Implications of anesthetic techniques on patients' recovery in laparoscopic cholecystectomy

Background/Aim. Different techniques of general anesthesia are used for laparoscopic cholecystectomy (LC). The aim of the study was to establish the best anesthetic technique for achieving better results during awakening affecting not only patient's recovery, but activities of anesthesiological team, as well. Methods. The study was conducted as a prospective comparative clinical trial. The patients (n=90) were classified according to the applied anesthetic technique into two groups: Volatile Induction and Maintenance Anesthesia (VIMA) with sevofluran and Target Controlled Infusion (TCI). The results relating to parameters of recovery after anesthesia and surgery were compared between these two groups. The following parameters were analyzed: demographic patients' characteristics, duration of anesthesia, the times to eye opening, to respond to a command, to extubation, and to orientation, from the last anesthetic dose receiving until post anesthesia discharge (PAD), frequency of postoperative nausea, vomiting and agitation (PONVA). Results. In the examined groups there were no statistically significant differences in the duration of anesthesia (68.29 ? 6.47 vs 66.29 ? 11.97 min, p = 0.327). The time to eye opening was significantly shorter in the group VIMA compared to the group TCI (4.49 ? 1.20 vs 7.42 ? 1.25 min, p = 0.000), as well as the time to respond to a command (5.93 ? 1.12 vs 8.47 ? 1.08 min, p = 0.000). The patients anesthetized with VIMA technique were statistically significantly extubated earlier (6.84 ? 1.19 vs 9.69 ? 1.31 min, p = 0.000). Considering orientation time, there was also statistically significant difference between the two groups (7.51 ? 0.97 vs 11.60 ? 1.75 min, p = 0.000). There was no statistically significant difference in PAD time duration (19.42 ? 5.99 vs 20.80 ? 1.59 min, p = 0.142). There were no statistically significant differences in PONVA events between the examined groups. Conclusion. This study showed that VIMA technique with sevofluran in LC provides faster and more qualitative recovery of patients. Thus this technique should be applied in everyday anesthesiological procedures in LC, as well as in other minimally invasive videoendoscopic surgical procedures.

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Effectiveness of a home care teaching program for prostatectomized patients: a randomized controlled clinical trial

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2018012503421 ◽

2019 ◽

Vol 53 ◽

Author(s):

Luciana Regina Ferreira da Mata ◽

Cissa Azevedo ◽

Mariana Ferreira Vaz Gontijo Bernardes ◽

Tânia Couto Machado Chianca ◽

Maria da Graça Pereira ◽

...

Keyword(s):

Clinical Trial ◽

Home Care ◽

Self Efficacy ◽

Intervention Group ◽

Control Group ◽

Controlled Clinical Trial ◽

Teaching Program ◽

Significant Difference ◽

The Times

ABSTRACT Objective: To evaluate the effectiveness of a teaching program for hospital discharge of patients submitted to radical prostatectomy based on the self-efficacy construct of the Cognitive Social Theory. Method: A controlled clinical trial carried out on a 2-month follow-up of 68 prostatectomized men randomized into intervention group (n = 34) and control (n = 34). The intervention group received routine guidance from the service plus the teaching program. The control group only received routine guidance from the service. The data collection instruments were: sociodemographic and clinical questionnaire, self-efficacy scale, hospital depression and anxiety scale, household care knowledge questionnaire, and an item on satisfaction with a score of 1 to 5. Results: There was a significant difference between the intragroups for satisfaction (p<0.001) and knowledge (p<0.001) of the pre-test to the post-test. In the intervention group, there were significant changes between the times for anxiety (p=0.011) and knowledge (p<0.001). Conclusion: The teaching program with a combination of oral guidance, written instruction and telephone follow-up was effective in improving knowledge about home care and personal satisfaction. Brazilian Registry of Clinical Trials: RBR-5n95rm.

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Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/05166 ◽

2021 ◽

Vol 23 (05) ◽

pp. 421-432

Author(s):

Dr. Mohammad Kheiri Mahmod ◽

◽

Dr. Bashar Naser Hussein ◽

Dr. Ammar Hamid Hanoosh ◽

◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Analgesic Effect ◽

Analgesic Requirement ◽

Pain Scores ◽

Post Operative Pain ◽

Significant Difference ◽

Group A ◽

Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

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Comparison of the Costs and Recovery Profiles of Three Anesthetic Techniques for Ambulatory Anorectal Surgery

Anesthesiology ◽

10.1097/00000542-200011000-00015 ◽

2000 ◽

Vol 93 (5) ◽

pp. 1225-1230 ◽

Cited By ~ 121

Author(s):

Shitong Li ◽

Margarita Coloma ◽

Paul F. White ◽

Mehernoor F. Watcha ◽

Jen Wun Chiu ◽

...

