The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Abstract Background: Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Methods: Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Results: Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). Conclusions: During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Pneumatosis Cystoides Intestinalis with Non-surgical Encapsulated Pneumoperitoneum: Case Presentation and Literature Review

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by cysts or air bubbles in the intestinal wall, usually asymptomatic. Its uncomplicated forms are managed conservatively, and the severe ones require surgical intervention. The presence of pneumoperitoneum is a disturbing radiological finding but not an indicator of surgical intervention. Clinical case: A 23-year-old man presented with weight loss, diarrhea, and rectal bleeding; a colonoscopy showed multiple violaceous cysts in the sigmoid and descending colon that collapsed after puncture and biopsies. Computed tomography (CT) confirmed the diagnosis and the presence of an encapsulated pneumoperitoneum. The absence of signs of potential lethality allowed conservative treatment with clinical remission during the first eight months of follow-up. Discussion: The pathophysiology of PCI is not well defined. Our patient's diagnosis was incidental when performing a colonoscopy for rectal bleeding. Asymptomatic encapsulated pneumoperitoneum should be interpreted as an important but not decisive sign of surgical intervention. Its presence, along with the medical history and physical, biochemical, endoscopic, and imaging examination, can prevent unnecessary surgery.

Introducción: la neumatosis quística intestinal es una entidad infrecuente, caracterizada por la presencia de quistes o burbujas de aire en la pared intestinal, usualmente asintomática. Sus formas no complicadas son manejadas conservadoramente y las graves requieren intervención quirúrgica. La presencia de neumoperitoneo es un hallazgo radiológico inquietante, pero no es indicador de intervención quirúrgica. Caso clínico: hombre de 23 años con pérdida de peso, diarrea y rectorragia, la colonoscopia mostró múltiples quistes violáceos localizados en el sigmoide y descendente que colapsaron tras la punción y biopsias, la tomografía axial computarizada (TAC) confirmó el diagnóstico y la presencia de un neumoperitoneo encapsulado. La ausencia de signos de potencial letalidad permitió un tratamiento conservador con remisión clínica durante los primeros 8 meses de seguimiento. Discusión: la fisiopatología de la neumatosis quística intestinal no está bien definida. En el paciente presentado el diagnóstico se realizó de forma incidental al realizar una colonoscopia por una rectorragia. El neumoperitoneo asintomático encapsulado debe interpretarse como un signo importante pero no determinante de intervención quirúrgica y su presencia junto con los antecedentes médicos, examen físico, bioquímico, endoscópico e imagenológico puede evitar cirugías innecesarias.

A RARE PRESENTATION OF MASSIVE PNEUMOPERITONEUM FOLLOWING INGESTION OF LIQUID NITROGEN SNACK WITHOUT IDENTIFIABLE GASTROINTESTINAL PERFORATION

A 26 year old male patient presented with abdominal distension following ingestion of liquid nitrogen and was diagnosed to have massive pneumoperitoneum both clinically and radiologically. Patient underwent emergency laparotomy in search of perforation, the stomach, Intestines was examined and no hollow viscous perforation was found. All abdominal contents were normal, no tissue necrosis or haemorrhage, no free ?uid or bleeding was found in the abdomen. Two abdominal drains were placed in the lesser sac and the pelvis and abdomen were closed. The patient was stable post operatively and tolerated oral feeds and discharged on 7th post operative day. Our study revealed that despite of having massive pneumoperitoneum, site of perforation cannot be identi?ed

Optimización de neumoperitoneo preoperatorio en hernia ventral: Uso de un dispositivo de compresión externa

