Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress.

OBJECTIVE: To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy. MATERIALS AND METHODS: Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery. RESULTS: Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group. CONCLUSIONS: Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.

Reduction of postoperative haemorrhage with the use of a haemostatic thrombin matrix in patients who underwent decortication.

OBJECTIVE: To assess the efficacy of two measures for the control of postoperative haemorrhage in patients with fibrothoracic disease secondary to symptomatic extraparenchymal restrictive disease (e.g.empyema, haematoma) undergoing decortication. METHODS: This randomized, prospective study was performed in 50 adult patients with fibrothoracic disease secondary to symptomatic extraparenchymal restrictive disease who were scheduled to undergo decortication. Patients were randomized to receive either electrocautery plus hot compressor application or a thrombin-added haemostatic matrix (THM) for intraoperative haemostasis (n=25 per group). Control of postoperative haemorrhage was compared between groups by evaluation of pre- and postoperative blood characteristics and mean postoperative drainage volume and blood transfusion requirements. RESULTS: Mean postoperative drainage and blood transfusion volumes were significantly lower in the THM group versus the electrocautery plus hot compress group. There was no difference in preoperative and postoperative blood tests in the THM group, whereas significant differences were observed in the electrocautery plus hot compress group. There were no infections, systemic allergies or sensitization, or reoperations in either group. CONCLUSIONS: Compared with electro cautery plus hot compress, the use of a THM significantly reduced postoperative haemorrhage and blood transfusion requirements in patients who underwent decortication.