RESUMO
BACKGROUND: Laparoscopic bariatric surgeries in morbid obese patients may be associated with atelectasis, hypercapnia, and hypoxemia, intra and postoperatively. Several strategies are used for the prevention of these consequences. This study aimed to examine the effects of three different recruitment maneuvers comparatively during surgery and the influence of the maneuvers on some cardiopulmonary indices. MATERIALS AND METHODS: In a clinical trial, ninety participants of laparoscopic surgery with body mass index higher than 40 were randomly divided into three equal groups. The first group was subject to 10 cmH2O positive end-expiratory pressure (PEEP) during surgery, the second group, after venting the pneumoperitoneum, had 5 deep breaths with a positive pressure of 40 cmH2O, and the third group was subject to both. Some pulmonary and hemodynamic parameters were measured every 15 min and compared between three groups. RESULTS: The average of peak airway pressure, plateau airway pressure, and SpO2 static and dynamic compliance between the three groups had no meaningful differences (P > 0.05), but PaCO2in the second group was statistically higher than the other two groups (P < 0.05). CONCLUSION: Multiple deep breaths alone are not as effective as PEEP or PEEP plus MDB in preventing adverse pulmonary effects in laparoscopic bariatric surgeries of morbid obese patients.
RESUMO
BACKGROUND: The aim of this study was to compare the effect of topical glycerol trinitrate ointment (GTN) with topical diltiazem hydrochloride ointment (DTZ) in the treatment of chronic anal fissure. METHOD: Prospectively, 102 patients were treated randomly with either GTN ointment (0.2%) or DTZ ointment (2%) couple of times daily for 12 weeks. RESULTS: Forty-five patients (88.2%) in group DTZ and 36 patients (70.6%) in group GTZ had reduction of symptoms. The decrease in the symptoms for group DTZ were significantly more than that for group GTN (P = 0.02). Mean time of symptom reduction was 2.44 +/- 0.30 in group DTZ and 2.50 +/- 0.28 weeks in group GTN without significant differences between two groups (P > 0.05). Complete relieving of symptoms was observed in 72.5%, 54.9% patients in groups DTZ and GTN, respectively. The frequency of complete relieving of symptoms between two groups was not significant (P > 0.05). Complete remission of anal fissure was occurred in 66.7% patients in group DTZ and 54.9% patients in group GTN, which was no different, significantly. Mean time taken for fissure healing in GTN group was dramatically less than DTZ group (P = 0.001). Finally, 33.3% of patients in DTZ group and 45.1% of patients in GTN group was operated. The need for operation was not significant between two groups (P > 0.05). CONCLUSION: Both DTZ and GTN are equally effective and can be the preferred first-line treatment of chronic anal fissure a. However, GTN is associated with a higher rate of headache, and it should be replaced by DTZ.
