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Background: The use of minimal access techniques to achieve similar objectives as in open surgical procedures has witnessed a steady progress in the last two decades. The efficacy and safety of this mode of surgery has long been established. Medical doctors are not only members of the society; with their level of knowledge, their opinion is a strong mirror image of the pulse of the patients they treat. Aim of the study was to ascertain the knowledge, attitude, extent of practice, and factors affecting laparoscopic surgery among medical doctors in Port Harcourt, Nigeria.Methods: A cross sectional study of four hundred and fourteen (414) practicing medical doctors was conducted. Using stratified sampling method, self-administered semi-structured questionnaires was distributed to respondents in Port Harcourt in 2018. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0.Results: Knowledge of laparoscopic surgery among respondents was 89.6% (371). Three hundred and twelve respondents (75.4%) were willing to pay if such surgery is necessary and offered in Port Harcourt. Only 2.4%. of respondents asserted that laparoscopic surgery services are offered regularly in their hospital. Only 1 respondent (0.2%) was willing to pay ₦151,000.00 - 200,000.00 ($430 - $570) for commonly performed laparoscopic abdominal surgical procedures.Conclusions: Willingness to accept and knowledge of laparoscopic surgery was relatively high among medical doctors, hence a high prospect for laparoscopic surgery practice in Port Harcourt is therefore likely. The practice of laparoscopic surgery seems low and willingness to pay, even among doctors seem to be a challenge.
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Introduction: Laparoscopic surgeries in various surgical specialties are most routinely performed with general anesthesia. Thephysiological effects of intra-abdominal CO2 insufflation combined with the variations in patient positioning can have a majorimpact on cardiorespiratory function. Prolongation of corrected QT interval (QTc) has been known to predispose torsades depointes, a potentially fatal ventricular arrhythmia may occur during CO2 insufflation. Our aim is to evaluate the effect of insufflationof CO2 on QT interval and QTc during prolonged laparoscopic surgeries.Methodology: Fifty patients of American Society of Anesthesiologists physical status 1 and 2, of either sex, between the agesof 25 and 65 years posted for laparoscopic surgeries included in the study. After general anesthesia, we measured mean arterialpressure, heart rate, SpO2 and ETCO2 before anesthesia induction, before CO2 insufflation, 30, 60, 120, and 150 min after CO2insufflation, 5 min after CO2 deflation, and at the end of surgery. We observed statistically significant increase of QTc intervalaround 120 min after CO2 insufflation.Conclusion: The cause of this QTc interval prolongation is multifactorial and clinical significance of producing life-threateningcardiac arrhythmias has to be determined.
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Background:The benefits of laparoscopic surgeries include less pain,early mobilization,shorter hospital stay which have further increased its applications.But during laparoscopic surgeries, CO2 is routinely used to create pneumoperitoneum,which causes increased plasma levels of catecholamine and vasopressin.Elevation of intraabdominal pressure with raised diaphragm causes adverse effects on cardiovascular system such as decreased cardiac output,elevated arterial pressure and elevated systemic vascular resistence leading to hypertension and tachycardia.Hence drug which can blunt hemodynamic response to laryngoscopy,intubation and pneumoperitoneum without any adverse side effect is required for this purpose.Dexmedetomidine is a alpha 2 adrenergic agonist which has properties of sedation,sympatholysis