La hernia incisional compleja es un desafío para el cirujano. Son ampliamente conocidos los factores que han permitido mejorar los resultados de la reparación herniaria, entre ellos el neumoperitoneo preoperatorio. Durante la insuflación preoperatoria, el aire difunde tanto en la cavidad abdominal como en el saco herniario. Sin embargo, gran porcentaje del contenido administrado, se distribuye mayormente en el saco herniario y no en la cavidad abdominal. En Latinoamérica, diversos equipos de cirujanos de pared abdominal han compartido experiencias en lo que respecta a la optimización de esta técnica como adyuvancia para el manejo de las hernias complejas. En este contexto, y para optimizar la distribución del aire insuflado hacia la cavidad abdominal, se comenzó a utilizar un dispositivo externo de compresión. Este trabajo busca estandarizar por primera vez esta técnica durante el neumoperitoneo preoperatorio buscando disminuir el volumen de aire insuflado, los días de neumoperitoneo y, por lo tanto, los días de hospitalización previo a la cirugía.

Complicated incisional hernia is challenging for surgeons. The factors that have improved the results of hernia repair are widely known, including preoperative pneumoperitoneum. During preoperative insufflation, air diffuses into both the abdominal cavity and the hernia sac. However, a large percentage of the administered content is distributed mainly in the hernia sac and not in the abdominal cavity. Latin-American teams of abdominal wall surgeons have shared experiences regarding the optimization of this technique as an adjuvant for the management of complicated hernias. In this context and to optimize the distribution of the insufflated air into the abdominal cavity, an external compression device began to be used. This article aims to standardize this technique for the first time during preoperative pneumoperitoneum. The target is to reduce the volume of air insufflated, the days of pneumoperitoneum and, therefore, the days of hospitalization prior to surgery.

Pneumobilia, pneumoperitoneum and pneumowirsung of traumatic etiology: Case report and review of the literature

Pneumobilia is a phenomenon associated with the presence of a biliary-enteric fistula or manipulation of the bile duct during procedures or surgical interventions that cause dysfunction of the sphincter of Oddi. A known, but infrequently reported event, is the increase in intraabdominal pressure after closed abdominal trauma, which causes pneumobilia due to a mechanism of retrograde air leakage towards the bile duct. Depending on the general compromise of each patient, the prognosis can vary from a benign condition that only requires conservative management, to being life threatening. We present the case of a 75-year-old male patient who, after suffering a closed thoraco-abdominal trauma, presented with rib fracture and, in addition, gallbladder wall rupture, pneumoperitoneum, pneumobilia, and pneumowirsung, having a favorable clinical course after receiving conservative management.

La neumobilia es un fenómeno asociado a presencia de fístula bilioentérica o manipulación de la vía biliar durante procedimientos o intervenciones quirúrgicas que condicionan disfunción del esfínter de Oddi. Un evento poco reportado, pero ya conocido, es el aumento de la presión intraabdominal tras un trauma abdominal cerrado, que condiciona neumobilia por un mecanismo retrógrado de fuga de aire hacia la vía biliar. Según el compromiso general de cada paciente, el pronóstico puede variar desde un cuadro benigno, que solo requiere un manejo conservador, hasta ser amenazante para la vida. Se presenta el caso de un paciente varón de 75 años, quien después de presentar un trauma toracoabdominal cerrado cursa con fractura costal y, además, ruptura de pared vesicular, neumoperitoneo, neumobilia, y neumowirsung, cursando con evolución favorable tras recibir manejo conservador.

Gastric rupture during fiberoptic bronchoscopy, a rare complication of oxygen administration by nasopharyngeal cannula: a case report

Abstract Concomitant use of a nasopharyngeal catheter is frequently used for oxygen supply during fiberoptic bronchoscopy (FOB). This is a procedure that presents possible complications that are not negligible. We demonstrate the case of a 61-year-old woman who underwent FOB due to a history of hemoptoic sputum. During the procedure, gastric rupture occurred with a large pneumoperitoneum and bilateral pneumothorax requiring immediate drainage of the air and an emergent laparotomy. This was probably a complication of the nasopharyngeal catheter. The knowledge of these complications is essential for their correct identification and treatment.

