Effects of oxycodone hydrochloride and dezocine on hemodynamics and levels of inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia

Abstract We aimed to compare the effects of oxycodone hydrochloride and dezocine on hemodynamics and inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia. A total of 246 patients were divided into group A and B (n=123). Hemorheology indices were recorded 5 min after anesthesia (T0), 1 min after pneumoperitoneum (T1), when position was changed 5 min after pneumoperitoneum (T2), 15 min after pneumoperitoneum (T3), 1 min (T4) and 5 min (T5) after position was restored. Visual analogue scale scores 1, 2, 6, 12, 24 and 48 h after operation were recorded. Postoperative adverse reactions and visceral pain were observed. The expression levels of inflammatory factors were detected by enzyme-linked immunosorbent assay 12 h after operation. Compared with group A, group B had higher heart rate and mean arterial pressure at T2, lower central venous pressure and cardiac output at T1-T3, and higher systemic vascular resistance at T1-T5 (P<0.05). The incidence rate of pain syndrome in group A was lower (P<0.05). Group A had lower tumor necrosis factor-alpha and interleukin-6 expression levels and higher interleukin-10 level than those of group B (P<0.05). For gynecological laparoscopic surgery, oxycodone preemptive analgesia has superior outcomes to those of dezocine

Lesión esplénica accidental en cirugía ginecológica laparoscópica asociada con la técnica de entrada. Reporte de un caso y revisión bibliográfica / Incidental splenic injury during laparoscopic gynecological surgery associated with the entry technique. A case report and literature review

Resumen: ANTECEDENTES: Las lesiones accidentales del bazo durante la cirugía laparoscópica ginecológica son complicaciones raras, con gran repercusión en la morbilidad y mortalidad perioperatoria. La cirugía laparoscópica mediante compresión asistida y administración de hemostáticos es una opción viable en pacientes con lesiones esplénicas derivadas del acceso de los trocares. CASO CLÍNICO: Paciente de 48 años, con síndrome anémico secundario a trastornos (hipermenorrea y metrorragias) menstruales de seis meses de evolución, atendida en el departamento de Ginecología del Hospital General Dr. Manuel Gea González donde se clasificó con P0A0L1M0-C0O1E1I0N0 (FIGO 2011). Se decidió la histerectomía laparoscópica con salpingooforectomía bilateral. Durante el procedimiento quirúrgico tuvo sangrado activo, dependiente de la pared esplénica. Se ejerció compresión del sitio sangrante y se aplicó Surgicel® (producto hemostático absorbible-Ethicon), con adecuada hemostasia. La paciente evolucionó satisfactoriamente y fue dada de alta sin contratiempos. CONCLUSIÓN: Existen pocos reportes de lesiones esplénicas accidentales en cirugía ginecológica laparoscópica. La parte más peligrosa es la introducción de la aguja de Veress y del trócar, que pueden provocar lesiones viscerales o a vasos sanguíneos. Las pacientes con lesiones esplénicas accidentales deben ser tratadas por un equipo multidisciplinario.

Abstract: BACKGROUND: Incidental spleen injuries during gynecological laparoscopic surgery are rare complications that have a major impact on perioperative morbidity and mortality. Laparoscopic management through assisted compression and haemostatic products has been a recommended option in patients who have splenic lesions secondary to the path of laparoscopic trocars. CLINICAL CASE: 48-year-old patient with anemic syndrome secondary to 6-month-old menstrual disorders. It is protocolized in the Department of Gynecology of the Hospital Dr. Manuel Gea González where it is classified P0A0L1M0 - C0O1E1I0N0 (FIGO 2011). It is proposed for laparoscopic hysterectomy with bilateral salpingophrectomia. In the surgical act there is active bleeding dependent on splenic wall. It is compressed from the bleeding site and Surgicel® (absorbable hemostatic product - Ethicon) is applied, presenting hemostasis. The patient evolved successfully and left without incident. CONCLUSION: There are few documented reports of incidental splenic injuries in laparoscopic gynecological surgery. The most dangerous part of laparoscopy is the introduction of the Veress needle and the trocar, where visceral lesions or blood vessels may occur. Timely diagnosis of these complications is important for proper treatment. Incidental splenic injuries should be treated by a multidisciplinary team.