Keyword(s):

Oral Intake ◽

Ambulatory Setting ◽

Anesthetic Technique ◽

Patient Acceptance ◽

Intravenous Sedation ◽

Anesthetic Techniques ◽

Anorectal Surgery ◽

Significant Difference ◽

Group 3 ◽

Group 1

Background Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting. Methods Ninety-three consenting adult outpatients undergoing anorectal surgery were randomly assigned to one of three anesthetic treatment groups: group 1 received local infiltration with a 30-ml mixture containing 15 ml lidocaine, 2%, and 15 ml bupivacaine, 0.5%, with epinephrine (1:200,000) in combination with intravenous sedation using a propofol infusion, 25-100 microg. kg-1. min-1; group 2 received a spinal subarachnoid block with a combination of 30 mg lidocaine and 20 microg fentanyl with midazolam, 1-2-mg intravenous bolus doses; and group 3 received general anesthesia with 2.5 mg/kg propofol administered intravenously and 0.5-2% sevoflurane in combination with 65% nitrous oxide. In groups 2 and 3, the surgeon also administered 10 ml of the previously described local anesthetic mixture at the surgical site before the skin incision. Results The mean costs were significantly decreased in group 1 ($69 +/- 20 compared with $104 +/- 18 and $145 +/- 25 in groups 2 and 3, respectively) because both intraoperative and recovery costs were lowest (P < 0.05). Although the surgical time did not differ among the three groups, the anesthesia time and times to oral intake and home-readiness were significantly shorter in group 1 (vs. groups 2 and 3). There was no significant difference among the three groups with respect to the postoperative side effects or unanticipated hospitalizations. However, the need for pain medication was less in groups 1 and 2 (19% and 19% vs. 45% for group 3; P < 0.05). Patients in group 1 had no complaints of nausea (vs. 3% and 26% in groups 2 and 3, respectively). More patients in group 1 (68%) were highly satisfied with the care they received than in groups 2 (58%) and 3 (39%). Conclusions The use of local anesthesia with sedation is the most cost-effective technique for anorectal surgery in the ambulatory setting.

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CHOLECYSTECTOMY;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.07.1033 ◽

2017 ◽

Vol 24 (07) ◽

pp. 1062-1066

Author(s):

Bashir Ahmed ◽

Hamid Raza ◽

Kamlaish -

Keyword(s):

Laparoscopic Cholecystectomy ◽

Patient Population ◽

P Value ◽

Care Hospital ◽

Rescue Analgesia ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Eye Opening ◽

Group B

Objectives: The aim of our study which is to compare total intravenousanesthesia with target controlled infusion using the drugs Propofol and remifenatnil with thetechniques of volatile induction maintenance anesthesia using sevoflurane and sufentanil inpatients undergoing laparoscopic cholecystectomy procedure, at a tertiary care hospital inKarachi, Pakistan. Study Design: The type of study is a randomized control trial, conductedfor a period of 8 months Period: from June 2015 to January 2016 Setting: at a tertiary carehospital in Karachi Pakistan. Method: The patient population consisted of n=100 patientsbelonging to the ASA class I and II and undergoing laparoscopic cholecystectomy procedure atour institute. The patients were divided into two groups group A consisted of all those patientswho underwent total intravenous anesthesia and group B consisted of patients who underwentvolatile induction maintenance anesthesia. Appropriate blinding measures were taken for thosewho were involved in the post-operative care of the patients, and the patients themselves. Duringthe procedure routine monitoring was done, data was recorded in a pre-designed proforma.Patients were analyzed in the post-operative period for side effects and pain levels. Statisticalanalysis was done using SPSS version 23, a p value of less than 0.05 was considered to bestatistically significant. Results: The patient population consisted of n= 100 patients dividedinto two groups. No statistically significant difference was found between the demographicvariables of the patients of both groups (age, weight, baseline values of blood pressure, heartrate, time duration of surgery and anesthesia). The time for the loss of corneal reflex was longerin the group A (109 +/- 90) as compared to group B (45 +/- 10) having a p value of less than0.001. However the time for opening of the eyes and the duration of post anesthesia care unitwas shorter in group A (420 +/- 130 seconds for eye opening and 45 +/- 15 min for PACU) andin group B (484 +/- 116 seconds for eye opening and 53 +/- 25 mins for PACU) having p valuesof 0.006 (eye opening) and 0.017 (PACU) respectively. In group A n= 44 (88%) of the patientsrequired rescue analgesia, and in group B n= 36 (72%) of the patients required it, having a pvalue of 0.013 respectively. The need for the use of ephedrine and atropine in the pre and portoperative period was similar in both the groups. Conclusion: According to the results of ourstudy we found that each method of anesthesia has its own advantages and disadvantagesand the anesthetist present should weigh the risks and benefits for each patient individually,and use the most beneficial method of administration of anesthesia in the patient undergoinglaparoscopic cholecystectomy procedure, accordingly.