Effects of different carbon dioxide pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery / 中国医师进修杂志

Objective:To study the effects of different carbon dioxide (CO 2) pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery. Methods:A retrospective collection of 100 colon cancer cases from February 2020 to February 2021 in the Jiading Branch of Shanghai First People′s Hospital (Jiangqiao Hospital, Jiading District) and the Shanghai First People′s Hospital were divided into low pressure group and high pressure group according to different CO 2 pneumoperitoneum pressure values, each with 50 cases and 12 mmHg(1 mmHg = 0.133 kPa) and 18 mmHg CO 2 pneumoperitoneum pressure values were used to inflate, and the perioperative status, cerebral oxygen metabolism status, and stress response of the two groups were observed. Results:The take food time, first time out of bed in the low pressure group were lower than those in the high pressure group: (45.67 ± 7.34) h vs. (49.67 ± 8.16) h, (34.69 ± 8.26) h vs. (39.87 ± 7.16) h, there were statistical differences( P<0.05). The time of first anal exhaust and hospital stay in the two groups had no significant differences ( P>0.05). Repeated measures analysis of variance results showed that the levels of partial pressure of carbon dioxide in artery, oxyhemoglobin saturation, arterial blood lactate acid, benous blood lactic acid were different followed the time and treatment methods ( P<0.05). The levels of heart rate, mean arterial pressure, cortisol and thyroid stimulating hormone in the low pressure group were higher than those in the high pressure group: (73.68 ± 6.35) beats/min vs. (84.84 ± 6.86) beats/min, (81.67 ± 13.68) mmHg vs. (93.68 ± 14.37) mmHg, (100.24 ± 12.34) μg/L vs. (135.68 ± 13.69) μg/L, (3.12 ± 0.43) mU/L vs. (3.54 ± 0.34) mU/L, there were statistical differences ( P<0.05). Conclusions:Different CO 2 pneumoperitoneal pressures affect the brain oxygen metabolism of patients, and clinical attention should be paid to them.

Neumoperitoneo progresivo preoperatorio para el tratamiento de la hernia inguinoescrotal gigante: reporte de caso / Progressive Preoperative Pneumoperitoneum for Giant Inguinoscrotal Hernia: a Case Report

Resumen Introducción: El procedimiento de neumoperitoneo progresivo preoperatorio para el manejo de hernias gigantes con "Pérdida de dominio" o Pérdida de derecho a domicilio" fue introducido en 1940 por Goñi Moreno en Argentina. Autores como Herszage, Berlemont, Koontz, Gravez y Martínez Munive presentaron variaciones interesantes del método original. Su uso se recomienda para preparación previa de pacientes con hernias gigantes y grandes contenidos de vísceras en el saco herniario, en los cuales no sería posible su re-introducción y efectuar la hernioplástia, o en los que su reducción de manera forzada pudiera llevar al paciente al desarrollo de un síndrome compartimental abdominal en el postoperatorio inmediato. Caso clínico: Paciente de sexo masculino de 65 años de edad, que presenta cuadro clínico de un mes de evolución caracterizado por dolor a nivel de la región inguinal izquierda, en el cual se evidencia presencia de hernia inguino escrotal gigante izquierda, no reductible, con aproximadamente un 40% de contenido abdominal. Resultados: La mayoría de los estudios describen el uso del neumoperitoneo progresivo para la reparación de las eventraciones gigantes, sin embargo, en nuestra experiencia y en la de otros autores, esta técnica también puede utilizarse para resolver las hernias inguinales y umbilicales gigantes, con buenos resultados. En todos los casos se aconseja utilizar material protésico. Conclusión: El uso del neumoperitoneo preoperatorio progresivo, se trata de una técnica segura y fácil de realizar que puede complementar las técnicas de eventroplastía complejas, aportando ventajas en la preparación de los pacientes con grandes defectos de pared abdominal y obteniendo buenos resultados.

