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Objective:To study the effects of different carbon dioxide (CO 2) pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery. Methods:A retrospective collection of 100 colon cancer cases from February 2020 to February 2021 in the Jiading Branch of Shanghai First People′s Hospital (Jiangqiao Hospital, Jiading District) and the Shanghai First People′s Hospital were divided into low pressure group and high pressure group according to different CO 2 pneumoperitoneum pressure values, each with 50 cases and 12 mmHg(1 mmHg = 0.133 kPa) and 18 mmHg CO 2 pneumoperitoneum pressure values were used to inflate, and the perioperative status, cerebral oxygen metabolism status, and stress response of the two groups were observed. Results:The take food time, first time out of bed in the low pressure group were lower than those in the high pressure group: (45.67 ± 7.34) h vs. (49.67 ± 8.16) h, (34.69 ± 8.26) h vs. (39.87 ± 7.16) h, there were statistical differences( P<0.05). The time of first anal exhaust and hospital stay in the two groups had no significant differences ( P>0.05). Repeated measures analysis of variance results showed that the levels of partial pressure of carbon dioxide in artery, oxyhemoglobin saturation, arterial blood lactate acid, benous blood lactic acid were different followed the time and treatment methods ( P<0.05). The levels of heart rate, mean arterial pressure, cortisol and thyroid stimulating hormone in the low pressure group were higher than those in the high pressure group: (73.68 ± 6.35) beats/min vs. (84.84 ± 6.86) beats/min, (81.67 ± 13.68) mmHg vs. (93.68 ± 14.37) mmHg, (100.24 ± 12.34) μg/L vs. (135.68 ± 13.69) μg/L, (3.12 ± 0.43) mU/L vs. (3.54 ± 0.34) mU/L, there were statistical differences ( P<0.05). Conclusions:Different CO 2 pneumoperitoneal pressures affect the brain oxygen metabolism of patients, and clinical attention should be paid to them.
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Objetivo: Descrever o processo de prototipação de um dispositivo de filtragem para manejo de aerossóis em procedimentos laparoscópicos durante a pandemia do coronavírus SARS-CoV-2. Método: Estudo descritivo, tipo relato de experiência sobre o protótipo de dispositivo de filtragem para manejo de aerossóis em laparoscopia durante a pandemia de COVID-19 pelo SARS-CoV-2, com base nos processos de imersão, ideação e prototipação do design thinking. Resultados: Os processos de imersão preliminar e profunda permitiram a abordagem do problema. A utilização do mapa mental proporcionou a identificação dos fatores relacionados às suspensões de cirurgias em decorrência do SARS-CoV-2. Pelas medidas do aspirador das salas cirúrgicas, idealizaram-se os recursos materiais necessários: extensor de aspiração, filtro bacteriológico e viral, conector e ponteira. Conclusão: O dispositivo para filtragem do dióxido de carbono do pneumoperitônio obteve boa aceitação da equipe cirúrgica e foi incorporado à rotina do setor durante a realização de cirurgias laparoscópicas.
Objective: To describe the prototyping process of a filtration device for aerosol management in laparoscopic procedures during the SARSCoV-2 coronavirus pandemic. Method: Descriptive study with the report of experience on the prototype filter device for aerosol management in laparoscopy during the SARS-CoV-2 COVID-19 pandemic, based on immersion, ideation and design thinking prototyping processes. Results: Preliminary and deep immersion processes allowed the problem to be addressed. The use of a mental map helped to identify factors related to surgery suspensions due to the SARS-CoV-2. Based on the measurements of the operating room aspirator, the necessary material resources were idealized: suction extender, bacteriological and viral filter, connector and tip. Conclusion: The device for filtering carbon dioxide from the pneumoperitoneum was well accepted by the surgical team and incorporated into the sector's routine for laparoscopic surgeries.