and analgesia without having any adverse side effects. AIM: PRIMARY OBJECTIVES:1)To compare two doses of dexmedetomidine(0.50mcg/kg and 0.75mcg/kg) in attenuatuating stress response during laryngoscopy and intubation in patients undergoing laparoscopic surgeries.2)To compare the effects of two doses of dexmedetomidine in attenuating intraoperative hemodynamic changes during laparoscopic surgeries.3)To compare reduction in intraoperative analgesic requirements with two doses of dexmedetomidine used as premedicants. SECONDARY OJECTIVES:1)To study and compare the sedation score and duration of post operative analgesia with two different doses of dexmedetomidine.2)To study the side effects and complications related to dexmedetomidine if any.Material and Method:It was a randomized, prospective, double blinded, comparative hospital based study at Department of Anaesthesiology, Gandhi Medical College, Bhopal. 60 ASA Grade I-II patients, age ranging from 18-60 years of either sex, scheduled for laparoscopic surgeries were randomly allocated into three groups of 20 patients each:ŸGroup P(n=20): received 20 ml of normal saline as placebo over 10 minutes prior to induction.ŸGroup D(n=20): received i/v dexmedetomidine 0.5mcg/kg diluted upto 20ml with normal saline slowly over 10 minutes prior to indution.ŸGroup M(n=20): received i/v dexmedetomidine 0.75mcg/kg diluted upto 20 ml with normal saline slowly over 10 minutes. Results:There was significant decrease in mean HR and MAP in group M as compared to saline group and group D (Dxm=0.50mcg/kg) through-out the surgery (P< 0.05) which shows that dexmedetomidine (0.75 mcg/kg/h) was effective in reduction of HR and BP due to stress response of laparoscopic surgery and endotracheal intubation. The duration of analgesia was significantly higher in the patients belonging to the Group M. Likewise, the average number of rescue analgesic doses received by Group D patients were more compared to patients in Group M. Conclusion: From our study we conclude that Dexmedetomidine 0.75μg/kg is significantly superior to Dexmedetomidine 0.50μg/kg in attenuating hemodynamic respose to laryngoscopy ,pneumoperitoneum,sedation and postoperative analgesia when used as premedicant in patients undergoing laparoscopic surgeries.
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Background: In laparoscopic surgeries, insufflation with carbon dioxide triggers vagal afferents on the bowel and peritoneum which induces emesis by activating the vomiting center. It is hypothesized that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. So, the present study was planned to compare the efficacy of granisetron, dexamethasone and combination of granisetron with dexamethasone to prevent PONV.Methods: This randomized prospective double-blind study was performed on 120 patients, aged between 18 and 58 years of ASA physical status I and II of either sex undergoing laparoscopic surgeries under general anesthesia. Patients were randomized in three groups, group I (granisetrone 2 mg I.V.), group II (dexamethasone) 8 mg I.V., group III (granisetrone+dexamethasone) 2 mg+8 mg I.V. with 40 patients in each group. Complete response, incidence of nausea, vomiting, and rescue antiemetic were recorded at specified intervals.Results: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 75% of the patients given granisetron, 70% in dexamethasone and in 92.5% of the patients given granisetron plus dexamethasone (P <0.05). The overall cumulative incidences (0-24 hours) of PONV were 10 (25%) in the granisetron, 12 (30%) in the dexamethasone and 3 (7.5%) in the combination group. No difference in adverse events were observed in any of the groups.Conclusions: The prophylactic therapy of granisetron 2 mg plus dexamethasone 8 mg just before induction of anaesthesia is significantly effective in prevention of PONV in patients undergoing laparoscopic surgeries.