Abstract Introduction: The procedure of progressive preoperative pneumoperitoneum for the management of giant hernias with "Loss of domain" or "Loss of the right of domain" was introduced in 1940 by Goñi Moreno in Argentina, followed in later years by authors such as Herszage, Berlemont, Koontz, Gravez and Martínez Munive, all with some interesting variations of the original method. Its use is recommended for previous preparation of patients with giant hernias and large contents of viscera in the hernial sac, in which it would not be possible to re-introduce and perform hernioplasty, or in which its forced reduction could lead to the patient to the development of an abdominal compartment syndrome in the immediate postoperative period. Clinical case: A 65-year-old male patient with a clinical picture of one month of evolution characterized by pain in the left inguinal region. There was evidence of a giant left inguinal scrotum, not reducible, with approximately 40% abdominal contents. Results: Most studies describe the use of progressive pneumoperitoneum for the repair of giant hernias, however, in our experience and in that of other authors, this technique can also be used to resolve hernias giant inguinal and umbilical, with good results. In all cases it is recommended use prosthetic material. Conclusion: The use of progressive preoperative pneumoperitoneum is a safe and easy-to-perform technique that can complement complex eventroplasty's techniques, providing advantages in the preparation of patients with large abdominal wall defects and obtaining good results.

Signo de Chilaiditi, diagnóstico tomográfico / Chilaiditi Sign, Tomographic Diagnosis / Sinal de Chilaiditi, diagnóstico tomográfico

Figura 1. Tomografía Computarizada de tórax (corte coronal). Se observan ambos campos pulmonares y las cavidades cardiacas. La flecha roja señala el área hipodensa ovalada correspondiente al aire dentro de un asa de colon interpuesta entre el hemidiafragma derecho (línea hiperdensa arriba) y el borde superior del hígado (abajo), causando una depresión del borde superior del hígado. Fuente: tomada de la historia clínica, previa autorización del paciente.

Figure 1. Chest Computed Tomography Scan (coronal plane) Both lung fields and cardiac chambers are observed. The red arrow indicates the oval hypodense area corresponding to the air inside the loop of colon interposed between the right hemidiaphragm (hyperdense line up) and superior border of the liver (down), causing a depression of the superior border of the liver. Source: taken with authorization from the patient's medical record.

Figura 1. Tomografia Computadorizada de tórax (corte coronal). Observam-se ambos os campos pulmonares e as cavidades cardíacas. A seta vermelha aponta para a área hipodensa oval correspondente ao ar dentro de uma alça do cólon interposta entre o hemidiafragma direito (linha hiperdensa acima) e a borda superior do fígado (abaixo), causando uma depressão da borda superior do fígado. Fonte: obtida com permissão do histórico clínico do paciente.

Comportamiento de presiones intrapulmonares con inversión de la relación inspiración espiración en colecistectomía laparoscópica / Behavior of intrapulmonary pressures with inversion of the inspiration-expiration ratio in laparoscopic cholecystectomy

Resumen: Objetivo: Evaluar el comportamiento de las presiones intrapulmonares con la inversión del índice inspiración espiración durante la colecistectomía electiva videolaparoscópica. Material y métodos: Se realizó un ensayo clínico controlado fase tres acerca de tales presiones intrapulmonares, durante operaciones de colecistectomía laparoscópica, en el Hospital Universitario «Manuel Ascunce Domenech¼, en el período de septiembre del 2016 a febrero del 2020. El universo estuvo constituido por los pacientes que cumplieron con los criterios de inclusión, y una muestra de 106 de ellos, los cuales se dividieron en dos conjuntos de 53 personas cada uno, por método aleatorio simple. La fuente primaria de obtención de datos la constituyeron las historias clínicas y el resultado de una encuesta. Los datos se recogieron en un modelo diseñado en correspondencia con la bibliografía. Resultados: Se presentó aumentos de la presión inspiratoria pico y presión meseta luego del neumoperitoneo, con descenso de ambas tras la transposición del índice I:E, además de hipertensión arterial, arritmias e hipotensión arterial, sin guardar relación con la aplicación del indicador I:E invertido. Conclusiones: La inversión de la inspiración espiración contribuyó a mejorar los efectos del neumoperitoneo sobre dichas presiones intrapulmonares, manteniendo una oxigenación adecuada y nulos efectos cardiovasculares.

