scholarly journals The Effects of Different Pressure Pneumoperitoneum on the Pulmonary Mechanics and Surgical Satisfaction in the Laparoscopic Cholecystectomy

2021 ◽  
Vol 17 (6) ◽  
pp. 33-41
Author(s):  
B. Küçüköztaş ◽  
L. İyilikçi ◽  
S. Ozbilgin ◽  
M. Ozbilgin ◽  
T. Ünek ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minute Ventilation ◽  
Peak Inspiratory Pressure ◽  
Low Pressure ◽  
Pulmonary Mechanics ◽  
Abdominal Pressure ◽  
Hemodynamic Parameters ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
Standard Pressure

Objectives. Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient position. This study aims to evaluate the effects of intra-abdominal pressure increase based on CO2 pneumoperitoneum in laparoscopic operations on hemodynamic parameters and respiratory dynamics and satisfaction of surgeon and operative view.Materials and Methods. A total of 116 consecutive, prospective, ASA class I–III cases aged 18–70 years undergoing laparoscopic cholecystectomy were enrolled in this study. Data of 104 patients were analysed. Patients were divided into two groups as the group Low Pressure (<12 mmHg) (Group LP) (n=53) and the group Standard Pressure (>13 mmHg) (Group SP) (n=51). In this study administration of general anesthesia used total intravenous anaesthesia in both groups. All groups had standard and TOF monitorization applied. The anaesthesia methods used in both groups were recorded. Before, during and after peritoneal insufflation, the peroperative ventilation parameters and hemodynamic parameters were recorded. The adequacy of pneumoperitoneum, gastric and the operative view were evaluated by the operating surgeon and recorded.Results. The peripheral oxygen saturation showed no significant difference between the low and standard pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, and minute ventilation values. In terms of hemodynamics, when values just after intubation and before extubation were compared, it was observed that in the LP group systolic, diastolic and mean blood pressure values were higher. In terms of heart rate, no significant difference was observed in determined periods between groups. There was no significant difference between the groups in terms of surgical satisfaction and vision.Conclusion. Low pressure pneumoperitoneum provides effective respiratory mechanics and stable hemodynamics for laparoscopic cholecystectomy. It also provides the surgeon with sufficient space for hand manipulations. Anaesthetic method, TIVA and neuromuscular blockage provided good surgery vision with low pressure pneumoperitoneum.

scholarly journals Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

2018 ◽  
Vol 9 (4) ◽  
pp. 17-22
Author(s):  
Bikash Chandra Ghosh ◽  
Ambar Gangopadhyay
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Gall Stone ◽  
Low Pressure ◽  
Stone Disease ◽  
Care Hospital ◽  
Significant Difference ◽  
Gall Stone Disease ◽  
Standard Pressure ◽  
Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

scholarly journals Comparative evaluation of hemodynamic and capnographic changes in low pressure versus normal pressure pneumoperitoneum in laparoscopic cholecystectomy

2017 ◽  
Vol 4 (8) ◽  
pp. 2642
Author(s):  
Shailendra Pal Singh ◽  
Shashank Verma ◽  
Anand Pandey ◽  
Usha Shukla ◽  
Vipin Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Normal Pressure ◽  
Low Pressure ◽  
Abdominal Pressure ◽  
Group A ◽  
Standard Pressure ◽  
Group B ◽  
Control Study ◽  
Mean Heart Rate

Background: In laparoscopic cholecystectomy (LC), the extent of hemodynamic changes associated with creation of pneumoperitoneum depends on the intra-abdominal pressure attained, volume of CO2 absorbed, and patient’s intravascular volume. In our study, we attempted to compare the hemodynamic and capnographic changes in the low pressure (<8mm Hg) and standard pressure (12-14mm Hg) LC.Methods: In this randomized case control study, Group A included patients undergoing Low pressure LC (<8mm Hg). In group B, Standard pressure LC (12-14mmHg) was performed. Both groups were evaluated for the hemodynamic and capnographic changes and other parameters.Results: Difference in mean heart rate of Group A and Group B was found to be statistically significant at 10 min after induction. After 30 minutes of surgery, systolic blood pressure of Group B was found to be higher than that of Group A (p <0.05). Differences in diastolic blood pressure among patients of Group A and Group B were found to be statistically significant only at 30 min and 40 min after induction. Except at 30 min after induction, differences in EtCO2 levels of patients of Group A and Group B were found to be statistically significant.Conclusions: It appears that low pressure pneumoperitoneum appears to be having fewer effects on blood pressure- both systolic and diastolic, as compared to standard pressure pneumoperitoneum in patients undergoing LC. It also appears to be causing fewer derangements in ETCO2. This may help in smooth recovery and less post-operative problems.

scholarly journals Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247088
Author(s):  
Marcos Antonio Marton Filho ◽  
Rodrigo Leal Alves ◽  
Paulo do Nascimento ◽  
Gabriel dos Santos Tarquinio ◽  
Paulo Ferreira Mega ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Cystatin C ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Low Pressure ◽  
Abdominal Pressure ◽  
Pressure Group ◽  
Significant Difference

Background Increased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers. Methods This randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P10-12, 10–12 mm Hg) and a low intra-abdominal pressure group (P6-8, 6–8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant. Results In total, 64 patients completed the study—33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups. Conclusions In laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.

scholarly journals Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

2017 ◽  
Vol 4 (11) ◽  
pp. 3740
Author(s):  
Salil Mahajan ◽  
Manu Shankar ◽  
Vinod K. Garg ◽  
Vijender Gupta ◽  
Jaya Sorout
Keyword(s):  
High Pressure ◽  
Laparoscopic Cholecystectomy ◽  
Shoulder Pain ◽  
Postoperative Period ◽  
Low Pressure ◽  
Randomized Clinical Study ◽  
Early Return ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Bile Spillage

Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial

2016 ◽  
Vol 31 (3) ◽  
pp. 1287-1295 ◽  
Author(s):  
Hemanga K. Bhattacharjee ◽  
Azarudeen Jalaludeen ◽  
Virinder Bansal ◽  
Asuri Krishna ◽  
Subodh Kumar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Randomised Controlled Trial ◽  
Shoulder Pain ◽  
Controlled Trial ◽  
Low Pressure ◽  
Standard Pressure ◽  
Randomised Controlled

scholarly journals Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Ali Ghomeishi ◽  
Ahmad Reza Mohtadi ◽  
Kaveh Behaeen ◽  
Sholeh Nesioonpour ◽  
Nima Bakhtiari ◽  
...  
Keyword(s):  
Heart Rate ◽  
Laparoscopic Cholecystectomy ◽  
Stress Hormones ◽  
Endocrine System ◽  
Atrial Pressure ◽  
Hemodynamic Parameters ◽  
Hemodynamic Variables ◽  
Anesthetic Drugs ◽  
Epinephrine Level ◽  
Significant Difference

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient. Objectives: The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery. Methods: Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method. Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001). Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

scholarly journals Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

2019 ◽  
Vol 2 (2) ◽  
pp. 47-51
Author(s):  
Sania Waseem ◽  
Humera Naz Altaf ◽  
Sehrish Latif ◽  
Omar Shahzad Altaf ◽  
Fareeha Farooqui ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Cavity ◽  
Low Pressure ◽  
Intraabdominal Pressure ◽  
P Value ◽  
Reduced Pressure ◽  
Quasi Experimental ◽  
Group A ◽  
Standard Pressure ◽  
Group B

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (<12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain. Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum Methods: Our study was quasi experimental study conducted at  KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value.  Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = <0.001). Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

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