Subject(s)
Chylous Ascites/drug therapy , Chylous Ascites/etiology , Gastrointestinal Agents/therapeutic use , Nephrectomy/adverse effects , Octreotide/therapeutic use , Thoracic Duct/injuries , Adenocarcinoma/surgery , Aged , Chylous Ascites/diet therapy , Humans , Kidney Neoplasms/surgery , Male , RuptureABSTRACT
BACKGROUND AND OBJECTIVES: The effectiveness of EMLA eutectic mixture of local anesthetics, (ASTRA Co, France) cream in minor surgery on the penis and its acceptability in unpremedicated outpatients were assessed. METHODS: EMLA cream was applied 1 hour before surgery (fremulum plasty, circumcision or dorsal section for phimosis, and condyloma accuminatum) in addition to a subcutaneous infiltration of lidocaine 1%, just before incision in cases of circumcision. Verbal Rating Scale (VSR) was assessed during the surgery and the acceptance 15 days later by a questionnaire. RESULTS: Thirty-two patients included. In all of the cases, the application of EMLA cream was sufficient, with the exception of one (fremulum plasty). General anesthesia was used for this patient unable to tolerate the proprioceptive sensations (VRS = 0). In cases of circumcision, the subcutaneous infiltration was not experienced as painful. Eighty-eight percent of patients who answered the questionnaire confirmed that if they had to be reoperated on, they would opt for this technique of anesthesia. CONCLUSION: EMLA cream is effective in minor penile surgery in adult patients, and it is associated with subcutaneous infiltration of local anesthetic in the case of circumcision.
Subject(s)
Anesthetics, Combined/administration & dosage , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Prilocaine/administration & dosage , Adult , Circumcision, Male/methods , Condylomata Acuminata/surgery , Humans , Labial Frenum/surgery , Lidocaine, Prilocaine Drug Combination , Middle Aged , Minor Surgical Procedures , Ointments , Prospective StudiesABSTRACT
PURPOSE: To assess the effect of pneumoperitoneum on P(a-ET)CO2 gradient in children. METHODS: Sixty one ASA I and II children (10.7 +/- 3.0 yr, 38.4 +/- 14.2 kg, mean +/- SD), scheduled for visceral or urological laparoscopic procedures, were studied. They were anaesthetized, intubated, paralysed and their lungs ventilated with constant ventilator settings to obtain PETCO2 values between 4.3 and 4.8 kPa. Intra-abdominal pressure was maintained between 8 and 14 mmHg. The following measurements were performed at steady state, before the pneumoperitoneum (T1) and 15 min later (T2): heart rate, systolic and diastolic arterial pressure; peak airway and intra-abdominal pressure; PaCO2 corrected for the patient's temperature; PETCO2 drawn between the micropore filter and the ventilator tubes, corrected for BTPS conditions; P(a-ET)CO2. Values between -1.0 and +1.0 mmHg were considered nil; patient position (horizontal or head-down tilt): all patients were horizontal at T1. RESULTS: Arterial pressure, heart rate and peak airway pressure increased at T2: PaCO2 and PETCO2 increased by 14%. The incidence of negative gradients increased from 54 to 67% although mean P(a-ET)CO2 remained clinically unchanged. No difference was found in P(a-ET)CO2 gradient, whatever the position and intra-abdominal pressure. The 95% confidence intervals for P(a-ET)CO2 were [-5.6; +3.2] at T1 and [-8.8; +4.8] at T2. CONCLUSION: PETCO2 often overestimates PaCO2 during laparoscopy in children, by up to 8.8 mmHg. Arterial blood gas analysis should be performed during long procedures to avoid hyperventilation.
