Attending Surgeons Demonstrate Greater Correlations of Skill Assessment and Anticipation of Adverse Events Than Residents During Laparoscopic Cholecystectomy

Background: Being one of the most commonly performed surgery in the modern era, post-operative complications following laparoscopic cholecystectomy deserve special mention. Though not very life threatening, they are quite common. Considering these aspects, this study aims to identify them and possibly a potential remedy for decreasing the incidence in the future.Methods: This is a retrospective, institution-based, observational and cross-sectional analysis conducted in R.G. KAR Medical College and Hospital over 5 years on 1000 patients undergoing surgery. Here we intend to observe the adverse events following laparoscopic cholecystectomy in the post-operative period.Results: Most of the complications were seen in the age group greater than 40 years(63%) followed by the age group 30-40 years (26%).Adverse events were much more common in females (85%) followed by males (15%). The symptoms appeared mostly during 3-7 days post operatively (57%) followed by 20% within the first 6 hours. Non-specific abdominal pain (28%) was the most common adverse event followed by port-site infection in 16.5% cases.Conclusions: Proper pre-anaesthetic check-up with proper instrument handling with proper caution and before closing confirmation of proper placement of clip and no other unintentional injury anywhere can decrease the post-operative complication.

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Dexmedetomidine as a Single Bolus Dose in Laparoscopic Cholecystectomy under General Anesthesia – A Comparison of Different Doses

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i2.31415 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1045-1049

Author(s):

Kumud Pyakurel ◽

Lalit Kumar Rajbanshi ◽

Chitra Thapa ◽

Gunjan Regmi

Keyword(s):

Heart Rate ◽

Laparoscopic Cholecystectomy ◽

Mean Arterial Pressure ◽

Adverse Events ◽

Arterial Pressure ◽

General Anesthesia ◽

Induction Dose ◽

Pharmacodynamic Profile ◽

Duration Of Surgery ◽

Sedation Scores

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

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Comparative Study between General and Thoracic Epidural Anesthesia in Laparoscopic Cholecystectomy as Regard to Postoperative Pain , Adverse Events and Patient Satisfaction

Al-Azhar Medical Journal ◽

10.12816/0015760 ◽

2015 ◽

Vol 43 (1) ◽

pp. 49-57

Author(s):

Adel El Hadi Ahmed Diab

Keyword(s):

Patient Satisfaction ◽

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Adverse Events ◽

Comparative Study ◽

Epidural Anesthesia ◽

Thoracic Epidural Anesthesia ◽

Thoracic Epidural

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Monetary Lessons from Litigation Involving Laparoscopic Cholecystectomy

The American Surgeon ◽

10.1177/000313480507100714 ◽

2005 ◽

Vol 71 (7) ◽

pp. 606-612 ◽

Cited By ~ 3

Author(s):

Thomas R. Mclean

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Adverse Events ◽

Limited Information ◽

Red Flags ◽

Negotiated Settlement ◽

Bile Duct Injuries ◽

The Relationship

Limited information exists on the relationship between adverse events associated with laparoscopic cholecystectomy (LC) and subsequent litigation. Out of 104 suits concerning LC, 18 cases were settled for $628,138; 48 cases resulted in a plaintiff's verdict with the plaintiff receiving $2,891,421; and 18 cases resulted in a surgeon's verdict. However, when multiple defendant cases were excluded, there was <$20,000 difference between a negotiated settlement and plaintiff's verdict. Given the minimal monetary differences between a settlement and a plaintiff's verdict, when a surgeon is the sole defendant in a malpractice case concerning LC, the surgeon should encourage their carriers not to settle before trial; as only a trial will exonerate the surgeon. However, this encouragement should be tempered when there are “red flags” that favor the plaintiff, including multiple defendants (especially a hospital), male plaintiffs, bile duct injuries, knowledgeable and well-financed plaintiff's attorneys, and certain plaintiff's venues.

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