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Comparison of 3-port with standard 4-port laparoscopic cholecystectomy: A clinical trial

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.2.101 ◽

2020 ◽

pp. 52-57

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Gallstone Disease ◽

Control Group ◽

P Value ◽

Case Group ◽

Double Blind ◽

Laparoscopic Cholecystectomy Group ◽

Significant Difference ◽

Duration Of Surgery

Introduction: Since the laparoscopic cholecystectomy was introduced first in 1990, the 4-port laparoscopic cholecystectomy was the gold standard. The 4-port (lateral) is used to hold gallbladder fundus and observe Calot's triangle. It is discussed that the 4-port technique is not required in many patients. Therefore, this study aimed to make a comparison between 3-port and 4-port laparoscopic cholecystectomy methods in the treatment of gallstone disease. Methods: A double-blind clinical trial was performed on patients admitted to Imam Reza Hospital, Birjand, Iran. The patients with gallstone disease (n=60) were randomly assigned into the case (3-port) and control (4-port) groups using balanced block randomization and underwent 3- or 4-port laparoscopic cholecystectomy. Postoperative pain was measured by a visual analog scale four h after surgery. The amount of pain-killer, duration of surgery, as well as length of stay and scars were measured in this study. Data were analyzed statistically in SPSS software (version 18) through the Chi-square test and t-test. A p-value less than 0.05 was considered statistically significant. Results: The groups were compared in terms of demographic characteristics. There were 24 females (80%) and 6 males (20%) in the control group and 25 females (83.4%) and 5 males (16.7%) in the case group (P=0.739). Moreover, the mean ages of the control and case groups were 59.823±7.8 and 61.10±4.7, respectively, and there was no significant difference between the groups in this regard (P=0.348). Furthermore, length of operation (P=0.001) and analgesic consumption (P=0.001) in the 3-port laparoscopic cholecystectomy group were lower than those in the 4-port group; however, the hospital stay (P=0.896) was the same in both groups. Conclusions: The 3-port laparoscopic cholecystectomy is a safe, reliable, and cost-effective method in patients who underwent laparoscopic cholecystectomy.

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

PLoS ONE ◽

10.1371/journal.pone.0247088 ◽

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.

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Effects of dexmedetomidine addition to low concentration of lidocaine/ropivacaine mixtures for ultrasound-guided axillary brachial plexus block

10.21203/rs.3.rs-26724/v1 ◽

2020 ◽

Author(s):

Qi Wang ◽

Wengang Ding ◽

Lu Feng ◽

Wenzhi Li

Keyword(s):

Clinical Trial ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Onset Time ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Low Concentration ◽

Significant Difference ◽

The Times ◽

Plexus Block

Abstract BackgroundDexmedetomidine(DEX) has been used in combination with different local anesthetics (LAs) to improve the quality of peripheral nerve blocks. However, there is little evidence of the effects of DEX in a mixture of two LAs for brachial plexus block (BPB).The aim of this study was to investigate if DEX combined with low concentration of lidocaine/ropivacaine mixtures may further reduce the onset time and prolong block duration and analgesia time for performing ultrasound-guided axillary BPB.MethodsSeventy-five ASA Ι or II patients, scheduled for forearm or hand surgery were randomly allocated into three groups: Group R (n = 25) received 30 mL of 0.25% ropivacaine + 3 mL of 0.9% NaCl; Group RL (n = 25) received 30 mL of 1:1 0.25% ropivacaine/0.5% lidocaine + 3 mL of 0.9% NaCl; Group RLD (n = 25) received 30 mL of 1:1 0.25% ropivacaine/ 0.5%lidocaine + 3 mL of 0.75 µg/kg DEX. The hemodynamic changes, BIS values, onset time and duration of sensory and motor blocks, the analgesic time and the times of rescue analgesics within 48 h were recorded.ResultsThe onset times of sensory and motor blocks were significantly shorter in group RL and group RLD compared with group R (P < 0.0001), but no significant difference was detected between group RL and group RLD (P > 0.05). The analgesic time and the block durations in group RLD were significantly longer than that in group R and group RL (P < 0.0001). In group RLD, the times of flurbiprofen treatment were significantly reduced compared with group R and group RL(P < 0.0001). The BIS values in group RLD were significantly decreased than those of group R and group RL from 20 min till 60 min(P < 0.05).ConclusionsCombination of ropivacaine and lidocaine produces shorter onset time than ropivacaine alone in axillary BPB. DEX added to ropivacaine/lidocaine mixtures prolongs the duration of sensory and motor blocks, extends analgesic time and exerts a considerable sedative effect.Trial registrationThe clinical trial was registered in “Chinese Clinical Trial Registry” (http://www.chictr.org.cn/index.aspx) and the registered number was “ChiCTR-IPR-16007742”, on 12th January 2016.