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Resumen OBJETIVO: Primario: observar si el grado de dificultad de la intervención y la experiencia del equipo quirúrgico influyen en la incidencia de complicaciones y consecuencias adversas de la cirugía laparoscópica ginecológica. Secundario: valorar cuál de las dos variables influye de forma más negativa y, además, estudiar los mecanismos que pueden implementarse en la práctica diaria, clínica y formativa para reducir las consecuencias quirúrgicas adversas. MATERIALES Y MÉTODOS: Estudio descriptivo, observacional y retrospectivo efectuado en el Hospital Universitario Virgen Macarena de Sevilla entre enero de 2015 y febrero de 2016. Se incluyeron todas las cirugías laparoscópicas indicadas por diagnóstico de patología benigna. La muestra se dividió en 3 grupos en función de la distribución de los cirujanos y su experiencia quirúrgica. Las intervenciones se categorizaron conforme a la dificultad en tres grados (el 3 correspondió al de mayor dificultad). RESULTADOS: Se incluyeron 195 cirugías laparoscópicas. La experiencia del equipo quirúrgico fue un factor determinante en los desenlaces heterogéneos, por lo que el grado de dificultad de la intervención tuvo una relación más estrecha con las consecuencias quirúrgicas adversas. Por lo que se refiere al grado de dificultad previo a la cirugía, solo fueron estadísticamente significativos el tiempo quirúrgico y la pérdida hemática, que fue mayor en las intervenciones grado 3. La estancia hospitalaria media, las reintervenciones, reingreso, conversión a laparotomía o complicaciones también fueron mayores en el grupo con grado 3 de dificultad y menor en el 1, pero sin significación estadística. CONCLUSIÓN: Con base en lo reportado se desprende que el grado de dificultad de la intervención tiene más influencia en las complicaciones quirúrgicas que la experiencia del cirujano y el ayudante.
Abstract OBJECTIVE: Primary: to observe whether the degree of difficulty of the intervention and the experience of the surgical team influence the incidence of complications and adverse consequences of laparoscopic gynecological surgery. Secondary: to assess which of the two variables influences more negatively and, in addition, to study the mechanisms that can be implemented in daily, clinical and educational practice to reduce the adverse surgical consequences. MATERIALS AND METHODS: Retrospective, observational and descriptive study carried out in the Virgen Macarena University Hospital of Seville, between January 2015 and February 2016. Including all laparoscopic surgeries performed for benign pathology in that period. The sample has been divided into 3 groups according to the distribution of the surgeons, taking into account their surgical experience. On the other hand, the interventions have been categorized according to the difficulty in three levels (with 3 being the most difficult). RESULTS: 195 laparoscopic surgeries have been collected. The experience of the surgical team has been a factor that has shown heterogeneous results, so the level of difficulty of the intervention seems more related to the surgical adverse effects. Regarding the level of difficulty prior to surgery, only surgical time and blood loss were statistically significant, which was greater in level 3 interventions. Variables such as average hospital stay, reoperations, readmission, conversion to laparotomy or complications were also higher in the group of level 3 of difficulty and lower in group 1, but without statistical significance. CONCLUSION: The results raise the theory of which the level of difficulty of the intervention influences of more direct form in the surgical complications that the surgical experience of the surgeon and the assistant.
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Background: General inhalational anaesthesia associated with adjuvant intravenous agents provides better sedation, hypnosis and analgesia. Drugs with such effects already established in the literature include benzodiazepines and opioids. Aim: Aim of the study was to evaluate the effect of continuous infusion of Dexmedetomidine, on Sevoflurane requirement during general anesthesia with continuous monitoring of depth of anesthesia by BIS (Bispectral index) analysis in patients undergoing elective laparoscopic surgeries. Materials and methods: 60 patients with ASA grade I and II, aged between 35-55 years, submitted to elective laparoscopic cholecystectomies under General Anesthesia were randomly divided into two groups of 30 each, one group received a loading dose of Dexmedetomidine at 1 mcg/kg for 10 min (10 minutes before starting the surgery), followed by maintenance dose of 0.5 mcg/kg/hour, till the end of surgery. The other group received similar volume of IV Normal Saline. MAP, HR, SpO2, EtCO2 and BIS were evaluated. Results: There was no significant difference (p>0.05) between Dexmed and Saline groups with respect to mean age, weight, height, duration of anaesthesia and ASA grade. There was no significant difference (p>0.05) in the baseline heart rates and baseline mean arterial pressure between the two groups. There was a clinically and statistically significant reduction in HR and MAP in the Dexmed Nitesh Kabra, Nama Nagarjuna Chakravarthy, G. Venkateshwarlu. A bispectral index guided study on the effect of dexmedetomidine on sevoflurane requirements during elective laparoscopic surgeries. IAIM, 2018; 5(7): 67-80. Page 68 group throughout intraoperative period compared to Saline group (p <0.05). There was a statistically significant rise in HR and MAP in the Saline group during laryngoscopy and 15 minutes after the creation of pneumoperitoneum (p<0.05). Dexmed group had a stable hemodynamics during laryngoscopy and creation of pneumoperitoneum. No statistically significant difference was noted in the extubation time of both the groups. Mean RAMSAY Sedation score and Modified ALDRETE score was higher in Dexmed group. Usage of Sevoflurane (in ml) and usage of Sevoflurane /min was significantly low in Dexmed group. Conclusion: Dexmedetomidine as a preanesthetic medication and intraoperative infusion was effective in blunting stress response to laryngoscopy and creation of pneumoperitoneum. It also decreased intraoperative anaesthetic requirement and had significant anaesthetic sparing property during BIS guided general anaesthesia providing a lighter sedation without the prolongation of extubation time or without any significant adverse effects.
