ABSTRACT
Background: Managing ventilation and oxygenation during laparoscopic procedures in morbidly obese patients undergoing surgery represents many challenges. There is no specific guideline on the ventilation modes for this group of patients. Although several studies have been performed to determine the optimal ventilatory settings for those patients, the answer is yet to be found. The aim of this study was to determine which mode of ventilation is more effective in improvement of intraoperative oxygenation and prevention of postoperative pulmonary atelectasis with its consequences is PEEP 10cm H[2]O alone is effective or Recruitment maneuver followed by PEEP 10 cm H[2]O has better results
Aim of the work: The study will be performed to compare different intra-operative ventilatory techniques that prevent early postoperative pulmonary complications espescially atelectasis in obese patients undergoing laparoscopic surgery
Patients and methods: This prospective, interventional, therapeutic, randomized clinical study was conducted at Ain Shams University Hospitals, operating theatre department on 100 morbidly obese adult patients of ASA physical status II, admitted to Ain Shams university hospital, scheduled for elective laparoscopic surgery either bariatric or non bariatric. The study was carried out after approval of the departmental ethical committee. The patients were subdivided into 4 groups A, B, C and D, [25] patients for each group
Results: Regarding the value of PO2/ Fi O2, there is no statistically significant difference between all groups in the preoperative and intra operative values. But there is statistically significant increase in group D and group C respectively compared to group A and B in both post operative and 6 hours post operative values. Regarding CT chest, Group A showed the highest number of both lobar and segmental atelectasis followed by group B which showed also a high number of segmental atelectasis. In despite, group C showed a higher number of plate and lamellar atelectasis followed by group D that showed a high number of lamellar atelectasis but the lowest number of other atelectasis scores
Conclusion: In conclusion, repeated Recruitment Maneuvers combined with 10 cm H[2]O of PEEP have beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post operative period in morbid obese patients undergoing laparoscopic surgery
Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this work
ABSTRACT
Background: Various adjuvants have been used to prolong spinal anesthesia, with the additional advantages of delaying the onset of postoperative pain and reducing postoperative analgesic requirements. Pregabalin is an R-aminobutyric acid analog that binds to the á2-ä subunit of presynaptic voltage-gated calcium channels
Objective: The aim of this work is to evaluate the efficacy of a single dose of pregabalin in terms of spinal blockade duration and its potential opioid-sparing effect during the first 24 hours postoperatively
Patients and Methods: There were limitations to the present study. First, since only 1 dosage of pregabalin was evaluated, we could not determine the most effective dosage. Second, clinically meaningful improvements in recovery were not assessed. Adequate postoperative pain control provides early postsurgical mobilization, shortened hospitalization, and increased patient satisfaction. Third, preoperative pain and anxiety scores were not recorded. Pregabalin might affect the preoperative pain, mood, and anxiety scores, and these factors can be related to the postoperative pain score
Results: The mechanisms by which pregabalin premedication prolongs motor and sensory blocks using local anesthetics in spinal anesthesia are not fully understood. There may be several reasons for the prolongation of spinal anesthesia. Gabapentinoids are an r-aminobutyric acid analog that binds to Alpha2-Delta subunit of presynaptic voltage-gated calcium channels, and this inhibition decreases postsynaptic excitability by reducing potassium-evoked excitatory transmitter release. These medications provide antiepileptic, anxiolytic, and analgesic features by modulating both GABAergic neurotransmission and calcium influx. Gabapentinoid compounds produce a significant and clinically important improvement in preoperative anxiety scores. Since patients may be anxious in the perioperative period, the anxiolytic effects and euphorigenic effects of pregabalin may be beneficial