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Variability of anesthetic depth in total intravenous anesthesia vs balanced anesthesia using entropy indices: a randomized, crossover, controlled clinical trial

Colombian Journal of Anesthesiology ◽

10.1097/cj9.0000000000000163 ◽

2020 ◽

Vol 48 (3) ◽

pp. 111-117

Author(s):

Henry Oliveros ◽

Fernando Ríos ◽

Daniel A. Botero-Rosas ◽

Sandra C. Quiroga ◽

Freddy C. Cifuentes ◽

...

Keyword(s):

Clinical Trial ◽

Total Intravenous Anesthesia ◽

Controlled Clinical Trial ◽

Anesthetic Techniques ◽

Depth Of Anesthesia ◽

Minimal Alveolar Concentration ◽

Intravenous Anesthesia ◽

Significant Difference ◽

Balanced Anesthesia ◽

The Individual

Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening. Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5mg/mL for 15minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t test. Results: The treatment effect showed no significant difference in the average values of RE, during TIVA=97.23 vs BA 97.04 (P=0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different. Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.

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Investigation of Ondansetron, Haloperidol, and Dexmedetomidine Efficacy for Prevention of Postoperative Nausea and Vomiting In Patients with Abdominal Hysterectomy

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.366 ◽

2018 ◽

Vol 6 (9) ◽

pp. 1659-1663 ◽

Cited By ~ 4

Author(s):

Alireza Kamali ◽

Lida Ahmadi ◽

Maryam Shokrpour ◽

Shirin Pazuki

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Randomised Clinical Trial ◽

Abdominal Hysterectomy ◽

The Other ◽

Nausea And Vomiting ◽

Significant Difference ◽

The Mean

AIM: This study was aimed to compare the effects of ondansetron, haloperidol, and dexmedetomidine for reducing postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. METHODS: This randomised clinical trial study was performed on p.patients who were candidates for abdominal hysterectomy referring to Taleghani hospital in Arak. In this study, 114 patients with abdominal hysterectomy were randomly assigned to three groups (ondansetron, haloperidol, and dexmedetomidine) using the cubull randomisation method. RESULTS: The results revealed a significant difference between the three groups of ondansetron, haloperidol and dexmedetomidine in terms of scorpion vomiting in recovery, 2 and 4 hours after surgery, and vomiting score was significantly lower in the ondansetron group compared with the other two groups (P = 0.04; P = 0.02; P = 0.001). There was a significant difference between the three groups of e ondansetron, haloperidol and dexmedetomidine regarding the mean dose of metoclopramide in mg for 24 hours after surgery. Therefore, the dosage of dexmedetomidine in the ondansetron group was less than the other two groups (P = 0.001). CONCLUSION: these three drugs are effective in reducing PONV in patients undergoing a hysterectomy. However, the effect of ondansetron was found to be more than the other two drugs in reducing PONV.

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Efficacy of methadone for the management of postoperative pain in laparoscopic cholecystectomy: A randomized clinical trial

Medwave ◽

10.5867/medwave.2021.02.8134 ◽

2021 ◽

Vol 21 (02) ◽

pp. e8134-e8134

Author(s):

Nicolás Arriaza ◽

Cristian Papuzinski ◽

Matías Kirmayr ◽

Marcelo Matta ◽

Fernando Aranda ◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Pain Management ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Postoperative Pain Management ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Methadone Group ◽

Eye Opening

Background Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. Methods We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). Results Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. Conclusion Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

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