Abstract: Objective: Evaluating the behavior of intrapulmonary pressures with the inversion of the inspiration expiration index, during elective videolaparoscopic cholecystectomy. Material and methods: A phase three controlled clinical trial was conducted on intrapulmonary pressures during laparoscopic cholecystectomies at the «Manuel Ascunce Domenech¼ University Hospital, from September 2016 to February 2020, the universe consisted of patients who met the inclusion criteria, from which a sample of 106 patients was selected, by a simple randomizing method. The primary source of data collection was the medical records and the result of a survey. These data were collected in a model designed in correspondence with the bibliography reviewed. Results: Measured by variation in peak inspiratory pressure and plateau pressure after pneumoperitoneum, with significant decrease of both after inversion of I:E index. More than half of the patients presented arterial hypertension, arrhythmias and arterial hypotension, without them being related to the application of the inverted I:E index. Conclusions: The inversion of inspiratory expiration contributed to improve the effects of pneumoperitoneum on intrapulmonary pressures, with adequate oxygenation and no cardiovascular effects.

Study of Hemodynamic Effects of Preoperative Single-Bolus Dexmedetomidine in Elective Laparoscopic Surgeries

Objective: To observe the hemodynamic effects of a single bolus dose of dexmedetomidine in patients undergoing elective laparoscopic surgeries.Methods: A total of 60 adult patients were randomized into two groups of 30 each. Group D patients were given 1 µg/kg dexmedetomidine in 50 mL of saline as a single-dose infusion over 10 min before induction. Group S patients were given a 50-mL 0.9% NS slow infusion over 10 min. Groups D and S patients were premedicated 10 min prior to surgery. Baseline vital and hemodynamic parameters were monitored during the perioperative period. Conclusion: Premedicating with a single bolus of 1 µg/kg IV dexmedetomidine has been proven safe and effective in maintaining perioperative hemodynamic stability, although few developed bradycardia and hypotension, which were managed without any adverse outcome. Furthermore, dexmedetomidine effectively reduced the incidence of shivering.

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas-filled cysts in the intestinal wall. Although rare, it may also involve other regions, such as the mesentery. PCI is classified as primary or secondary and is associated with multiple predisposing factors. It may be associated with either a benign condition or a potentially fatal condition, such as mesenteric ischemia. The objective of this study was to review the medical literature on the rare benign presentations of PCI, excluding cases associated with intestinal ischemia.Methods: We conducted a systematic literature review according to the PRISMA statement. We searched PubMed and LILACS databases for articles published between January 2015 and December 2020 using the following Medical Subject Headings: "pneumatosis cystoides intestinalis" and "pneumoperitoneum," "pneumatosis intestinalis," and "pneumoperitoneum" or "mesenteric pneumatosis."Results: We included 51 articles comprising 58 patients with PCI and pneumoperitoneum. Most patients were men, and mean patient age was 64.9 years. We identified an idiopathic etiology in 29.31% of cases, and the most common predisposing factor was immune dysfunction (29.31%). A total of 24.13% of patients were asymptomatic. The most commons symptoms were abdominal pain (43.10%), nausea and vomiting (41.37%), and abdominal distention (37.93%). Diagnostic surgery was conducted in 26 patients (44.82%). Only 1 patient underwent surgical treatment.Conclusions: PCI is a clinical condition that may have a benign etiology and not require surgery. Treatment of the benign etiology is conservative. Thus, life-threatening conditions should be excluded in all cases.

