-11. [PMID: 35789962 PMCID: PMC9249797 DOI: 10.1016/j.sopen.2022.05.011] [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: 03/23/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022] Open
Abstract
Background Up to 10% of patients undergoing breast surgery suffer from bleeding complications. Some experience severe hypotension and bradycardia of unclear etiology. Similar to the vasovagal hyperstimulation provoked by abdominal insufflation during laparoscopic surgery, we hypothesize that chest wall stretch from postoperative breast hematoma may mechanically stretch the vagus nerve, triggering dysautonomia disproportionate to the degree of blood loss. Methods A single-institution retrospective review of patients requiring reoperation for hematoma evacuation following breast surgery between 2011 and 2021 was performed. The relationship between hematoma volume and hemodynamic instability, as well as hematoma volume and vasovagal symptoms, was measured. Results Sixteen patients were identified. Average hematoma volume was 353 mL, and average minimum mean arterial pressure was 64 mm Hg (range: 34–102 mm Hg). Fifty-six percent of patients reported symptoms including dizziness, somnolence, and/or syncope. Accounting for body surface area, patients with larger hematomas had similar minimum mean arterial pressures compared to those with smaller hematomas, 55 and 73 mm Hg, respectively (P = .0943). However, patients in the large hematoma group experienced over 3 times as many vasovagal symptoms, 88% and 25%, respectively (P = .0095). Conclusion Patients with large hematomas reported significantly more vagal symptoms compared to those with small hematomas despite similar mean arterial pressures. In addition, the trend of lower mean arterial pressures and heart rates more closely resembles vagal hyperstimulation than hypovolemic shock. Early hematoma evacuation to relieve vagal nerve stretch and parasympatholytics to reverse dysautonomia are targeted interventions to consider in this patient population rather than fluids, vasopressors, and blood products that are used in cases of hemodynamic instability due to hypovolemia alone.
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Percutaneous delivery of self-propelling hemostatic powder for managing non-compressible abdominal hemorrhage: a proof-of-concept study in swine. Injury 2022; 53:1603-1609. [PMID: 35067343 DOI: 10.1016/j.injury.2022.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-compressible intra-abdominal hemorrhage (NCIAH) is a major cause of preventable death on the battlefield and in civilian trauma. Currently, it can only be definitively managed with surgery, as there are limited strategies for controlling ongoing NCIAH in the prehospital environment. We hypothesized that a self-propelling thrombin-containing powder (SPTP) could increase survival in a swine model of NCIAH when delivered percutaneously into the closed abdomen using an engineered spray system. MATERIALS AND METHODS Nineteen swine underwent surgical laparotomy followed by a Grade V liver injury that created massive hemorrhage, before closing the abdomen with sutures. Animals either received treatment with standard of care fluid resuscitation (n=9) or the SPTP spray system (n=10), which consisted of a spray device and a 14 Fr catheter. Using the spray system, SPTP was delivered into a hemoperitoneum identified using a focused assessment with sonography in trauma (FAST) exam. Lactated Ringer's solution was administered to all animals to maintain a mean arterial pressure (MAP) of >50 mmHg. The primary outcome was percentage of animals surviving at three hours following injury. RESULTS In the swine model of NCIAH, a greater percentage of animals receiving SPTP survived to three hours, although differences were not significant. The SPTP spray system increased the median survival of animals from 1.6 hr in the fluid resuscitation group to 4.3 hr. The SPTP spray system delivered a total mass of 18.5 ± 1.0 g of SPTP. The mean change in intra-abdominal pressure following SPTP delivery was 5.2 ± 1.8 mmHg (mean ± SEM). The intervention time was 6.7 ± 1.7 min. No adverse effects related to the SPTP formulation or the spray system were observed. SPTP was especially beneficial in animals that had either severely elevated lactate concentrations or low mean arterial pressure of <35 mmHg shortly after injury. CONCLUSIONS This demonstrates proof-of-concept for use of a new minimally invasive procedure for managing NCIAH, which could extend survival time to enable patients to reach definitive surgical care.
