scholarly journals Surgeon’s physical and mental stress while performing laparoscopic cholecystectomy

2017 ◽  
Vol 4 (4) ◽  
pp. 111-117
Author(s):  
Mukund Raj Joshi ◽  
Tanka P Bohara ◽  
Anuj Parajuli ◽  
Shail Rupakheti
Keyword(s):  
Patient Outcome ◽  
Laparoscopic Cholecystectomy ◽  
Mental Stress ◽  
Analogue Scale ◽  
Laparoscopic Cholecystectomy Group ◽  
The Difference ◽  
Clinically Significant ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Additional Port

Background: Laparoscopic cholecystectomy is performed either by four port or three port. Although the overall patient outcome has been studied with comparable results, surgeon’s stress level has not been addressed commonly.Objective: To compare the difference in surgeon’s physical and mental stress between three port and four port laparoscopic cholecystectomy.Methods: This prospective randomized comparative study was carried out from January 2014 to August 2014 in patients undergoing laparoscopic cholecystectomy with American technique. Patients were randomized into four port laparoscopic cholecystectomy group and three port laparoscopic cholecystectomy group. Surgery was performed by experienced laparoscopic surgeons. At the end of procedure, surgeons were given questionnaire to evaluate physical and mental stress faced by them based on Visual Analogue Scale. The results obtained were compared.Results: Total 60 cases were evaluated, 30 in each group. Mean age of patients and American society of Anesthesiologists score were not different. Surgeon’s perception regarding physical and mental stress while performing in two different groups was analyzed. The difference is not statistically significant. Neither any of the three port group needed to add additional port nor any of the patients were converted to open surgery. None of the patient in either group developed clinically significant complication.Conclusion: Both the four and three port laparoscopic cholecystectomy techniques are comparable in regards to patient outcome as well as to the physical and mental stress experienced by the surgeons.

Anaesthesia data

2018 ◽  
Author(s):  
Charles Gibson ◽  
Fred Roberts
Keyword(s):  
Patient Outcome ◽  
Normal Values ◽  
Pulmonary Function Tests ◽  
Cardiovascular Physiology ◽  
Confidential Enquiry ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Selection Of

This final chapter contains a selection of useful information for the anaesthetist, gathered together for convenience and for the aid of revision in examinations. It contains the American Society of Anesthesiologists classification, the (National) Confidential Enquiry into Patient Outcome and Death classification, the Mapleson classification of breathing systems, a discussion of pulmonary function tests and their normal values, cardiovascular physiology data, the Glasgow Coma Scale, and a series of useful anaesthetic equations and definitions. It concludes with a table of normal values, a list of useful websites, and a checklist for anaesthetic equipment.

scholarly journals Comparison in Sedative Effects between Dexmedetomidine and Midazolam in Dental Implantation: A Randomized Clinical Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Li Wang ◽  
Yi Zhou ◽  
Tiejun Zhang ◽  
Lili Huang ◽  
Wei Peng
Keyword(s):  
Vital Signs ◽  
Pain Scores ◽  
Dental Implantation ◽  
Group I ◽  
Random Manner ◽  
The Difference ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Adrenergic Receptor Agonist ◽  
Alternative Drugs

Dexmedetomidine refers to an α2-adrenergic receptor agonist causing potent sedative, analgesic, and minimal respiratory depression compared with alternative drugs. The present study was aimed at comparing the efficaciousness and safety of midazolam and dexmedetomidine as sedatives for dental implantation. We recruited 60 patients belonging to group I or II of the American Society of Anesthesiologists (ASA) and treated them with either midazolam or dexmedetomidine in a random manner. Patients’ duration of analgesia after surgery, surgeon and patient degrees of satisfaction, Observer’s Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, visual analogue scale (VAS) pain scores, and vital signs were recorded variables. Patients administered dexmedetomidine had significantly lower OAAS scores than those administered midazolam (p<0.05). Patients administrated dexmedetomidine had a significantly longer analgesia duration after the surgical procedure than those administered midazolam, and the difference was statistically significant (p<0.05). Dexmedetomidine had a significantly larger number of surgeons satisfied with the level of sedation/analgesia than midazolam (p<0.05). Accordingly, it is considered that dexmedetomidine can achieve better postoperative analgesia, surgeon satisfaction, and sedation than midazolam.

scholarly journals Study of efficacy of combination of dexamethasone and ondansetron versus ondansetron alone using SAMBA guidelines for postoperative nausea and vomiting in laparoscopic cholecystectomy.