Objetivo: Describir el proceso de prototipado de un dispositivo de filtración para el manejo de aerosol en procedimientos laparoscópicos durante la pandemia de Coronavirus SARS-CoV-2. Método: Estudio descriptivo, un relato de experiencia sobre el prototipo de dispositivo de filtrado para el manejo de aerosol en laparoscopia durante la pandemia de COVID-19 por SARS-CoV-2, a partir de los procesos de inmersión, ideación y prototipado del Design Thinking. Resultados: Los procesos de inmersión profunda y preliminar permitieron abordar el problema. El uso del Mapa Mental permitió identificar los factores relacionados con la suspensión de cirugías debido al SARS-CoV-2. A partir de las mediciones del aspirador de las salas quirúrgicas, se idearon los recursos materiales necesarios: extensor de aspiración, filtro bacteriológico y viral, conector y férula. Conclusión: El dispositivo para filtrar dióxido de carbono del neumoperitoneo obtuvo buena aceptación por parte del equipo quirúrgico y fue incorporado a la rutina del sector durante las cirugías laparoscópicas.
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Humans , Pneumoperitoneum , Laparoscopy , Betacoronavirus , Surgical Equipment , Aerosols , PandemicsABSTRACT
INTRODUCTION: The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. METHODS: A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. RESULTS: After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). CONCLUSION: The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.
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Objective:To investigate the characteristics of atelectasis and its relationship with the degree of diaphragm inhibition in elderly patients with artificial pneumoperitoneum under general anesthesia.Methods:Patients of both sexes, aged 20-80 yr, of American society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 20-29 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=20 each) according to age: young and middle-aged group and elderly group.Total intravenous anesthesia was applied and intraoperative pressure of artificial pneumoperitoneum was set at 10 mmHg.Before anesthesia, at 5 min of mechanical ventilation, at 5 min of artificial pneumoperitoneum, at 20 min of artificial pneumoperitoneum, at 5 min after the end of artificial pneumoperitoneum and at 15 min after extubation, diaphragmatic excursion (DE) was measured at the right diaphragm point using M-mode ultrasound.The minimal DE was recorded and the maximum degree of diaphragm inhibition was calculated.B-mode was used to assess the lung ultrasound images at the upper bedside lung ultrasound in emergency (BLUE) point, the lower BLUE point and the diaphragm point, and the cumulative scores before anesthesia and perioperative maximum cumulative scores of lung ultrasound score (LUS) were recorded. Results:Compared with the young and middle-aged group, the maximum cumulative scores of LUS were significantly increased, the degree of DE before anesthesia, the perioperative maximum degree of diaphragm inhibition were increased ( P<0.05), and no significant change was found in LUS cumulative scores in elderly group ( P>0.05). Conclusion:The degree of atelectasis is more serious in the elderly patients with artificial pneumoperitoneum under general anesthesia, and the mechamism may be related to the increased degree of diaphragm inhibition.
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Objective:To investigate the effects of oxycodone on vascular endothelial injury in patients undergoing laparoscopic surgery under general anesthesia.Methods:Eighty patients who received laparoscopic surgery in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China between September 2018 and September 2019 were included in this study. They were randomly assigned to undergo either intravenous administration of 10 mL 0.9% sodium chloride injection (control group, n = 40) or intravenous administration of 10 mg oxycodone hydrochloride before pneumoperitoneum (observation group, n = 40). Serum levels of norepinephrine (NE), epinephrine (E), heparin sulfate (HS), DPT-1 and vascular cell adhesion molecule-1 (VCAM-1) were measured in each group before pneumoperitoneum (baseline, T 0), at 1 hour after pneumoperitoneum (T 1), 2 hours after pneumoperitoneum (T 2), at the end of pneumoperitoneum (T 3) and at 24 hours after surgery (T 4). Operative time, pneumoperitoneum time and blood loss were recorded in both groups. The incidence of complications (arrhythmia, hypertension, irritability, pruritus, postoperative nausea and vomiting) was recorded. Postoperative Visual Analogue Scale score was compared between the observation and control groups. Results:At T 3 and T 4, serum levels of HS, DPT-1 and VCAM-1 in each group were significantly increased compared with T 0 (all P < 0.05). At T 4, serum levels of HS, DPT-1, and VCAM-1 in the observation group were (15.7 ± 4.8) μg/L, (31.5 ± 6.4) μg/L and (609.7 ± 90.4) μg/L, respectively, which were significantly lower than those in the control group [(18.6 ± 5.4) μg/L, (36.9 ± 7.3) μg/L, (653.2 ± 91.8) μg/L, t = 2.539, 3.518, 2.135, all P < 0.05]. At T 2 and T 3, serum levels of NE and E in each group were significantly increased compared with T 0 (all P < 0.05). At T 2, serum levels of NE and E in the observation group were (124.6 ± 14.5) μg/L and (106.4 ± 11.5) μg/L, respectively, which were significantly lower than those in the control group [(132.9 ± 12.4) μg/L, (111.8 ± 10.4) μg/L, t = 2.751, 2.203, both P < 0.05]. The incidence of postoperative irritability and Visual Analogue Scale score in the observation group were significantly lower than those in the control group (both P < 0.05). Conclusion:Intravenous administration of 10 mg oxycodone hydrochloride before pneumoperitoneum in patients subjected to laparoscopic surgery is beneficial to inhibiting inflammatory reaction, reducing the degradation of endothelial glycocalyx caused by pneumoperitoneum in laparoscopic surgery, and reducing vascular endothelial injury. This study is innovative and scientific.
