Hemodynamic profile during laparoscopic cholecystectomy versus laparoscopic bariatric surgery: the impact of morbid obesity

The present study investigated the hemodynamic profile using impedance cardiography [ICG] monitor during pneumoperitoneum for laparoscopic cholecystectorny versus bariatric surgery in order to determine the impact of body weight on hemodynamics. 32 adult patients [two groups, each 16 patients] were studied. Group 1 [16 patients] scheduled to undergo laparoscopic cholecystectorny [lapchole] with body mass index [BMI] 28 +/- 5 kg/m[2]. Group 2[16 patients] scheduled to undergo laparoscopic adjustable b and [LAGB] surgery for treatment of morbid obesity with BMI 45.3 +/- 8 kg/m[2]. under general anesthesia. Besides routine monitoring, impedance cardiography was used for hemodynamic monitoring. Three stages were identified for statistical analysis A, pre-insufflation, B, during vere pneumoperitoneum and C, at gas deflation. The mean values of cardiac index in group 1 at stages A, B and C were, 3.0 +/- 1.7, 2.5 +/- 0.5 and 2.7 +/- 0.5 L/min/m[2] respectively with significant low values in stage B compared to stage A [p < 0.05]. The same trend continue in group 2 where the mean values were, 2.4 +/- 0.6, 1.8 +/- 0.6 and 2.3 +/- 0.9 L/min/m[2] respectively with significant differences compared to group 1 mean values [p < 0.05]. Other hemodynamic variables showed non-significant differences [p > 0.05]. Cardiac index showed significant decreasing trend in morbid obese patients compared to nonobese, which may reflect the effect of body weight on hemodynamics. On the other h and other hemodynamic parameters was not altered by body weight. We believe that hemodynamics should be closely monitored during laparoscopic surgery with pneumoperitoneum

Anesthesia for thoracoscopic thymectomy: modified non-muscle relaxant technique: case reports

Anesthesia for thymectomy in myasthenia gravis is challenging. The anesthetic experience of that technique is quite large. It involves either muscle relaxant or non-muscle relaxant techniques. However, the literature is deficient of st and ard anesthetic technique for thoracoscopic thymectomy. Therefore we present in this report a modified non-muscle relaxant technique for thoracoscopic thymectomy [TT]. We report two cases who underwent TT under general anesthesia using sufentanil and propofol for induction and local anesthesia spray to the vocal cords to facilitate endobronchial intubation using non-muscle relaxant technique. The intubating, operating and postoperative conditions were excellent. To the best of our knowledge, this is the first report on modified non-muscle relaxant technique for TT in myasthenia gravis. Further cases have to be done to verify our technique