2020 ◽  
Vol 27 (09) ◽  
pp. 1839-1844
Author(s):  
Ali Arslan Munir ◽  
Abeera Zareen ◽  
Sumbal Rana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Memory Loss ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Military Hospital ◽  
Significance Level ◽  
American Society ◽  
Group B ◽  
Post Operative Nausea ◽  
American Society Of Anesthesiologists

Objectives: Comparing the effectiveness of combining ondansetron and dexamethasone vs ondansetron unaided in amounts suggested by SAMBA strategies for stoppage of post-operative nausea and vomiting in laparoscopic cholecystectomy patients. Study Design: Randomized Control trial. Setting: Department of Anaesthesia, Combined Military Hospital, Rawalpindi. Period: Six months (April 2015–October 2015). Material & Methods: A sum of 160 patients were experimented by taking 80 in every group. Group A: of ondansetron. Group B: ondansetron plus dexamethasone. Significance level: 5% Test power: 80% Proportion of the projected population A is 72%1. Foreseen population percentage B is 88%1. Besides successive non-probability specimen system was taken for sample gathering. Patients who were selected were American society of anesthesiologists 1 & 2 while ones with struggle in communiqué e.g. psychologic issues, memory loss, loss of speech etc, pregnant and menstruating ladies3, known of PONV, motion disease, ear problems and vertigo, on long term steroid use3, anguished from diabetes mellitus, hiatal hernia were excluded. The frequency of side effects were duly scribed down and doses of drugs wrote down. Rescue anti vomiting was secondhand for ones of PONV. Results: We deduced that mixture of ondansetron & dexamethasone was effectual in averting post-operative nausea & vomiting equated to Ondansetron unaided. Conclusion: There is variance in incidence of PONV in mutual clusters with combination remedy of ondansetron plus dexamethasone being safer as equated to Ondansetron unaided.

scholarly journals Revisiting Mini-Cholecystectomy in Laparoscopic Era – A Retrospective Study

2020 ◽  
Vol 7 (45) ◽  
pp. 2617-2620
Author(s):  
Phungreikan Ningshen ◽  
Khumallambam Ibomcha Singh ◽  
Ningombam Minita Devi ◽  
Malem Devi M ◽  
Yumkhaibam Sabir Ahmed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Hospital Stay ◽  
Resource Constraints ◽  
Operating Time ◽  
Rectus Muscle ◽  
Normal Activity ◽  
Incision Length ◽  
American Society ◽  
American Society Of Anesthesiologists

BACKGROUND Mini-cholecystectomy (MC), with its varied incision length, has long been considered feasible with comparable results to laparoscopic cholecystectomy (LC) 1-6,7 We undertook this study, driven by resource-constraints, by well-experienced surgeons, using 3 - 5 cm incision length, in our patients with low BMI. The aim of this study is to compare the results and outcomes between MC and LC. METHODS In this retrospective study of a prospectively maintained database, first 50 patients each were selected for MC and LC respectively. Operative time, pain-score, SSI (Surgical Site Infection), hospital stay, return to normal activity and complications were compared. RESULTS Both groups were matched for age, sex, BMI (Body Mass Index) and American Society of Anesthesiologists (ASA) grading. The mean operating time for MC was 43 minutes and for LC, 64 minutes. Hospital stay for MC was 1.9 days and for LC was 1.8 days, which was statistically not significant. Return to normal activity was 8 days for MC and 6.6 days for LC. In a subset analysis of eight lean and thin patients using 3 - 3.5 cm length incision with rectus muscle splitting, the return to normal activity was 6.9 days which is comparable to LC patients. CONCLUSIONS Mini-cholecystectomy and laparoscopic cholecystectomy produce comparable patient outcomes. In lean and thin patient, MC may be slightly more advantageous than LC in terms of less operating time. KEYWORDS Mini-Cholecystectomy, Laparoscopic Cholecystectomy, Outcome, Lean and Thin Patient