Hernia inguinal gigante en un adulto / Giant inguinal hernia in an adult

Se describe el caso clínico de un paciente de 58 años de edad con antecedentes personales de insuficiencia cardiaca congestiva mal controlada, quien acudió a emergencias del Hospital Luis Bernaza de Guayaquil, Ecuador, por presentar dolor abdominal difuso, constipación y masa inguinoescrotal gigante. Se realizan los estudios pertinentes y se diagnostica una hernia inguinoescrotal gigante con pérdida de domicilio, sin datos de obstrucción intestinal. Se empleó la técnica de Goñi Moreno durante 12 días para aumentar el diámetro de la cavidad abdominal y regresar el contenido del saco a su lugar. Se efectuó laparotomía exploratoria y hernioplastia con resultado satisfactorio y seguimiento por consulta externa durante 2 meses, sin alteraciones.

The case report of a 58 years patient with personal history of a poor controlled congestive heart failure is described, who went to the emergency service of Luis Bernaza Hospital in Guayaquil, Ecuador, due to a diffuse abdominal pain, constipation and giant inguinoescrotal mass. The pertinent studies were carried out and a giant inguinoescrotal hernia is diagnosed with home loss, without data of intestinal obstruction. The Goñi Moreno technique was used during 12 days to increase the diameter of the abdominal cavity and return the content from the sack to its place. An exploratory laparotomy and hernioplastia were carried out with satisfactory result and follow up in the outpatient department during 2 months, without alterations.

Manejo de aerossóis durante a pandemia da COVID-19 / Aerosol management during the COVID-19 pandemic / Manejo de aerosol durante la pandemia COVID-19

Objetivo: Descrever o processo de prototipação de um dispositivo de filtragem para manejo de aerossóis em procedimentos laparoscópicos durante a pandemia do coronavírus SARS-CoV-2. Método: Estudo descritivo, tipo relato de experiência sobre o protótipo de dispositivo de filtragem para manejo de aerossóis em laparoscopia durante a pandemia de COVID-19 pelo SARS-CoV-2, com base nos processos de imersão, ideação e prototipação do design thinking. Resultados: Os processos de imersão preliminar e profunda permitiram a abordagem do problema. A utilização do mapa mental proporcionou a identificação dos fatores relacionados às suspensões de cirurgias em decorrência do SARS-CoV-2. Pelas medidas do aspirador das salas cirúrgicas, idealizaram-se os recursos materiais necessários: extensor de aspiração, filtro bacteriológico e viral, conector e ponteira. Conclusão: O dispositivo para filtragem do dióxido de carbono do pneumoperitônio obteve boa aceitação da equipe cirúrgica e foi incorporado à rotina do setor durante a realização de cirurgias laparoscópicas.

Objective: To describe the prototyping process of a filtration device for aerosol management in laparoscopic procedures during the SARSCoV-2 coronavirus pandemic. Method: Descriptive study with the report of experience on the prototype filter device for aerosol management in laparoscopy during the SARS-CoV-2 COVID-19 pandemic, based on immersion, ideation and design thinking prototyping processes. Results: Preliminary and deep immersion processes allowed the problem to be addressed. The use of a mental map helped to identify factors related to surgery suspensions due to the SARS-CoV-2. Based on the measurements of the operating room aspirator, the necessary material resources were idealized: suction extender, bacteriological and viral filter, connector and tip. Conclusion: The device for filtering carbon dioxide from the pneumoperitoneum was well accepted by the surgical team and incorporated into the sector's routine for laparoscopic surgeries.

