Effect of different doses of remifentanil on stress response during laparoscopic cholecystectomy

2019 ◽  
Vol 15 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Laura Levantesi, MD ◽  
Flaminio Sessa, MD ◽  
Elisabetta Congedo, MD ◽  
Francesco Di Nardo, MD ◽  
Marco Oggiano, MD ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Stress Response ◽  
Venous Blood ◽  
Stress Hormones ◽  
Insertion Time ◽  
Perioperative Analgesia ◽  
Trocar Insertion ◽  
Control Pain ◽  
Double Blinded ◽  
Different Doses

Objectives: An adequate perioperative analgesia reduces neuroendocrine stress response and postoperative complications. Opioids are the most effective parenteral drugs to control pain and stress response.Design: This is a prospective randomized double-blinded controlled study.Setting: Institutional tertiary level.Patients, participants: Fifty patients underwent general anesthesia with desflurane for laparoscopic cholecystectomy.Main outcome measures: To compare two different doses of remifentanil (0.15 mcg/kg/min or 0.3 mcg/kg/min) in reducing markers of stress. Perioperative stress was assessed through the dosage of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and prolactin (PRL). Three venous blood samples were collected from patients: before transferring the patient to the operating room (Time 0), at the trocar insertion (Time 1), and 1 hour after the end of the surgery (Time 2).Results: Hemodynamic parameters showed no differences between the two groups. The authors observed an increase of GH and PRL in both groups at trocar insertion (Time 1) (p = 0.473 and 0.754, respectively). ACTH and cortisol showed a decrease at Time 1 and an increase after surgery (p = 0.586). The modification of stress parameters levels showed no significant differences between the two groups.Conclusions: The results of our study showed that a lower dose of remifentanil is equally effective in controlling stress hormones during laparoscopic cholecystectomy.

scholarly journals PO-115 Effects of Phosphatidylserine on Mental States in Elite Shooters

2018 ◽  
Vol 1 (4) ◽  
Author(s):  
Jiaojiao Lu ◽  
Yan An
Keyword(s):  
Sleep Quality ◽  
Statistical Significance ◽  
Venous Blood ◽  
Stress Hormones ◽  
Serum Levels ◽  
Mental States ◽  
Brain Regions ◽  
Mood States ◽  
Whole Brain ◽  
Double Blinded

Objective The purpose of this study was to examine effects of a short-term oral supplementation of PS on biochemical stress indicators, whole brain neurotransmitters, mood states, and sleep quality in elite shooters. Methods Eighteen shooters including 9 males and 9 females participated in the study.  They were randomly assigned into either of the three groups: 1) those who ingested PS at 400 mg∙day-1 (n=6) (PS-400); 2) those who ingested PS at 800 mg∙day-1 (n=6) (PS-800); 3) those who with no supplement (n=6) (CON). PS supplementation lasted for 14 days and was administered in a double-blinded fashion. Within a week prior to the supplementation, serial venous blood samples were taken for measuring serum levels testosterone (T), cortisol (C), blood urea nitrogen (BUN), and creatine kinase (CK).  Subjects also completed the Profile of Mood States (POMS) scale and the Pittsburgh Sleep Quality Index (PSQI) questionnaire and undertook electroencephalogram that determined activation values of six neurotransmitters in whole brain, including inhibition of medium (INH), five hydroxy-tryptamine (5-HT), acetylcholine (ACH), dopamine (DA), norepinephrine (NE), and excited medium (EXC). Subjects repeated the same testing protocols and all variables were measured again after 14 days of supplementation. Results No between-group differences in all variables were observed at the baseline prior to the start of supplementation.  After supplementation, both C and C increase were lower (P=0.025, P=0.016, respectively) in PS 800 than CON, while no significant differences in C and C increase were seen between PS-400 and CON and between PS-800 and PS-400.  5-HT and DA were higher  (P=0.049, P=0.019, respectively) in PS-800 than CON, while no differences in 5-HT and DA were observed between PS-400 and CON and between PS-800 and PS-400.  All neurotransmitters were increased by supplementation in PS-800, with ACH and DA reaching statistical significance (P=0.050,P=0.029, respectively).  A synchronized trend of INH, 5-HT, ACH, DA，NE, and EXC were observed in a few brain regions (P<0.05).  PS Supplementation decreased panic score of POMS following both PS-400 and PS-800, with a greater decrease seen in PS-800.  The panic score post-supplementation was lower in PS-800 than PS-400 (P=0.016) or CON (P=0.027).  Although results of PSQI indicated an improved sleep quality following supplementation in both PS-400 and PS-800, these improvements did not reach statistical significance and no differences in PSQI were seen across the three groups. Conclusions It appears that supplementation with phosphatidylserine at 800 mg∙day-1 for 14 days can reduce stress hormones, modulate central neurotransmitters, and mitigate negative emotions, thereby alleviating stress levels among elite shooters.

scholarly journals EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HAEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC SURGERIES

2017 ◽  
Vol 10 (3) ◽  
pp. 409
Author(s):  
Sidharth Sraban Routray ◽  
Ramakanta Mohanty
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Stress Response ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Significant Rise ◽  
Hemodynamic Stability ◽  
Blinded Study ◽  
Double Blinded

ABSTRACTObjective: During laparoscopic surgeries, pneumoperitoneum can lead to various pathophysiologic changes in the cardiovascular system resulting inhypertension and tachycardia. Search for ideal drug to prevent this hemodynamic response goes on. The aim of our study was to evaluate the effect oforally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.Methods: A total of 50 adult acetylsalicylic acid I and II patients scheduled for elective laparoscopic surgeries were selected for this prospectiverandomized double-blinded study. They were randomly allocated into two groups: moxonidine group (M) and placebo group (P). M group receivedoral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that ofthe M group.Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR)was higher in P group in comparison to M group which was statistically significant.Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided betterperioperative hemodynamic stability in patients undergoing laparoscopic surgeries.Keywords: Moxonidine, Stress response, Laparoscopic.

scholarly journals Effect of two different doses of dexmedetomidine on the hemodynamics of “Hypertensive Patients” undergoing laparoscopic cholecystectomy

2020 ◽  
Vol 14 (3) ◽  
pp. 401
Author(s):  
Ravi Prakash ◽  
Shefali Gautam ◽  
Vijay Prakash ◽  
Neelkamal Mishra ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hypertensive Patients ◽  
Different Doses

scholarly journals Comparison of Complications between Direct Trocar Insertion Versus Veress Needle for Creation of Pneumoperitoneum in Patients Undergoing laparoscopic Cholecystectomy: A Randomized Control Trial

2021 ◽  
pp. 294-299
Author(s):  
Kamran Hamid ◽  
Shabbir Ahmad ◽  
Bahzad Akram Khan ◽  
Muhammad Faheem Answer ◽  
Amer Latif ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Needle Insertion ◽  
Veress Needle ◽  
P Value ◽  
Surgical Department ◽  
Trocar Insertion ◽  
Laparoscopic Entry ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Direct Trocar Insertion

Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy. Design: Randomized controlled trial Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020. Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant. Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001). Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.

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