The effect of preoperative application of Xuesaitong on acute inflammatory response and cognitive function of patients after gynecological laparoscopic surgery / 中国中西医结合急救杂志

Objective To investigate the effect of Xuesaitong injection on acute inflammatory response and preoperative cognitive dysfunction (POCD) in patients after gynecological laparoscopic surgery. Methods From July 2016 to September 2017, there were 246 patients having undergone gynecological laparoscopic surgery in the Department of Obstetrics and Gynecology of Guangyuan Central Hospital. And according to whether Xueseton was used or not preoperatively, they were divided into a control group (n = 118) and an observation group (n =128). The patients in the observation group were given intravenous drip with 400 mg Xuesaitong at 30 minutes before surgery, while the patients in the control group were given intravenous drip with equal amount of 5% glucose solution at 30 minutes before surgery. The enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin-1 and -6 (IL-1, IL-6) and tumor necrosis factor-α (TNF-α); the neuropsychological tests were used to assess the patients' cognitive function; visual analogue scale (VAS) score was applied to assess the postoperative pain of patients; the intra-operative situation and the postoperative related risk occurrence were recorded in the two groups. Results The comparisons of indicators between the observation group and control group were as follows: the operation time (minutes: 106.2±30.6 vs. 114.6±22.7), anesthesia time (minutes: 126.1±21.2 vs. 122.1±25.3), intra-operative blood loss (mL: 324.4±63.1 vs. 313.6±65.1) and postoperative rash (1 case vs. 2 cases), chest distress (11 cases vs. 8 cases), palpitation (10 cases vs. 8 cases), asthma (5 cases vs. 4 cases), hematuria (2 cases vs. 3 cases), incision bleeding (4 cases vs. 3 cases), lower limb deep venous thrombosis (DVT: 11 cases vs. 14 cases) and VAS score (3.6±0.9 vs. 3.8±0.8), prothrombin time [PT (s): 10.7±2.2 vs. 9.7±1.5], activated partial thromboplastin time [APTT (s): 30.3±3.3 vs. 30.7±4.3], international normalized ratio (INR: 0.9±0.1 vs. 1.1±0.1), all of the above comparisons in indexes between the two groups had no statistical significant differences (all P > 0.05); with prolonged treatment, the IL-1, IL-6 and TNF-α levels were gradually decreased in two groups, reached the lowest levels at 12 hours after surgery, and the changes in the observation group were more significant than those in the control group [IL-1 (pg/L): 3.8±1.0 vs. 6.5±1.2, IL-6 (pg/L): 6.3±1.3 vs. 10.3±1.6, TNF-α (pg/L): 5.6±1.3 vs. 8.4±1.2]; after surgery the scores of MMSE test (score: 25.8±3.1 vs.20.8±3.3) and the word fluency test (14.9±1.8 vs. 12.8±1.8) in the observation group were significantly higher than those in the control group, while the incidence of POCD was significantly lower than that in the control group [18.7% (24/128) vs. 33.8% (40/118), all P < 0.05]. Conclusion The use of Xuesaitong before gynecological laparoscopic surgery can reduce the patients' expression levels of serum IL-1, IL-6 and TNF-α at acute inflammatory stage, reduce the occurrence of POCD and does not increase the related risk after surgery.

Effect of preemptive ketamine administration on postoperative visceral pain after gynecological laparoscopic surgery / 华中科技大学学报（医学）（英德文版）

The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. Group 3 was intravenously injected with preincisional ketamine (0.3 mg/kg) and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale (VAS) scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively (P<0.05 and P<0.01, respectively). At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1 (P<0.01). Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.