Preoperative Multimodal Analgesia for Laparoscopic Cholecystectomy

2018 ◽  
pp. 217-222
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Study Groups ◽  
Multimodal Analgesia ◽  
Double Blind Study ◽  
Double Blind ◽  
Same Day Discharge ◽  
Elective Laparoscopic Cholecystectomy ◽  
American Society ◽  
American Society Of Anesthesiologists

This case focuses on the use of local anesthesia, nonsteroidal anti-inflammatory or opioid drugs, for laparoscopic cholecystectomy by asking the question: Does prophylactic multimodal nociceptive blockade delay the onset of postoperative pain, decrease analgesic requirements, speed recovery, and facilitate same-day discharge in patients undergoing elective laparoscopic cholecystectomy? In this randomized, double-blind study, intraoperative anesthetic care and postoperative pain and nausea management were standardized for all patients. Study groups were similar in terms of patient age, gender, weight, American Society of Anesthesiologists class, baseline and preinduction pain and nausea scores, duration of surgery, and total dose of propofol received. This study demonstrated the benefit of preoperative multimodal analgesia on recovery and discharge.

scholarly journals The Effect of Incisional and/or Intraperitoneal Local Anesthetic Application on Postoperative Pain during Laparoscopic Cholecystectomy

2016 ◽  
Vol 1 (05) ◽  
Author(s):  
Oguz Ugur Aydin ◽  
Eda Uysal Aydin ◽  
Ozgur Dandin ◽  
Diğdem Ozer Etik ◽  
Nedım Cekmen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Placebo Group ◽  
Postoperative Pain ◽  
Shoulder Pain ◽  
Postoperative Pain Control ◽  
Combined Application ◽  
Pain Scores ◽  
Group I ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective - In this study, we aimed to determine the effect of levobupivacaine (LB) application by intraperitoneal, incisional, and both together on postoperative pain after laparoscopic cholecystectomy. Materials and Methods - One hundred ASA (American Society of Anesthesiologists) I-II patients undergoing laparoscopic cholecystectomy were recruited in the study. The patients were randomized into four groups: placebo group (P), incisional group (I), intraperitoneal group (IP), and the combined (incisional+intraperitoneal) group (C). In the postoperative period, pain in the patients during resting and coughing was evaluated after 30 min, 2, 4, 8, 12, and 24 hours by employing visual analogue scale (VAS) for pain. Applied analgesic quantity, shoulder pain, and the existence of nausea-vomiting were also recorded. Results - Pain scores during resting and coughing were significantly lower in the combined group compared with others. Pain scores were similar in the incision and intraperitoneal groups, whereas in the placebo group were significantly lower. The analgesic need was lowest in the combined group and highest in the placebo group. There was no shoulder pain either in the combined or intraperitoneal groups. Nausea-vomiting rates were similar in all groups. Conclusions - We conclude that combined application of 0.25 % levobupivacaine can be used as an effective and safe method for postoperative pain control after laparoscopic cholecystectomy.