Objetivo: Describir el proceso de prototipado de un dispositivo de filtración para el manejo de aerosol en procedimientos laparoscópicos durante la pandemia de Coronavirus SARS-CoV-2. Método: Estudio descriptivo, un relato de experiencia sobre el prototipo de dispositivo de filtrado para el manejo de aerosol en laparoscopia durante la pandemia de COVID-19 por SARS-CoV-2, a partir de los procesos de inmersión, ideación y prototipado del Design Thinking. Resultados: Los procesos de inmersión profunda y preliminar permitieron abordar el problema. El uso del Mapa Mental permitió identificar los factores relacionados con la suspensión de cirugías debido al SARS-CoV-2. A partir de las mediciones del aspirador de las salas quirúrgicas, se idearon los recursos materiales necesarios: extensor de aspiración, filtro bacteriológico y viral, conector y férula. Conclusión: El dispositivo para filtrar dióxido de carbono del neumoperitoneo obtuvo buena aceptación por parte del equipo quirúrgico y fue incorporado a la rutina del sector durante las cirugías laparoscópicas.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Application of optical trocar insertion in laparoscopic surgery after previous abdominal surgery / 临床肝胆病杂志

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.

Characteristics of atelectasis and its relationship with degree of diaphragm inhibition in elderly patients with artificial pneumoperitoneum under general anesthesia / 中华麻醉学杂志

Objective:To investigate the characteristics of atelectasis and its relationship with the degree of diaphragm inhibition in elderly patients with artificial pneumoperitoneum under general anesthesia.Methods:Patients of both sexes, aged 20-80 yr, of American society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 20-29 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=20 each) according to age: young and middle-aged group and elderly group.Total intravenous anesthesia was applied and intraoperative pressure of artificial pneumoperitoneum was set at 10 mmHg.Before anesthesia, at 5 min of mechanical ventilation, at 5 min of artificial pneumoperitoneum, at 20 min of artificial pneumoperitoneum, at 5 min after the end of artificial pneumoperitoneum and at 15 min after extubation, diaphragmatic excursion (DE) was measured at the right diaphragm point using M-mode ultrasound.The minimal DE was recorded and the maximum degree of diaphragm inhibition was calculated.B-mode was used to assess the lung ultrasound images at the upper bedside lung ultrasound in emergency (BLUE) point, the lower BLUE point and the diaphragm point, and the cumulative scores before anesthesia and perioperative maximum cumulative scores of lung ultrasound score (LUS) were recorded. Results:Compared with the young and middle-aged group, the maximum cumulative scores of LUS were significantly increased, the degree of DE before anesthesia, the perioperative maximum degree of diaphragm inhibition were increased ( P<0.05), and no significant change was found in LUS cumulative scores in elderly group ( P>0.05). Conclusion:The degree of atelectasis is more serious in the elderly patients with artificial pneumoperitoneum under general anesthesia, and the mechamism may be related to the increased degree of diaphragm inhibition.

Effects of oxycodone on vascular endothelial injury in patients undergoing laparoscopic surgery under general anesthesia / 中国基层医药

Objective:To investigate the effects of oxycodone on vascular endothelial injury in patients undergoing laparoscopic surgery under general anesthesia.Methods:Eighty patients who received laparoscopic surgery in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China between September 2018 and September 2019 were included in this study. They were randomly assigned to undergo either intravenous administration of 10 mL 0.9% sodium chloride injection (control group, n = 40) or intravenous administration of 10 mg oxycodone hydrochloride before pneumoperitoneum (observation group, n = 40). Serum levels of norepinephrine (NE), epinephrine (E), heparin sulfate (HS), DPT-1 and vascular cell adhesion molecule-1 (VCAM-1) were measured in each group before pneumoperitoneum (baseline, T 0), at 1 hour after pneumoperitoneum (T 1), 2 hours after pneumoperitoneum (T 2), at the end of pneumoperitoneum (T 3) and at 24 hours after surgery (T 4). Operative time, pneumoperitoneum time and blood loss were recorded in both groups. The incidence of complications (arrhythmia, hypertension, irritability, pruritus, postoperative nausea and vomiting) was recorded. Postoperative Visual Analogue Scale score was compared between the observation and control groups. Results:At T 3 and T 4, serum levels of HS, DPT-1 and VCAM-1 in each group were significantly increased compared with T 0 (all P < 0.05). At T 4, serum levels of HS, DPT-1, and VCAM-1 in the observation group were (15.7 ± 4.8) μg/L, (31.5 ± 6.4) μg/L and (609.7 ± 90.4) μg/L, respectively, which were significantly lower than those in the control group [(18.6 ± 5.4) μg/L, (36.9 ± 7.3) μg/L, (653.2 ± 91.8) μg/L, t = 2.539, 3.518, 2.135, all P < 0.05]. At T 2 and T 3, serum levels of NE and E in each group were significantly increased compared with T 0 (all P < 0.05). At T 2, serum levels of NE and E in the observation group were (124.6 ± 14.5) μg/L and (106.4 ± 11.5) μg/L, respectively, which were significantly lower than those in the control group [(132.9 ± 12.4) μg/L, (111.8 ± 10.4) μg/L, t = 2.751, 2.203, both P < 0.05]. The incidence of postoperative irritability and Visual Analogue Scale score in the observation group were significantly lower than those in the control group (both P < 0.05). Conclusion:Intravenous administration of 10 mg oxycodone hydrochloride before pneumoperitoneum in patients subjected to laparoscopic surgery is beneficial to inhibiting inflammatory reaction, reducing the degradation of endothelial glycocalyx caused by pneumoperitoneum in laparoscopic surgery, and reducing vascular endothelial injury. This study is innovative and scientific.