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Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.
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Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.
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BACKGROUND: The aim of this study was to investigate the effect of the steep Trendelenburg position (STP) with pneumoperitoneum on whole-blood viscosity (WBV) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). The study also analyzed the associations of clinical patient-specific and time-dependent variables with WBV and recorded postoperative outcomes. METHODS: Fifty-eight adult male patients (ASA physical status of I or II) undergoing elective RALP were prospectively analyzed in this study. WBV was intraoperatively measured three times: at the beginning of surgery in the supine position without pneumoperitoneum; after 30 min in the STP with pneumoperitoneum; and at the end of surgery in the supine position without pneumoperitoneum. The WBV at a high shear rate (300 s- 1) was recorded as systolic blood viscosity (SBV) and that at a low shear rate (5 s- 1) was recorded as diastolic blood viscosity (DBV). Systolic blood hyperviscosity was defined as > 13.0 cP at 300 s- 1 and diastolic blood hyperviscosity was defined as > 4.1 cP at 5 s- 1. RESULTS: The WBV and incidences of systolic and diastolic blood hyperviscosity significantly increased from the supine position without pneumoperitoneum to the STP with pneumoperitoneum. When RALP was performed in the STP with pneumoperitoneum, 12 patients (27.3%) who had normal SBV at the beginning of surgery and 11 patients (26.8%) who had normal DBV at the beginning of surgery developed new systolic and diastolic blood hyperviscosity, respectively. The degree of increase in WBV after positioning with the STP and pneumoperitoneum was higher in the patients with hyperviscosity than in those without hyperviscosity at the beginning of surgery. Higher preoperative body mass index (BMI) and hematocrit level were associated with the development of both systolic and diastolic blood hyperviscosity in the STP with pneumoperitoneum. All patients were postoperatively discharged without fatal complications. CONCLUSIONS: Changes in surgical position may influence WBV, and higher preoperative BMI and hematocrit level are independent factors associated with the risk of hyperviscosity during RALP in the STP with pneumoperitoneum. TRIAL REGISTRATION: Clinical Research Information Service, Republic of Korea, approval number: KCT0003295 on October 25, 2018.
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Blood Viscosity , Head-Down Tilt , Intraoperative Period , Laparoscopy , Prostatectomy , Robotic Surgical Procedures , Aged , Body Mass Index , Cohort Studies , Hematocrit , Humans , Male , Middle Aged , Pneumoperitoneum, Artificial , Supine PositionABSTRACT
Objective@#To evaluate the protective effects of ulinastatin combined with lung-protective ventilation on lungs in patients undergoing laparoscopic colorectal carcinoma surgery.@*Methods@#A total of 120 patients undergoing laparoscopic radical resection of colorectal cancer in Yuncheng Central Hospital were selected in this study.According to thedigital table, they were randomly divided into conventional mechanical ventilation group(G0 group), lung protection mechanical ventilation group(G1 group), conventional mechanical ventilation combined with ulinastatin group(G2 group)and lung protection mechanical ventilation combined with ulinastatin group(G3 group), with 30 cases in each group.Ulinastatin 2 500IU was intravenously infused 10min before induction of anesthesia in G2 group and G3 group.Ventilator parameters were set as tidal volume(VT)10mL/kg, respiratory frequency 12 times/min, inspiration-expiration ratio(I∶E)1∶2 in G0 group and G2 group.VT 6mL/kg in G1 group and G3 group , positive end-expiratory pressure ventilation(PEEP)5-10cmH2O, respiratory frequency 12-18 times/min, once every 30min.Before anesthesia induction(T0), before pneumoperitoneum(T1), 2h after pneumoperitoneum(T2), before extubation(T3), 24h after operation(T4), arterial blood was collected to detect partial pressure of oxygen(PaO2), oxygenation index(OI). And mean airway pressure(Pmean), peak airway pressure(Ppeak)at T1-3 were recorded.Venous blood was collected at T0, T3 and T4 to detect serum concentrations of interleukin-6(IL-6), interleukin-8(IL-8)and tumor necrosis factor-alpha(TNF-α).