The optimal combination of mechanical ventilator parameters under general anesthesia in obese patients undergoing laparoscopic surgery

ObjectiveTo describe the features related to patients with Covid-19 admitted to Unimed Recife hospitals, Recife, Brazil, evaluating demographic data, lethality, use of a mechanical ventilator, presence of associated diseases, the need to use the ICU, among other aspects related to the prognosis of these patients.MethodData were collected from the DRG Brazil health management platform, including the period from March 16, 2020, when the first patient with Covid-19 was admitted to the Hospital da Unimed III, until January 31, 2021. All patients admitted to one of the three hospitals of Unimed Recife - Hospital Unimed Recife I, Hospital Unimed Recife III, and Hospital Geral Unimed Recife – were included in the study. In the same period, we evaluated the number of patients with Covid-19 or suspected Covid-19 who were seen in the emergency room at Hospital Unimed Recife III.ResultsOne hundred twenty-six thousand five hundred fifty-three patients were seen in the Emergency Unit of Hospital Unimed Recife III in the period between March 26, 2020, and January 31, 2021; of those 126,553 patients seen in the emergency 39,340 (31.09%) patients were diagnosed with having Covid-19 or suspected of Covid-19. In the 10-month period, 1,039 patients with Covid-19 were hospitalized, 61% with hypertension, 31.1% with SARS, 30.0% with diabetes, and 9.9% were obese. The average hospital stay was 11.2 days. 342/1,039 (32.9%) patients were admitted to the ICU, and 57.9% of them had mechanical ventilation. The overall lethality was 13.76% (143 deaths/1,039 inpatients). An increase in lethality by Covid-19 was associated with increased age. Lethality in the first period of the Covid-19 pandemic was significantly higher when compared to the last 5 months of the pandemic(17.6% versus 9.7%). Obesity significantly increased lethality in patients with Covid-19 [120 deaths/1,016 non-obese patients (11.8%) versus 23 deaths/103 obese patients (22.3%), OR 2.15 (1.30 - 3.50), p = 0.005)].ConclusionWe conclude that Covid-19 is a disease with a poor prognosis, especially in the elderly and obese patients. In the second 5-month period of the Covid-19 pandemic, we noticed a significant reduction in lethality by Covid-19 in hospitalized patients. Covid-19 is a new disease and the mechanism by which the viruses multiply or how the pathophysiological process occurs in the infected organism are still barely understood.

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Assessing the effectiveness of a weight reduction program in hospitalized obese patients undergoing laparoscopic surgery

Gynecology and Minimally Invasive Therapy ◽

10.4103/gmit.gmit_73_20 ◽

2021 ◽

Vol 10 (1) ◽

pp. 44

Author(s):

Kenro Chikazawa ◽

Ken Imai ◽

Takaki Ito ◽

Azusa Kimura ◽

Hiroyoshi Ko ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Weight Reduction ◽

Obese Patients ◽

Weight Reduction Program ◽

Reduction Program

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Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0249808 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0249808

Author(s):

Jorge Kiyoshi Mitsunaga ◽

Vinicius Fernando Calsavara ◽

Elton Shinji Onari ◽

Vinicius Monteiro Arantes ◽

Carolina Paiva Akamine ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Laparoscopic Surgery ◽

General Anesthesia ◽

Controlled Trial ◽

Spinal Block ◽

Trendelenburg Position ◽

General Anesthesia Group ◽

Randomized Controlled ◽

Anesthesia Group ◽

Oncologic Patients

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

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Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery

Journal of Medical Academics ◽

10.5005/jp-journals-10070-0052 ◽

2020 ◽

Vol 3 (2) ◽

pp. 46-49

Author(s):

Hunsehalli Revanasiddappa Narendra ◽

Aparna Nerurkar ◽

Shibu Sasidharan

Keyword(s):

Laparoscopic Surgery ◽

General Anesthesia ◽

Endotracheal Tube ◽

Airway Pressure ◽

Cuff Pressure ◽

Pressure Gauge ◽

Endotracheal Tube Cuff ◽

Tube Cuff ◽

Observational Analysis ◽

Endotracheal Tube Cuff Pressure

ABSTRACT Background Laparoscopic surgery is performed under general anesthesia with mechanical ventilation, and a high-volume, low-pressure endotracheal tube (ETT) with a sealing cuff pressure about 20–30 cm of H2O is commonly used for a proper seal and avoidance of overinflation. Nitrous oxide (N2O) is an inhalational anesthetic that is used with oxygen in the ratio 50:50 for the maintenance of anesthesia if there is no facility of medical air. However, N2O increases the intracuff pressure of the tracheal tube due to diffusion of N2O in to cuff during general anesthesia. The present research was done to study the cuff pressure changes during laparoscopic surgeries with N2O anesthesia and to assess its variation during the various stages of surgery and also its correlation with position of the patient. Materials and methods A study was done in a tertiary-level hospital over a period of 1 year in 70 patients undergoing laparoscopic surgery. Endotracheal tube was inflated with incremental doses of 0.5 mL of air to a point where no leak on auscultation on the suprasternal area was noted. Cuff pressure measurement using cuff pressure monitor (Hand pressure gauge) was done at the time of first inflation of cuff up to 20–30 cm of H2O and airway pressure, along with total amount of air inflated was noted as “zero” reading. Thereafter, cuff pressure was measured at regular interval of 5 minutes. Cuff pressures and airway pressures were taken just prior to insufflation, 2 minutes after abdominal insufflation, thereafter every 15 minutes throughout surgery, and 2 minutes after desufflation and prior to extubation. Results Out of 70 patients, maximum patients were of the age-group of 20–50 years (78.5%). There was no statistically significant difference between the groups. Cuff pressure at the induction was kept in range of 20–30 cm of H2O. In this study, mean tracheal cuff pressure at baseline was 21.10 + 6.16 (p value of 0.207) and prior to insufflation was 21 + 7.13 (p value of 0.733). The cuff pressures at 2 minutes post insufflation (P2), P15, P30, P45, and P60 were 31.40 ± 12.54 cm of H2O, 25.79 ± 8.68 cm of H2O, 24.61 ± 7.37 cm of H2O, 23.83 ± 9.43 cm of H2O, and 24.63 ± 4.77 cm of H2O, respectively. p value was strongly significant showing a positive correlation between pneumo-peritoneum and cuff pressures. We could see the cuff pressure continuously increasing in successive readings. Post desufflation and prior to extubation, there was a fall in cuff pressure with mean cuff pressure being 17.24 + 5.32 cm of H2O and 15.27 + 4.00 cm of H2O, respectively, which also suggests that cuff pressures increased with pneumoperitoneum. Conclusion Use of N2O increases the cuff pressure (31.4 + 12.54 cm of H2O), especially immediately post-insufflation (35.54 + 12.06 cm of H2O), more so in head low position (36.28 + 12.13 cm of H2O). Mean airway pressure (Ppeak) also increased with pneumoperitoneum (22.60 + 4.38 cm of H2O). The regular monitoring of endotracheal tube cuff pressure should be a part of regular safe practice of anesthesia, and use of handy device like hand pressure gauge should be implemented in regular practice where N2O is used. How to cite this article Narendra HR, Nerurkar A, Sasidharan S. Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery. J Med Acad 2020;3(2):46–49.

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