Carbon Dioxide Pneumoperitoneum Research Articles

Evaluation of the Effects of Magnesium Sulphate versus Normal Saline on Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Numerous studies have shown that giving magnesium sulphate intravenously before carbon dioxide pneumoperitoneum is produced reduces the adverse hemodynamic response in patients undergoing elective laparoscopic cholecystectomy. 
 Objective: To examine the effects on hemodynamics in patients undergoing laparoscopic cholecystectomy between magnesium sulphate and normal saline.
 Methodology:The Department of Anaesthesia at the Pakistan Institute of Medical Sciences, SZABMU, Islamabad, conducted a Randomised Clinical Trial. The study involved the enrolment of 108 adult patients, regardless of gender, who were admitted for elective laparoscopic cholecystectomy and ranged in age from 18 to 65. Every patient who was enrolled was in ΑSΑ classes I and II. Patients were randomised equally to Group M, which received an IV slow bolus of magnesium sulphate (28 mg/kg) over a 20-minute period, and Group N, which received a 0.9% normal saline solution. The patient was tilted right and up by 15 degrees.
 Results:Both groups' baseline characteristics were comparable. The mean age of groups M and N was 42.2 years ± 7.6SD and 40.5 years ± 8.4SD, respectively (Ρ-value t-test=0.258). 22 (40.7%) men and 32 (59.3%) women made up group M, while 20 (37.0%) men and 34 (63.0%) women made up group N (Ρ-value chi-square = 0.693). Both groups' baseline and pre-pneumoperitoneum hemodyanamic parameters (HR, Systolic, BΡ, Diastolic BΡ, and MAΡ) were similar (Ρ-value t-test > 0.05).
 Conclusions:The adverse hemodynamic response caused by pneumoperitoneum was significantly attenuated by pretreatment with intravenous magnesium sulphate. Heart rate, systolic blood pressure, diastolic blood pressure, and MTH were all significantly lower than baseline. Significant hypotension and bradycardia, however, were not seen.

Association Between Acute Kidney Injury and the Trendelenburg Position Angle During Robot-assisted Radical Prostatectomy.

Robot-assisted radical prostatectomy (RARP) has been widely adopted as the standard treatment for localized prostate cancer. RARP is safer and results in better oncological control than conventional open total prostatectomy. However, it has also been reported that acute kidney injury (AKI) can be caused by the use of carbon dioxide pneumoperitoneum and a steep Trendelenburg position. We investigated the incidence of AKI after RARP and its relationship with the Trendelenburg position angle. Seventy-seven patients underwent RARP at our institution. They were divided into two groups: Those in which a Trendelenburg position with the head down at 20 degrees was employed (group A) and those in which a Trendelenburg position with the head down at 25 degrees was used (group B). To detect AKI, the serum creatinine concentration was measured at the following four points: Prior to surgery, on postoperative day 0 (immediately after RARP), and on postoperative days 1 and 6 after RARP. The incidence of AKI on POD 0 was lower in group B than in group A (p=0.0408). On POD 6, the renal function of all patients had improved to preoperative levels. Hypertension was a predictor of the incidence of AKI immediately after RARP. Although there was a significant Trendelenburg position angle-dependent difference in the incidence of AKI immediately after RARP, it was temporary. Hypertension is a predictor of AKI immediately after RARP. It is recommended that a 25-degree Trendelenburg position angle should be employed during RARP.

Effect of Carbon Dioxide Pneumo-peritoneum in Coagulation Profile of Patients undergoing Laparoscopic Cholecystectomy: A Prospective Cohort Study