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Introduction: Laparoscopic surgery is a routinely performed surgery and it is desirable to have stable intra-operative hemodynamic states by avoiding hypertension and tachycardia. Various drugs have been employed to attenuate this hemodynamic response. No single drug is satisfactory. Thus there is a need to find a simple efficient and reliably consistent method. Aim: The present study was undertaken to evaluate the comparison of Dexmedetomidine and Esmolol on perioperative hemodynamic response during laparoscopic cholecystectomy. Materials and methods: Prospective, randomized, controlled, single blinded trial comparing dexmedetomidine (alpha 2- agonist) and esmolol (beta 1-antagonist) done by allocating into two groups. It was conducted in 60 patients of both sex, belong to ASA I and ASA II of age group 20-60 years admitted for laparoscopic surgery from 2016-2017. They were randomly divided into two groups of 30 patients each. The Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP) were recorded prior to induction, after the induction, after the intubation, 15 min, 30 min, 45 min, 60 min after creation of pneumoperitoneum, post pneumoperitoneum, after extubation. Results: Heart rate and systolic blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative and postoperative period compared to Maskuri Soujanya, Nama Nagarjuna Chakravarthy, G. Venkateshwarlu. A study to compare the efficacy of dexmedetomidine with esmolol on hemodynamic response during laparoscopic cholecystectomy. IAIM, 2018; 5(8): 17-29. Page 18 Group B. Diastolic blood pressure were significantly lower in Group A after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Diastolic blood pressure was not significant after induction, at postoperative period. Mean blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Mean blood pressure were not significant at postoperative period. Conclusion: Dexmedetomidine is more effective agent than esmolol in maintaining stable hemodynamics during and after pneumoperitoneum in laparoscopic cholecystectomy.
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Background: Effective attenuation of the sympathoadrenal stress responses is an important goal in anesthesiology. Dexmedetomidine (Dex) a new generation highly selective α2 adrenoreceptor agonist might permit sedation and analgesia without the unwanted vascular effects from activation of α1 receptors. In addition, it has been shown to induce a centrally mediated reduction of sympathetic nervous system activity and decrease hemodynamic and plasma catecholamine response to stressful events. These properties theoretically make it a suitable agent for use as part of the anesthetic regimen. The aim was to study the effect of Dex infusion at two different doses on sedation and post-operative pain using Ramsay sedation score and visual analog scale (VAS) during the post-operative period for first 24 hrs. Methods: In this study, the patients were randomly divided into three different groups (control, Dex 0.3, and Dex 0.6) using computer generated random table. Post-operatively patient’s sedation pain scores were compared using Ramsay sedation score and VAS, respectively. Results: It was observed that the duration of surgery, duration of infusion and use of fentanyl (μg) was statistically insignificant in all the three groups. The mean pain in subjects of both Dex 0.3 and Dex 0.6 just after surgery till 6 hrs post-surgery were found to be significantly (p<0.01) lower when compared to control while in other periods it did not differed significantly (p>0.05) between the three groups i.e., remains statistically the same. On comparing the mean Sedation in subjects of Dex 0.3 and Dex 0.6 just after surgery till 12 hrs post-surgery were found to be significantly (p<0.05 or p<0.01) higher when compared to Control. Further, the mean Sedation in subjects of Dex 0.6 just after surgery and 2 hrs after surgery were also found to be significantly (p<0.01) higher than that of Dex 0.3. However, the mean sedation in all three groups at 18 hrs after surgery and 24 hrs after surgery remains the same i.e., did not differed significantly (p>0.05). Conclusion: The perioperative infusion of Dex may be an attractive option during laparoscopic surgery as it, offered better control of intraoperative and post-operative hemodynamics, and decreased post-operative pain level and better sedation scores, as compared with control.