Diaphragmatic Activity after Laparoscopic Cholecystectomy 

1999 ◽  
Vol 91 (2) ◽  
pp. 406-413 ◽  
Author(s):  
Rajiv R. Sharma ◽  
Hans Axelsson ◽  
Ake Oberg ◽  
Erica Jansson ◽  
Francois Clergue ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cross Section ◽  
Postoperative Phase ◽  
Partial Recovery ◽  
Diaphragmatic Function ◽  
Cross Section Area ◽  
Section Area ◽  
Tidal Changes ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Laparoscopic cholecystectomy is presumed to induce a reduction in diaphragmatic activity. Indirect indices of diaphragmatic function based on tidal changes in pressures and cross-section area measurements can be unreliable in the postoperative phase. The present study evaluates diaphragmatic activity by directly recording diaphragmatic EMG (EMGdia) data, along with indirect indices. Methods Thirteen adult patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy were examined preoperatively for inspiratory tidal changes in gastric (Pgas-insp) and esophageal (Peso-insp) pressures, and tidal changes in ribcage (Vthor) and abdominal (Vabd) cross-section areas and then again at 1, 6, and 24 h postoperatively combined with EMGdia recordings. Variations in inspiratory gastric (deltaPgas-insp) and inspiratory transdiaphragmatic (deltaPdi-insp) pressures were derived from the above. Results Laparoscopic cholecystectomy induced a significant reduction in mean deltaPgas-insp, mean deltaPdi-insp, and mean Vabd indicating a reduction of diaphragmatic activity postoperatively. DeltaPdi-insp decreased from 11.8+/-4.0 cm H2O preoperatively to 5.7+/-5.7 cm H2O at 1 h and 6.6+/-5.1 cm H2O at 6 h postoperatively (mean +/- SD; P &lt; 0.05). Vabd decreased from 327.0+/-113.0 ml preoperatively to 174.0+/-65.0 ml at 1 h and 175.0+/-98.0 ml at 6 h postoperatively (mean +/- SD; P &lt; 0.05). These values had partially recovered at 24 h. Conclusion The direct and indirect indices of diaphragmatic activity taken together confirm the presence of reduction in diaphragmatic activity after laparoscopic cholecystectomy followed by its partial recovery at 24 h.

Three-Port, Two Located on the Pfannenstiel Line, Laparoscopic Cholecystectomy Comparison with Traditional Laparoscopic Cholecystectomy

2017 ◽  
Vol 83 (3) ◽  
pp. 260-264
Author(s):  
Musa Akoglu ◽  
Erdal Birol Bostanci ◽  
Muhammet Kadri Colakoglu ◽  
Erol Aksoy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Results ◽  
Conversion To Open Surgery ◽  
Included Patient ◽  
History Of ◽  
Abdominal Operations ◽  
American Society ◽  
American Society Of Anesthesiologists

Laparoscopic cholecystectomy (LC) is seen as a gateway to minimally invasive surgery. We defined a new three-port technique with different port sites and compared the postoperative results with traditional four-port LC procedure in a case-match study. Between June 2012 and May 2013, 104 consecutive patients underwent three-port LC by same experienced surgeon. In the same center, 2963 consecutive patients underwent four-port LC, and of these 2963 patients, a matched group of 104 patients was selected. Data included patient age, gender, body mass index, American Society of Anesthesiologists score, history of abdominal operations, intraoperative data about operating time and conversion to open surgery, and postoperative data about length of hospital stay and postoperative complications were recorded prospectively. We concluded that our new three-port technique with different port sites is as feasible and safe as traditional four-port technique.

Predictors of Clinically Significant Postoperative Events after Open Craniosynostosis Surgery