@*Results@#At T3, the PaO2 of G1 group, G2 group and G3 group were (457±60)mmHg, (460±49)mmHg and (510±45)mmHg, respectively.At T4, the PaO2 of the three groups were (90±6)mmHg, (92±7)mmHg and (96±7)mmHg, respectively.The PaO2 in G1 group and G2 group were lower thanthose in G3 group at T3-4(t=3.872, 3.850, 4.186, 2.513, all P<0.05). At T2, the OI of the three groups were (460±44), (462±37) and (481±31), respectively.At T3, the OI of the three groups were (460±51), (475±62) and (504±38), respectively.The OI in G1 group and G2 group were lower than those in group G3 at T2-3(t=2.142, 3.753, 2.209, 2.170, all P<0.05). At T2, the Pmean of G1 group, G2 group and G3 group were (10.5±1.5)cmH2O, (11.2±1.9)cmH2O and (9.5±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.3±3.0)cmH2O, (24.0±3.3)cmH2O and (22.3±2.9)cmH2O, respectively.At T3, the Pmean of the three groups were (10.9±1.1)cmH2O, (11.1±1.8)cmH2O and (9.8±0.9)cmH2O, respectively, the Ppeak of the three groups were (22.8±2.7)cmH2O, (24.1±2.1)cmH2O and (21.6±2.0)cmH2O, respectively.The Pmean in G1 group and G2 group at T2-3 were lower than those in G3 group(t=3.061, 4.580, 5.759, 4.305, 3.746, all P<0.05), the Ppeak in G2 group at T2-3 were lower than those in G3 group(t=2.952, 4.630, all P<0.05). At T4, the serum concentrations of IL-6 of G1 group, G2 group and G3 group were (151±28)ng/L, (152±20)ng/L and (136±18)ng/L, respectively, the IL-8 levels of the three groups were (468±28)ng/L, (359±65)ng/L and (327±51)ng/L, respectively, the TNF-α levels of the three groups were (1.09±0.20)ng/L, (1.08±0.20)ng/L and (0.94±0.20)ng/L, respectively.The concentrations of IL-6, IL-8 and TNF-α at T4 in G1 group and G2 group were higher than those in G3 group(t=2.428, 4.094, 2.536, 4.251, 2.807, 3.128, 4.119, 2.592, 3.446, 2.555, all P<0.05).@*Conclusion@#The combination of ulinastatin and lung-protective ventilation provides protective effects on lungs and exerts better efficacy than either alone.
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ABSTRACT Objective: to demonstrate hemodynamic changes during laparoscopic cholecystectomy in elderly patients with trans-esophageal echocardiography. Methods: we studied 31 elderly patients (aged 60 years or older), ASA I or II, who underwent elective laparoscopic cholecystectomy under general, standardized anesthesia, with cardiovascular parameters measured using transesophageal echocardiography at three different times: before the pneumoperitoneum (T1), after CO2 insufflation (T2) and at deflation (T3). We statistically evaluated changes in systolic, diastolic and mean blood pressure, heart rate, cardiac output and index, and ejection fraction. Results: although small, only the diastolic blood pressure (DBP) and ejection fraction (EF) variations were statistically significant. The mean ± standard deviation of DBP in mmHg at the different times were: T1=67.5±10.3; T2=73.6±12.4; and T3=66.7±9.8. And for EF, in percentage (%) they were: T1=66.7±10.4; T2=63.2±9.9; and T3=68.1±8.4. There was no statistical correlation between hemodynamic variations, age and number of patients' comorbidities. Conclusion: laparoscopic cholecystectomy causes few hemodynamic changes that are well tolerated by the majority of the elderly patients; prior impairment of ventricular function represents a threat in elderly patients during surgery; there appears to be a lower hemodynamic effect caused by the pneumoperitoneum than by the patient's positioning in a reverse Trendelemburg during surgery.