Introduction: Laparoscopic Cholecystectomy (LC) is done under general anaesthesia with the patient in a reverse Trendelenburg position and with pressurised carbon dioxide in the peritoneum. This can induce venous stasis in the lower extremities and may affect the balance in the coagulation and fibrinolysis system, thereby thrombo-embolic complications. Aim: To investigate the effects of carbon dioxide pneumoperitoneum on the coagulation system of patients undergoing LC. Materials and Methods: A prospective longitudinal study was carried out from January 2021 to June 2021 among patients aged 18 to 60 years who attended the Surgery Department at Regional Institute of Medical Sciences, Imphal, Manipur, India and were diagnosed with gallstone disease and subsequently underwent LC. Independent variables like age, sex, religion, pre-operative prothrombin time, platelet count, activated Partial Thromboplastin Time (aPTT), and International Normalised Ratio (INR). Outcome variables comprised complications, postoperative prothrombin time, platelet count, aPTT, and INR. Data collected were analysed using Statistical Package for Social Sciences(SPSS) version 21.0. Paired t-tests were employed to test the association between mean values of post-operative and pre-operative PT, aPTT, INR, etc. A p-value of less than 0.05 was considered statistically significant. Results: The study enrolled 71 patients who encountered LC with carbon dioxide pneumo-peritoneum, including 18 male and 54 female patients. Maximum number of patients (28, 38.9%) fell into the 41 to 50 years age group. There was no significant difference in the mean value of prothrombin time (p=0.150) and INR (p=0.437) measured between the pre-operative and postoperative periods. Conclusion: LC is a safe procedure without clinically significant changes in the coagulation profile.

Effect of Oral Clonidine and Gabapentin as Premedication on Intraoperative Hemodynamic Responses and Postoperative Analgesia Requirement in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy pain is a sensory and emotional experience connected with actual or potential tissue damage. Effective pain control is quite important, with around 70% of patients still complaining of moderate-to-severe pain postoperatively. Uncontrolled perioperative pain may raise patient morbidity and mortality rates. Both gabapentin and clonidine as premeditated can be easily administered have minimal side effects, are easily available at a low price, both them have a sedative effect that can decrease anxiety and they can blunt the stress response. Moreover, both drugs have anti-nociceptive effects that may be beneficial for controlling postoperating pain which is the basis of our current study. Aims: This study aims to compare the efficacy of oral clonidine with gabapentin before induction of anesthesia in attenuating hemodynamic stress response to laryngoscopy, intubation, and carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy and to compare the efficacy of oral clonidine with oral gabapentin for postoperative pain control. Materials and Methods: Hundred patients undergoing laparoscopic surgery and qualifying inclusion criteria were randomly allocated into two groups each containing 50 patients. Group I patients were given Tab. Clonidine (300 μg) and Group II patients were given tablet Gabapentin (600 mg) orally 60 min before induction of general anesthesia. Hemodynamic changes and the incidence of postoperative pain in both groups were measured and compared. Results: Hemodynamic blunting to pressor stress of laryngoscopy and intubation was seen in both groups with better results obtained in the group receiving clonidine in the form of lesser variations in heart rate, systolic blood pressure, and diastolic blood pressure. Postoperative analgesia was achieved in both groups but gabapentin showed a better analgesic profile in the form of lesser Visual Analog Scale scoring and decreased utilization of rescue analgesia. Conclusion: Clonidine (300 μg) cause a greater attenuation of intraoperative hemodynamic stress responses, whereas gabapentin (600 mg) provides superior postoperative analgesia.

Liver Function Following Carbon-Di-Oxide Pneumoperitoneum in Laparoscopic Cholecystectomy