2015 ◽  
Vol 122 (5) ◽  
pp. 1021-1032 ◽  
Author(s):  
Susan M. Goobie ◽  
David Zurakowski ◽  
Mark R. Proctor ◽  
John G. Meara ◽  
Petra M. Meier ◽  
...  
Keyword(s):  
Body Weight ◽  
Tranexamic Acid ◽  
Primary Outcome Measure ◽  
Physical Status ◽  
Intraoperative Complication ◽  
Icu Admission ◽  
Increased Risk ◽  
Clinically Significant ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background: Craniosynostosis surgery is associated with clinically significant postoperative events requiring intensive care unit (ICU) admission. The authors investigate specific variables, which might influence the risk for these events, and thereby make recommendations regarding the need for postoperative ICU admission. Methods: A retrospective review of 225 children undergoing open craniosynostosis repair at a single center during a 10-yr period is reported. The primary outcome measure was the incidence of predefined clinically relevant postoperative cardiorespiratory and hematological events requiring ICU admission. Results: The incidences of postoperative cardiorespiratory and hematological events requiring ICU care were 14.7% (95% CI, 10.5 to 20.1%) and 29.7% (95% CI, 24.0 to 36.3%), respectively. Independent predictors of cardiorespiratory events were body weight less than 10 kg, American Society of Anesthesiologists physical status 3 or 4, intraoperative transfusion of greater than 60 ml/kg packed erythrocytes, and the occurrence of an intraoperative complication. The independent predictors of hematological events were body weight less than 10 kg, American Society of Anesthesiologists physical status 3 or 4, intraoperative transfusion of greater than 60 ml/kg packed erythrocytes, transfusion of hemostatic products (fresh-frozen plasma, platelets, and/or cryoprecipitate), and tranexamic acid not administered. Conclusions: Children undergoing craniosynostosis surgery are at increased risk for clinically significant postoperative events requiring ICU admission if they are less than 10 kg body weight, American Society of Anesthesiologists physical status 3 or 4, require intraoperative transfusion of greater than 60 ml/kg of packed erythrocytes, receive hemostatic blood products, or if they develop a significant intraoperative complication. Tranexamic acid administration was associated with fewer postoperative events. A predictive clinical algorithm for pediatric patients having major craniosynostosis surgery was developed and validated to risk stratify these patients.

Evaluating the Association of Preoperative Functional Status and Postoperative Functional Decline in Older Patients Undergoing Major Surgery

2012 ◽  
Vol 78 (12) ◽  
pp. 1336-1344 ◽  
Author(s):  
Steve Kwon ◽  
Rebecca Symons ◽  
Michi Yukawa ◽  
Nikolas Dasher ◽  
Victor Legner ◽  
...  
Keyword(s):  
Functional Decline ◽  
Health Assessment ◽  
Tertiary Hospital ◽  
Major Surgery ◽  
Number Of Patients ◽  
Physical Function Score ◽  
Duke Activity Status Index ◽  
Clinically Significant ◽  
American Society ◽  
American Society Of Anesthesiologists

This prospective cohort study sought to identify predictors of functional decline in patients aged 65 years or older who underwent major, nonemergent abdominal or thoracic surgery in our tertiary hospital from 2006 to 2008. We used the Stanford Health Assessment Questionnaire–Disability Index (HAQ-DI) to evaluate functional decline; a 0.1 or greater increase was used to indicate a clinically significant decline. The preoperative Duke Activity Status Index (DASI) and a physical function score (PFS), assessing gait speed, grip strength, balance, and standing speed, were evaluated as predictors of decline. We enrolled 215 patients (71.2 ± 5.2 years; 56.7% female); 204 completed follow-up HAQ assessments (71.1 ± 5.3 years; 57.8% female). A significant number of patients had functional decline out to 1 year. Postoperative HAQ-DI increases of 0.1 or greater occurred in 45.3 per cent at 1 month, 30.1 per cent at 3 months, and 28.3 per cent at 1 year. Pre-operative DASI and PFS scores were not predictors of functional decline. Male sex at 1 month (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.41 to 6.85); American Society of Anesthesiologists class (OR, 3.41; 95% CI, 1.31 to 8.86), smoking (OR, 3.15; 95% CI, 1.27 to 7.85), and length of stay (OR, 1.09; 95% CI, 1.01 to 1.16) at 3 months; and cancer diagnosis at 1 year (OR, 2.6; 95% CI, 1.14 to 5.96) were associated with functional decline.

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