RESUMO Objetivo: demonstrar as alterações hemodinâmicas durante a colecistectomia laparoscópica em pacientes idosos com auxílio da ecocardiografia trans-esofágica Métodos: foram estudados trinta e um pacientes idosos (com 60 anos de idade ou mais), ASA I ou II, submetidos à colecistectomia laparoscópica eletiva, sob anestesia geral padronizada, com aferição de parâmetros cardiovasculares através de ecocardiograma trans-esofágico em três momentos diferentes: antes do pneumoperitônio (T1), após a insuflação do CO2 (T2) e na desinsuflação (T3). As variações da pressão arterial sistólica, diastólica e média, da frequência cardíaca, do débito e do índice cardíaco, e da fração de ejeção foram avaliadas estatisticamente. Resultados: apesar de pequenas, somente as variações da pressão arterial diastólica (PAD) e da fração de ejeção (FE) foram estatisticamente significativas. A PAD, em mmHg, nos diferentes momentos, de acordo com a média e desvio padrão, foram: T1=67,5±10,3; T2=73,6±12,4; T3=66,7±9,8. E para a FE, em porcentagem (%), nos diferentes momentos, de acordo com média e desvio padrão, foram: T1=66,7±10,4; T2=63,2±9,9; T3=68,1±8,4. Não houve correlação estatística entre as variações hemodinâmicas, a idade e número de comorbidades dos pacientes. Conclusão: a colecistectomia laparoscópica causa poucas alterações hemodinâmicas que são bem toleradas pela maioria dos pacientes idosos; o comprometimento prévio da função ventricular representa ameaça em pacientes idosos durante a cirurgia; parece haver menor efeito hemodinâmico causado pelo pneumoperitônio do que pelo posicionamento do paciente em Trendelemburg reverso durante a cirurgia.
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Humans , Male , Female , Aged , Monitoring, Intraoperative , Cholecystectomy, Laparoscopic , Hemodynamics , Echocardiography, Transesophageal , Middle AgedABSTRACT
Objective The purpose of this study was to assess the safety of carbon dioxide pneumoperitoneum on patients during robotic rectectomy.Methods 50 patients [American Society of Anesthesiologists (ASA) physical status Ⅱ,18 and 65 years of age] underwent rectal cancer surgery were selected in our study.According to whether or not robotic assisted surgery was performed,they were divided into a robotic surgery group (group RS) and a laparoscopic surgery group (group LS) by surgical approach,25 patients in each group.All participants were given the same anesthesia protocol.Arterial blood samples 1 ml was obtained from the left radial artery for blood gas analysis to measure the partial pressure of arterial carbon dioxide (PaCO2) and and calculate the arterial-to-end-tidal carbon dioxide pressure difference (Pa-ETCO2) just 10 min after endotracheal intubation (T0),at 30 min(T1),1 h(T2),2 h(T3) after pneumoperitoneum and 30 minutes after release (T4).Meanwhile,the airway peak pressure was monitored.Blood samples (4 ml) extracted at T0,T3 and T4 were centrifuged and measured the serum levels of interleukin (IL)-6 and IL-10 by enzyme linked immunosorbent assay (ELISA).The time to resuscitation,extubation time,intraoperative medication and perioperative adverse events were all recorded.Results Compared with group LS,PaCO2 in the RS group was increased significantly at T1,T2 and T3 after pneumoperitonum and the IL-6 was lower at T4 (P ＜ 0.05).There were no statistically significant differences in Pa-ETCO2,airway peak pressure,IL-10,time to resuscitation,extubation time and the incidence of adverse events between the two groups (P ＞ 0.05).Conclusions It is safe for normal adult patients performed by intravenous anesthesia during robotic-assisted rectal surgery and the inflammatory response is small,which is beneficial to the patient's postoperative recovery.