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Laparoscopic adrenalectomy is one of the most clinically important advances in the past 2 decades for the treatment of adrenal disorders. When compared to open adrenalectomy, laparoscopic adrenalectomy is equally safe, effective, and curative; it is more successful in shortening hospitalization and convalescence and has less long-term morbidity. The laparoscopic approach to the adrenal is the procedure of choice for the surgical management of cortisol-producing adenomas and for patients with corticotropin (ACTH) dependent Cushing's syndrome for whom surgery failed to remove the source of ACTH. The keys to successful laparoscopic adrenalectomy are appropriate patient selection, knowledge of anatomy, delicate tissue handling, meticulous hemostasis, and experience with the technique of laparoscopic adrenalectomy.
A adrenalectomia laparoscópica é um dos avanços clínicos mais importantes das últimas duas décadas para o tratamento de doenças adrenais. Quando comparada à adrenalectomia aberta (convencional), a adrenalectomia laparoscópica é igualmente segura, efetiva e curativa; ela tem maior sucesso em encurtar a hospitalização e a convalescença e apresenta menor morbidade a longo prazo. A abordagem laparoscópica da adrenal é o procedimento de escolha para ao manejo cirúrgico dos adenomas produtores de cortisol e para os pacientes com síndrome de Cushing ACTH-dependente nos quais a cirurgia hipofisária falhou em remover a fonte de ACTH. Os pontos críticos para o sucesso da adrenalectomia laparoscópica são: a seleção apropriada do paciente, o conhecimento da anatomia da região, o manuseio cuidadoso do tecido, a homeostase meticulosa e a experiência com essa técnica cirúrgica.
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Humans , Adrenalectomy/methods , Cushing Syndrome/surgery , Laparoscopy/methods , Adrenalectomy , Feasibility Studies , LaparoscopyABSTRACT
PURPOSE: To evaluate the feasibility of a currently available robotic surgical system in performing various general surgical laparoscopic procedures in an acute porcine model. METHODS: Telepresence robotic laparoscopic surgeries, comprising cholecystectomy, Nissen-fundoplication, choledochocholedochostomy and gastrojejunostomy were performed in 5 swine models for 3 consecutive days by the same surgeon who is experienced in advanced conventional laparoscopic surgery. Data were collected from the da VinciTM Robotic System. RESULTS: Mean operative times were 24.4+/-10.6 minutes for cholecystectomy (N=5) 41.2+/-5.5 for Nissen fundoplication (N=5) 51+/-5.6 for choledochocholedochostomy (N=5), and 53.3+/-7.6 for gastrojejunostomy (N=3) but there were 2 cases of failure in the latter. In the case of choledochocholedochostomy, operative time was reduced from 76 minutes in the first case to 42 minutes in the last. Intra- operative blood loss was minimal and there was no intra- operative complication related with malfunction of robotic system. CONCLUSION: Robotic laparoscopic procedures can be performed effectively using the da VinciTM System. In this limited study, the learning curve and operative times were shorter with the da VinciTM System, and the intraoperative technical movements appeared inherently more intuitive. Additional chronic study comparing conventional laparoscopic with robotic surgery is mandatory.