Correlation between pneumoperitoneum pressure, level of blood uric acid and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy / 中国医师进修杂志

Objective:To study the correlation between pneumoperitoneum pressure, level of blood uric acid (UA) and postoperative cognitive function in elderly patients undergoing laparoscopic cholecystectomy (LC).Methods:One hundred and one patients from December 2018 to December 2019 in Wuhu First People′s Hospital of Anhui Province were selected. According to average value of intraoperative pneumoperitoneum pressure, the patients were divided into low pressure group (intraoperative pneumoperitoneum pressure<11.2 mmHg, 1 mmHg = 0.133 kPa; 50 cases) and standard pressure group (intraoperative pneumoperitoneum pressure ≥ 11.2 mmHg, 51 cases). According to preoperative average level of preoperative blood UA, the patients were divided into low-level UA group (UA<324.1 mmol/L, 50 cases) and high-level UA group (UA≥324.1 mmol/L, 51 cases). The cognitive function 24 h after surgery was assessed by mini-mental state examination (MMSE) scale and Loewenstein occupational therapy cognitive assessment (LOTCA) scale. The correlation between pneumoperitoneum pressure, level of blood UA and cognitive function was analyzed by Pearson correlation analysis.Results:There were no statistical differences in recovery time of spontaneous breathing, recovery time and extubation time between standard pressure group and low pressure group ( P>0.05); the recovery time of orientation in low pressure group was significantly shorter than that in standard pressure group: (12.54 ± 2.41) min vs. (14.65 ± 2.88) min, the postoperative MMSE score and LOTCA score were significantly higher than those in standard pressure group: (25.12 ± 2.03) scores vs. (20.84 ± 2.42) scores and (96.24 ± 6.54) scores vs. (85.15 ± 5.12) scores, and there were statistical differences ( P<0.01). The postoperative MMSE score and LOTCA score in high-level UA group were significantly higher than those in low-level UA group: (24.76 ± 2.53) scores vs. (21.12 ± 2.06) scores and (94.86 ± 6.18) scores vs. (86.34 ± 5.27) scores, and there were statistical differences ( P<0.01). The Pearson correlation analysis result showed that pneumoperitoneum pressure was negative correlation with MMSE score and LOTCA score ( r = -0.544 and - 0.615, P<0.01); while UA level was positive correlation with MMSE score and LOTCA score ( r = 0.433 and 0.405, P<0.01). Conclusions:The carbon dioxide pneumoperitoneum pressure and UA level are related to postoperative cognitive function in elderly LC patients. The postoperative cognitive function is relatively better in patients with lower intraoperative pneumoperitoneum pressure and higher preoperative UA level.