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Objective To evaluate the modifying efficacy of transversus abdominis plane (TAP) block combined with general anesthesia in elderly patients undergoing laparoscopic surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 65-80 yr,with body mass index of 18.5-24.0 kg/m2,scheduled for elective abdominal laparoscopic surgery,were divided into 2 groups (n =30 each) using a random number table:general anesthesia group (group GA) and TAP block combined with general anesthesia group (group TAP+GA).In group TAP+GA,bilateral TAP block was performed using the posterior approach,and 0.25％ ropivacaine 20 ml was injected into the two sides.Anesthesia was induced with Ⅳ midazolam,etomidate,sufentanil and cisatracurium besylate.Anesthesia was maintained using total intravenous anesthesia.When postoperative visual analog scale score ≥4,dezocine 5 mg was intravenously injected for analgesia.At 5 rmin after admission to the operating room,at 2 min after skin incision and at the end of pneumoperitoneum,venous blood samples were collected for determination of plasma norepinephrine concentrations.The intraoperative consumption of propofol and remifentanil and intraoperative requirement for sufentanil and postoperative requirement for dezocine were recorded.The development of adverse reactions was also recorded.Results Compared with group GA,the plasma norepinephrine concentrations were significantly decreased at 2 min after skin incision and at the end of pneumoperitoneum,the intraoperative consumption of propofol and remifentanil was reduced,the intraoperative requirement for sufentanil and postoperative requirement for dezocine were decreased (P＜0.05),and no significant change was found in the incidence of adverse reactions in group TAP+GA (P＞0.05).Conclusion When TAP block combined with general anesthesia is used in elderly patients undergoing laparoscopic surgery,it is helpful in carrying out anesthetic model of low-consumption opioids and more helpful in inhibiting intraoperative stress responses and postoperative pain responses than general anesthesia alone.
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Objective To compare the effect of different pressure CO2 pneumoperitoneum on hemodynamics and arterial blood gas in patients with laparoscopic gastrectomy.Methods 130 cases of patients with advanced or locally advanced distal gastric cancer in our hospital from June,2014 to December,2016 were selected and divided into three groups according to the random number table.The pressures of CO2 pneumoperitoneum were set at 6-8,9-11 and 12-14 mmHg in low pressure group,middle pressure group and high pressure group.The changes of heart rate (HR),mean arterial pressure (MAP),pH,partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) in three groups were measured before pneumoperitoneum (T1),60 minutes after pneumoperitoneum (T2),120 minutes after pneumoperitoneum (T3) and 60 minutes after discharge (T4).The complications of the three groups,such as abnormal intraoperative rhythm,hypercapnia,subcutaneous emphysema and air embolism were compared.Results Compared with T1,the HR and MAP of the three groups increased at T2,T3 and T4 points (P ＜0.05);The levels of HR,MAP and PaCO2 in T2,T3 and T4 points were higher in the middle pressure group and the high pressure group than that in the low pressure group at the same time point (P ＜ 0.05);There was no significant difference in pH value and PaO2 among the three groups (P ＞ 0.05);The incidence of central arrhythmia in the high pressure group was higher than that in the low pressure group and the middle pressure group (P ＜ 0.05).Conclusions The pressure of 6-8 mmHg CO2 pneumoperitoneum is conducive to maintain the hemodynamic stability of patients with laparoscopic gastrectomy and less impact on the PaCO2.
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Objective To evaluate the effect of deep and moderate neuromuscular blockade on surgical conditions during minor laparoscopic gynecologic surgery.Methods Sixty-five patients,with expected surgery time ＜ 3 h,aged 18-60 yr,with body mass index＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ orⅡ,scheduled for elective laparoscopic gynecological surgery,were allocated into deep neuromuscular blockade group (group D,n =33) and moderate neuromuscular blockade group (group M,n=32) using a random number table.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.Cisatracurium was continuously infused to maintain the degree of neuromuscular blockade in both groups to achieve the target degree post-tetanic count of 1 or 2 in group D and train-of-four (TOF) count of 1 or 2 in group M.Surgical conditions were assessed and scored after surgery.The recovery index,time for TOF ratio returning to 0.7 and 0.9,surgery time,mean intra-abdominal pressure,extubation time and TOF ratio at extubation were recorded.Results Compared with group M,the mean intra-abdominal pressure was significantly decreased,and the extubation time and time for TOF ratio returning to 0.7 and 0.9 were prolonged in group D (P＜0.05).There was no significant difference in the other parameters between the two groups (P＞0.05).Conclusion Moderate neuromuscular blockade can provide better surgical conditions for minor laparoscopic gynecological surgery with shorter recovery time.
