Cardiac and hemodynamic changes during carbon dioxide pneumoperitoneum for laparoscopic gynecologic surgery in Rajavithi Hospital.

OBJECTIVE: To study the effects of intraperitoneal CO2 insufflation on cardiopulmonary variables in gynecological laparoscopic patients. MATERIAL AND METHOD: A prospective descriptive study of BP, HR, End tidal CO2, and Sat O2 in 30 gynecologic patients who underwent laparoscopic surgery between 1 September 2006 and 30 July 2007. RESULTS: Blood pressure increased in the early state. The End tidal CO2 significant increased during surgery. Heart rate and Sat O2 did not change. At completion of the laparoscopic intervention, physiological variables exhibited a trend to baseline values. CONCLUSIONS: This prospective descriptive study documents significant changes in systemic hemodynamic variables that seem to be directly associated with the insufflation of CO2 during gynecologic intraperitoneal laparoscopic surgery. This ongoing evaluation confirms the effect of gynecological laparoscopic surgery and CO2 insufflation on cardiopulmonary function in patients.

Oral potassium chloride and oral rehydration solution supplement to prevent hypokalemia in sodium phosphate regimen for bowel preparation prior to gynecological laparoscopic surgery.

OBJECTIVE: To evaluate the efficacy of oral potassium chloride and oral rehydration solution (ORS) supplement for hypokalemia prevention after sodium phosphate (NaP) bowel preparation. MATERIAL AND METHOD: A comparative historical study of patients who underwent gynecological laparoscopic surgery between June 2005 and December 2007 and received NaP for bowel preparation prior to surgery. In the experiment group, a 10% Potassium chloride (KCl) elixir and ORS supplement was introduced to 47 of the patients. The control group of 42 patients received only pure water Age, body mass index, and time of defecation after NaP bowel preparation were recorded. Serum potassium level before NaP (K0), 4 hours (K4), and 10 hours (K10) after last dose of NaP were measured in both groups. RESULTS: It was found that the experiment group could maintain serum potassium level well. The mean +/- SD of serum potassium level before NaP (K0), at 4 hours after NaP (K4) and at 10 hours after NaP (K10) were 3.99 +/- 0.35, 4.09 +/- 0.43, 4.03 +/- 0.63, respectively. In the control group, the K0 was similar to that in the experiment group but the K4 decreased to 3.50 +/- 0.35 and K10 was 3.76 +/- 0.40 which had a significant difference (p = 0.011). Serum hypokalemia (K < 3.5 mmol/L) was found in 22 patients (52.38%) of the control group. CONCLUSION: Oral KCl elixir and ORS supplement for sodium phosphate bowel preparation regimen can prevent hypokalemia prior to surgery.