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Braathen MR, Rimstad I, Dybvik T, Nygård S, Ræder J. Online exhaled propofol monitoring in normal-weight and obese surgical patients. Acta Anaesthesiol Scand 2022; 66:598-605. [PMID: 35138633 PMCID: PMC9305953 DOI: 10.1111/aas.14043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 12/27/2022]
Abstract
Background Ion mobility spectrometry (IMS) allows for online quantification of exhaled propofol concentrations. We aimed to validate a bedside online IMS device, the Edmon®, for predicting plasma concentrations of propofol in normal‐weight and obese patients. Methods Patients with body mass index (BMI) >20 kg/m2 scheduled for laparoscopic cholecystectomy or bariatric surgery were recruited. Exhaled propofol concentrations (CA), arterial plasma propofol concentrations (CP) and bispectral index (BIS) values were collected during target‐controlled infusion (TCI) anaesthesia. Generalised estimation equation (GEE) was applied to all samples and stable‐phase samples at different delays for best fit between CP and CA. BMI was evaluated as covariate. BIS and exhaled propofol correlations were also assessed with GEE. Results A total of 29 patients (BMI 20.3–53.7) were included. A maximal R2 of 0.58 was found during stable concentrations with 5 min delay of CA to CP; the intercept a = −0.69 (95% CI −1.7, 0.3) and slope b = 0.87 (95% CI 0.7, 1.1). BMI was found to be a non‐significant covariate. The median absolute performance error predicting plasma propofol concentrations was 13.4%. At a CA of 5 ppb, the model predicts a CP of 3.6 μg/ml (95% CI ±1.4). There was a maximal negative correlation of R2 = 0.44 at 2‐min delay from CA to BIS. Conclusions Online monitoring of exhaled propofol concentrations is clinically feasible in normal‐weight and obese patients. With a 5‐min delay, our model outperforms the Marsh plasma TCI model in a post hoc analysis. Modest correlation with plasma concentrations makes the clinical usefulness questionable.
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Affiliation(s)
- Martin R. Braathen
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Anaesthesiology Division of Critical Care Oslo University Hospital Oslo Norway
| | - Ivan Rimstad
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Anaesthesiology Division of Critical Care Oslo University Hospital Oslo Norway
| | - Terje Dybvik
- Department of Anaesthesiology Division of Critical Care Oslo University Hospital Oslo Norway
| | - Ståle Nygård
- Department of Informatics Faculty of Mathematics and Natural Sciences University of Oslo Oslo Norway
- Department of Biostatistics Institute of Basic Medical Sciences Oslo Centre for Biostatistics and Epidemiology University of Oslo Oslo Norway
| | - Johan Ræder
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
- Department of Anaesthesiology Division of Critical Care Oslo University Hospital Oslo Norway
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Virág M, Rottler M, Gede N, Ocskay K, Leiner T, Tuba M, Ábrahám S, Farkas N, Hegyi P, Molnár Z. Goal-Directed Fluid Therapy Enhances Gastrointestinal Recovery after Laparoscopic Surgery: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12050734. [PMID: 35629156 PMCID: PMC9143059 DOI: 10.3390/jpm12050734] [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: 04/08/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Whether goal-directed fluid therapy (GDFT) provides any outcome benefit as compared to non-goal-directed fluid therapy (N-GDFT) in elective abdominal laparoscopic surgery has not been determined yet. (2) Methods: A systematic literature search was conducted in MEDLINE, Embase, CENTRAL, Web of Science, and Scopus. The main outcomes were length of hospital stay (LOHS), time to first flatus and stool, intraoperative fluid and vasopressor requirements, serum lactate levels, and urinary output. Pooled risks ratios (RRs) with 95% confidence intervals (CI) were calculated for dichotomous outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. (3) Results: Eleven studies were included in the quantitative, and fifteen in the qualitative synthesis. LOHS (WMD: −1.18 days, 95% CI: −1.84 to −0.53) and time to first stool (WMD: −9.8 h; CI −12.7 to −7.0) were significantly shorter in the GDFT group. GDFT resulted in significantly less intraoperative fluid administration (WMD: −441 mL, 95% CI: −790 to −92) and lower lactate levels at the end of the operation: WMD: −0.25 mmol L−1; 95% CI: −0.36 to −0.14. (4) Conclusions: GDFT resulted in enhanced recovery of the gastrointestinal function and shorter LOHS as compared to N-GDFT.
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Affiliation(s)
- Marcell Virág
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Department of Anesthesiology and Intensive Therapy, Szent György University Teaching Hospital of Fejér County, 8000 Székesfehérvár, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Máté Rottler
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Department of Anesthesiology and Intensive Therapy, Szent György University Teaching Hospital of Fejér County, 8000 Székesfehérvár, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Noémi Gede
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
| | - Klementina Ocskay
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Tamás Leiner
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Anaesthetic Department, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon PE29 6NT, UK
| | - Máté Tuba
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
| | - Szabolcs Ábrahám
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
| | - Nelli Farkas
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
| | - Péter Hegyi
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Division for Pancreatic Disorders, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
| | - Zsolt Molnár
- Szentágothai Research Centre, Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (M.V.); (M.R.); (N.G.); (K.O.); (T.L.); (M.T.); (S.Á.); (N.F.); (P.H.)
- Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, 1082 Budapest, Hungary
- Correspondence: ; Tel.: +36-30-302-6668
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