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Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions.The evidence supporting routine use of deep NMB is still under debate.We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery.We performed a systematic review and metaanalysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes.Trials were identified from Medline,Embase,and Central databases from inception to December 2016.We included randomized trials,crossover studies,and cohort studies.Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions.Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB,with a mean difference of 0.65 [95％ confidence interval (CI):0.47-0.83] on a scale of 1-5,and it facilitates the use of low-pressure pneumoperitoneum.Furthermore,deep NMB reduces postoperative pain scores in the postanaesthesia care unit,with a mean difference of-0.52 (95％ CI:-0.71 to -0.32).Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit.Whether this leads to fewer intraoperative complications,an improved quality of recovery,or both after laparoscopic surgery should be pursued in future studies.The review methodology was specified in advance and registered at Prospero on July 27,2016,registration number CRD42016042144.
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Objective To evaluate the effect of dexmedetomidine on the postoperative pulmonary function in patients undergoing laparoscopic operation.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 45-64 yr,weighing 45-70 kg,undergoing laparoscopic radical resection of rectal cancer,were divided into 2 groups (n =40 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).General anesthesia combined with epidural anesthesia was used.In group Dex,dexmedetonidine was intravenously infused as a bolus of 0.3 μg/kg over 10 min after epidural catheterization and before induction of general anesthesia,followed by an infusion of O.4 μg · kg-1 · h-1 starting from the end of tracheal intubation until 30 min before the end of operation.The equal volume of normal saline was given instead in group C.After epidural catheterization and before infusion of dexmedetomidine (T0),immediately before termination of pneumoperitoneum (T1) and at 1,6 and 24 h after operation (T2-4),blood samples were taken from the peripheral vein for determination of concentrations of serum interleukin-6 (IL-6),IL-10,tumor necrosis factor-alpha and malondialdehyde,and arterial blood gas analysis was performed simultaneously.Respiratory index and oxygenation index (OI) were calculated,and the occurrence of OI ≤ 300 mmHg was recorded.Results Compared with group C,the serum IL-6 and tumor necrosis factor-alpha concentrations and respiratory index were significantly decreased,and IL-1O concentrations and OI were increased at T1-4,and malondialdehyde concentrations were decreased at T1-3,and the incidence of OI ≤ 300 mmHg was decreased in group Dex (P＜0.05).Conclusion Dexmedetomidine can inhibit inflammatory responses and improve the postoperative pulmonary function in patients undergoing laparoscopic operation.
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Objective To evaluate the effect of alveolar recruitment maneuver on the perioperative pulmonary function in the morbidly obese patients undergoing laparoscopic sleeve gastrectomy.Methods Forty morbidly obese patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,with body mass index ≥ 40 kg/m2,scheduled for elective laparoscopic sleeve gastrectomy,were randomly divided into either control group (group C) or alveolar recruitment maneuver group (group R) using a random number table,with 20 patients in each group.Patients in group C were treated with volume-or pressure-controlled ventilation after creation of pneumoperitoneum,maintaining the peak inspiratory pressure (Ppeak) ≤ 30 cmH2O and partial pressure of end-tidal CO2 35-40 mmHg.Patients in group R received alveolar recruitment maneuver once every 30 min starting from creation of pneumoperitoneum until the end of surgery.Patients were transfered to post-anesthesia care unit (PACU) with endotracheal tube which was extubated when the unified extubation standard was achieved in PACU.The patients who stayed in PACU for 2 h showing no indications for extubation were transfered to intensive care unit for continuous ventilation support.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,and at the end of pneumoperitoneum,blood samples were collected from the radial artery for blood gas analysis.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,at the end of surgery,and immediately before discharge from PACU,Ppeak,plateau pressure (Peat),and dynamic lung compliance were recorded.The time for achieving extubation standard and time for achieving the standard for discharge from PACU were recorded.Patients were followed up until discharge,and the feeding time and duration of hospital stay were recorded.Results Compared with group C,PaO2 and oxygenation index were significantly increased at 90 min of pneumoperitoneum,at the end of surgery,and immediately before discharge from PACU,Ppeak was decreased at 60 and 90 min of pneumoperitoneum and immediately after the end of pneumoperitoneum,Pplat was decreased at 60 and 90 min of pneumoperitoneum,the dynamic lung compliance was increased at 30,60 and 90 min of pneumoperitoneum and immediately after the end of pneumoperitoneum,and the time for achieving extubation standard,time for achieving the standard for discharge from PACU,feeding time,and duration of hospital stay were shortened in group R (P＜0.05 or 0.01).In group C,one patient did not present with indications for extubation and were transfered to intensive care unit for continuous ventilation support.Conclusion Intraoperative alveolar recruitment maneuver can effectively improve the intraoperative pulmonary function and promote the recovery of postoperative pulmonary function in the morbidly obese patients undergoing laparoscopic sleeve gastrectomy.