Post-operative intravenous patient-controlled analgesic efficacy of morphine with ketorolac versus nefopam after laparoscopic gynecologic surgery: a randomized non-inferiority trial / 대한마취과학회지

BACKGROUND: Nefopam is a non-opioid non-steroidal centrally acting analgesic. This study was conducted to assess the analgesic efficacy of intravenous patient-controlled analgesia (IV-PCA) using nefopam alone, compared with a combination of morphine and ketorolac, after laparoscopic gynecologic surgery. METHODS: Sixty patients undergoing laparoscopic gynecologic surgery received IV-PCA. Group A (n = 30) received IV-PCA with a combination of morphine 60 mg and ketorolac 180 mg, while group B (n = 30) received nefopam 200 mg (basal rate 1 ml/h, bolus 1 ml, and lockout time 15 min for both). The primary outcome evaluated was analgesic efficacy using the visual analogue scale (VAS). Other evaluated outcomes included the incidence rate of postoperative nausea and vomiting (PONV), patient satisfaction of pain control, percentage of patients requiring additional opioids, and incidence rate of postoperative adverse effects. RESULTS: Group B was not inferior to group A in relation to the VAS in the post-anesthesia care unit, and at 12, 24, and 48 h after surgery (mean difference [95% confidence interval], 0.50 [-0.43 to 1.43], -0.30 [-1.25 to 0.65], -0.05 [-0.65 to 0.55], and 0.10 [-0.55 to 0.75], respectively). The incidence rate of nausea was lower in group B than in group A at 12 and 24 h after surgery (P = 0.004 and P = 0.017, respectively). There were no significant differences in the other outcomes between groups. CONCLUSIONS: IV-PCA using nefopam alone has a non-inferior analgesic efficacy and produces a lower incidence of PONV in comparison with IV-PCA using a combination of morphine and ketorolac after laparoscopic gynecologic surgery.

Self-designed cotton-padded covering for lithotomy position prevents complications in patients' lower extremities / 现代临床护理

Objective To explore the effect of the self-designed cotton-padded covering for a modified lithotomy position on preventing complications in the lower limbs in patients undergoing gynecological laparscopic surgery.Methods A total of 320 patients undergoing radical hysterectomy or deep invasive endometriosis were selected and randomly divided into an observation group(n=160) and a control group(n=160).The patients in the control group were placed on the routine lithotomy position,the lower extremity and popliteal space protected with oasis outline cushion in the control group,while the patients in the observation group were placed on the same pads,the lower extremity and popliteal space protected with the self-designed cotton-padded coverings.Results The average temperature of the lower limbs of patients after operation in the observation group was significantly higher than that in the control group (P<0.01).The incidences of complications in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion The self-designed cotton-padded covering for modified lithotomy position can effectively prevent the complications of the lower limbs and improve the comfort of patients.

Airway Sealing Effect and Gastroesophageal Regurgitation of Laryngeal Mask Airway-Proseal in Laparoscopy / 대한마취과학회지

BACKGROUND: The laryngeal mask airway Proseal (LMA-Proseal) is a renewed airway device with a modified cuff to improve the mask seal around the larynx. The classic LMA is known to have an incomplete mask seal during high positive pressure ventilation. Therefore, we examined whether the ventilation via a LMA-Proseal during laparoscopic surgery may be adequate and also observed the complications associated with a LMA-Proseal. METHODS: Thirty four patients undergoing elective gynecological laparoscopies were studied. After the insertion of a LMA-Proseal, we measured the peak airway pressure, plateau airway pressure, oropharyngeal leakage pressure, and the leakage around the neck before and after intra-abdominal CO2 insufflation. After extubation, we observed the complications, including the gastroesophageal regurgitation using a methylene blue staining method. RESULTS: The peak and plateau airway pressures after pneumoperitoneum increased significantly (P<0.05), compared with those before insufflation. However, the oropharyngeal leakage pressure was not changed and leakages around the neck were not observed. After extubation, a cuff stained with methylene blue occurred in 10 of 34 patients. Sore throat and dysphagia occurred in 8 and 4 of 34 patients, respectively. CONCLUSIONS: A LMA-Proseal during laparoscopic surgery permits adequate airway pressure, but does not protect the gastroesophageal regurgitation.