Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery

Effect of deep breathing exercise on oxygenation of patients under major abdominal surgery: randomized clinical trial

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2021.9.1.102 ◽

2021 ◽

pp. 8-16

Keyword(s):

Blood Pressure ◽

Clinical Trial ◽

Abdominal Surgery ◽

Randomized Clinical Trial ◽

T Test ◽

Major Abdominal Surgery ◽

Deep Breathing ◽

Breathing Exercise ◽

And Control ◽

Experimental Group

Introduction: The number of major abdominal surgical procedures is increasing around the world. A large number of the patients complain about postoperative pulmonary complications (PPCs) after abdominal surgery and show symptoms of breathing pattern disorder. Therefore, this study aimed to investigate the effect of deep breathing exercise on the oxygenation of patients undergoing major abdominal surgery. Methods: This single-blind randomized clinical trial was conducted on 40 patients who needed major abdominal surgery in Qom, Iran, in 2014. The participants were divided into two equal experimental (n=20) and control (n=20) groups. The cases in both groups received routine care, however, those in the experimental group exercised repeated deep breathing four times per hour for two consecutive hours after the surgery as well. The condition of the patients in both groups was similar in terms of position, mobility, and oxygen therapy. The patient’s oxygen saturation, respiratory rate (RR), heart rate, and the severity of pain in the surgery site were measured. The collected data were analyzed in SPSS software (Version. 18) using paired t-test, independent t-test, Mann-Whitney U test, Wilcoxon rank-sum test, Multiple regression analyses, Chi-square test, and Fischer’s exact test. A p-value less than 0.05 was considered statistically significant. Results: Based on the study findings, the deep breathing exercise significantly reduced the surgery site pain and mean blood pressure and increased O2 saturation in the experimental group after the intervention (P<0.05). Moreover, there was a statistically significant difference between the experimental and control groups, and a significantly higher O2 saturation was observed in the experimental group after deep breathing exercise post-operation (β=2.01, P<0.001). Conclusion: Deep breathing exercises can reduce the severity of pain in the surgery site and mean arterial blood pressure and increase O2 saturation in patients after major abdominal surgery.

Download Full-text

Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia

Anesthesiology ◽

10.1097/aln.0000000000002634 ◽

2019 ◽

Vol 130 (5) ◽

pp. 745-755 ◽

Cited By ~ 9

Author(s):

Fleur S. Meijer ◽

Chris H. Martini ◽

Suzanne Broens ◽

Martijn Boon ◽

Marieke Niesters ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Relative Risk ◽

Abdominal Surgery ◽

Standard Care ◽

Clinical Care ◽

Major Abdominal Surgery ◽

Control Group ◽

Noxious Stimulation ◽

Vasoactive Medication

Abstract Editor’s Perspective What We Already Know about This Topic The nociception level index (Medasense Biometrics Ltd., Ramat Gan, Israel), is a reliable measure of moderate to intense noxious stimulation during anesthesia and surgery What This Article Tells Us That Is New In a randomized trial in patients having major abdominal surgery, compared to standard practice, nociception level-guided analgesia resulted in 30% less intraoperative remifentanil consumption Background The multidimensional index of nociception, the nociception level, outperforms blood pressure and heart rate in detection of nociceptive events during anesthesia. We hypothesized that nociception level–guided analgesia reduces opioid consumption and suboptimal anesthesia events such as low blood pressure and use of vasoactive medication. Methods In this single-blinded randomized study, 80 American Society of Anesthesiologists class I–III adult patients of either sex, scheduled for major abdominal procedures under remifentanil/propofol anesthesia by target-controlled infusion, were included. During the procedure nociception level, noninvasive blood pressure, and heart rate were monitored. Patients were randomized to receive standard clinical care or nociception level–guided analgesia. In the nociception level–guided group, remifentanil concentration was reduced when index values were less than 10 or increased when values were above 25 for at least 1 min, in steps of 0.5 to 1.0 ng/ml. Propofol was titrated to bispectral index values between 45 and 55. The primary outcomes of the study were remifentanil and propofol consumption and inadequate anesthesia events. Results Compared with standard care, remifentanil administration was reduced in nociception level–guided patients from (mean ± SD) 0.119 ± 0.033 to 0.086 ± 0.032 μg · kg-1 · min-1 (mean difference, 0.039 μg · kg-1 · min-1; 95% CI, 0.025–0.052 μg · kg-1 · min-1; P < 0.001). Among nociception level–guided patients, 2 of 40 (5%) experienced a hypotensive event (mean arterial pressure values less than 55 mm Hg) versus 11 of 40 (28%) patients in the control group (relative risk, 0.271; 95% CI, 0.08–0.77; P = 0.006). In the nociception level–guided group, 16 of 40 (40%) patients received vasoactive medication versus 25 of 40 (63%) patients in the standard care group (relative risk, 0.64; 95% CI, 0.40–0.99; P = 0.044). Conclusions Nociception level-guided analgesia during major abdominal surgery resulted in 30% less remifentanil consumption.

Download Full-text