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Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch (HES 130/0.4) 500 ml was infused over 30 min.Before pneumoperitoneum (T1),at 5 min after pneumoperitoneum (T2),immediately before volume expansion (T3) and at 3 min after volume expansion (T4),cardiac output (CO),cardiac index (CI),SV,stroke volume index (SVI) and SVV were monitored and recorded.The changing rate of CI (△CI) was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve (95％ confidence interval) was 0.567 (0.378-0.757).Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.
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Objective To evaluate the changes in noxious stimulation intensity at different periods of pneumoperitoneum in patients undergoing gynecological laparoscopic surgery.Methods Forty-five ASA Ⅰ or Ⅱ patients,aged 25-36 years,with body mass index of 18-23 kg/m2,undergoing elective gynecological laparoscopic surgery,were randomly divided into three groups (n =15 each).In group Ⅰ,anesthesia was maintained with target-controlled infusion (TCI) of remifentanil (with target plasma concentration of 4-6 ng/ml) and propofol (with target plasma concentration of 2 μg/ml),and the concentrations were adjusted according to the changes in blood pressure (BP) and heart rate (HR) to maintain hemodynamics stable.Group Ⅱ and group Ⅲ received inhalation of isoflurane (with the end-tidal concentration of 1％-2％) and TCI of remifentanil (with target plasma concentration of 2-4 ng/ml).TCI of remifentanil was then stopped at 5 minutes before pneumoperitoneum (group Ⅱ) or at 5 minutes after the end of rapid inflation (group Ⅲ),and isoflurane was inhaled (with the end-tidal concentration of 1％-2％) to maintain anesthesia until the end of operation in groups Ⅱ and Ⅲ.Before anesthesia (T0),5 minutes before pneumoperitoneum (T1),after 5 and 15 minutes of pneumoperitoneum (T2,3),HR and mean arterial blood pressure (MAP) were monitored and venous blood samples were taken for determination of plasma concentrations of cortisol (Cor),norepinephrine (NE) and epinephrine (E).Results HR,MAP,and NE and E concentrations at T2,3,and Cor concentrations at T3 were significantly higher than those at T0 in group Ⅱ.They were significantly higher in group Ⅱ than in group Ⅰ (P ＜ 0.05),but were significantly lower in group Ⅲ than in group Ⅱ (P＜0.05).Conclusion The intensity of noxious stimulation is strongest during rapid inflation among the different periods of pneumoperitoneum in patients undergoing gynecological laparoscopic surgery and the depth of anesthesia should be regulated.
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Objective To evaluate the effect of inverse ratio ventilation (I ∶ E =1 ∶ 1) on ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery.Methods Sixty patients,aged 30-64 yr,of ASA physical status Ⅰ or Ⅱ],with body mass index of 30-40 kg/m2,scheduled for elective laparoscopic radical resection of rectal carcinoma,were divided into 2 groups (n =30 each) using a random number table:I∶E =1∶1 mode of ventilation after pneumoperitoneum (group A),and I∶E =1∶2 mode of ventilation after pneumoperitoneum (group B).Anesthesia was induced with midazolam,fentanyl,propofol and vecuronium.The patients were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with infusion of propofol and remifentanil,sevoflurane inhalation,and intermittent iv boluses of vecuronium.In group A,the patients received I ∶ E =1 ∶ 1 after pneumoperitoneum.In group B,the patients received I ∶ E =1 ∶ 2.PaO2,PaCO2,peak inspiratory pressure (PIP),mean airway pressure (Pmean),dynamic compliance (Cdyn),intrapulmonary shunt (Qs/Qt),PETCO2,RR,MAP and HR were recorded immediately after intubation,and at 30,60 and 120 min of pneumoperitoneum.Results Compared with group B,PaO2,Pmean and Cdyn were significantly increased,and PIP and Qs/Qt were decreased,and no significant changes were found in RR,PET CO2,PaCO2 and hemodynamic parameters in group A.Conclusion Inverse ratio ventilation (I ∶ E =1 ∶ 1) can effectively improve ventilatory function during pneumoperitoneum in the obese patients undergoing laparoscopic surgery without exerting adverse effects on hemodynamics.