Background: Laparoscopic surgery is performed by the insufflation of gas like carbon di oxide (CO2) into the peritoneal cavity by artificial port which is called creating pneumoperitoneum. The CO2 pneumoperitoneum causes changes in the splanchnic microcirculation and can affect liver physiology. Although laparoscopic cholecystectomy offered many advantages over laparotomy, new concerns arose regarding the effects of CO2 pneumoperitoneum on liver function. Knowledge of the effects of CO2 pneumoperitoneum on liver function can help minimize complications while profiting from the benefits of LC without concerns about its safety. It was noticed in many studies that following laparoscopic cholecystectomy (LC), liver function parameters were disturbed. Aims: To observe any alteration in liver function by carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy. Methods: Ninety-four patients with cholelithiasis having normal liver function enrolled in this study. Test obtained preoperatively including serum bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) then 24 &72 hour post operatively to compare and proceed. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS22). Results: The findings showed that mean duration of pneumoperitoneum was 43.8±9.1minutes. The mean serum bilirubin pre-operatively was 0.75±0.21 (mg/dL), post-operative 24 hours value was 0.77±0.23 (mg/dL) and post-operative 72 hours value was 0.73±0.18 (mg/dL). No significant difference was observed in pre-operative and postoperative values. The mean serum ALT preoperatively was 33.81±7.83 (IU/L), post-operative 24 hours value was 52.51±25.9 (IU/L) and postoperative 72 hours value was 46.3±21.33 (IU/L). The mean serum AST pre-operatively was 33.84±6.83 (IU/L), post-operative 24 hours value was 48.94±19.23 (IU/L) and post-operative 72 hours value was 44.36±15.7 (IU/L). The mean serum alkaline phosphatase pre-operatively was 72.57±25.95 (IU/L), post-operative 24 hours value was 88.26±41.69 (IU/L) and post-operative 72 hours value was 85.32±38.85 (IU/L). There were significant increase of post-operative 24 hours and 72 hours value of liver enzymes when compared to preoperatively. Conclusion: There was significant increase in, AST, ALT, ALP post-operative 24 hours and 72 hours after doing laparoscopic cholecystectomy when compared to preoperatively. There may be a transient elevation of hepatic enzymes after LC and the major causative factor seemed to be CO2 pneumoperitoneum.

A STUDY OF ALTERATION IN COAGULATION PROFILE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction: Laparoscopic cholecystectomy has become the gold standard for the treatment of cholelithiasis. It has many advantages such as better cosmetic, shorter hospitalization time, minimal postoperative pain, early return to normal life. However carbon dioxide pneumoperitoneum may cause alteration in the coagulation system and moreover the reverse Trendelenburg position adopted diring surgery can induce blood stagnation in the lower limbs leading to a hypercoagulable state. The aim Objective: of the study was to record the effect of carbon dioxide pneumoperitoneum on coagulation factors and brinolysis response during laparoscopic cholecystectomy and to assess if there is any risk of postoperative thromboembolic complications following laparoscopic cholecystectomy. Methods: The hospital based descriptive study of 50 patients undergoing elective laparoscopic cholecystectomy was designed to study alteration in Clotting time, Prothrombin time(PT), Activated partial thrombin time(aPTT), Fibrinogen and D-dimer, which were measured preoperatively and 6 hour postoperatively. Out of 50 Results: patients operated 38 were female and 12 were male. Signicant decrease in PT and aPTT suggested activation of coagulation pathways while signicant increase in d-dimer and brinogen suggested activation of brinolytic systems. None of the patients had any postoperative thromboembolic complications. From the study we found that there was activati Discussions: on of coagulation and brinolysis after laparoscopic cholecystectomy leading to a hypercoagulable state which may be either due to carbon dioxide pneumoperitoneum or due to increased intraabdominal pressure. Although none of the patients had any thromboembolic complications postoperatively, however there may be the need to use prophylactic measures for thrombosis in high risk patients.

Liver Dysfunction After Use of Nathanson Retractor During Laparoscopic Gastrectomy for Gastric Cancer.

Background: Cardiopulmonary complications and liver dysfunction are also specific complications and problems associated with laparoscopic surgery. The main causes of postoperative liver dysfunction, which may often occur after laparoscopic surgery, include carbon dioxide pneumoperitoneum and ligation of the aberrant left hepatic artery. Hepatic steatosis may develop as a natural consequence of neoadjuvant therapy, although rarely, owing to chemotherapy. Nathanson retractor may cause a prolonged elevation in liver enzymes of these patients compared with those who do not receive neoadjuvant therapy. Materials and Methods: The data of 151 patients who underwent laparoscopic radical gastrectomy between January 2017 and January 2022 for histologically proven primary gastric cancer in our clinic were retrospectively reviewed. Results: The mean length of hospital stay was 6.21 days. The mean time normalization of the aspartate aminotransferase (AST) value was 2.45 ± 1.83 (range, 0-12) days postoperatively. The analysis of the correlation between the preoperative and postoperative 1-day values of alanine aminotransferase (ALT) and AST revealed a significant difference between the preoperative and postoperative 1-day median values of both parameters (P < .001). Each one unit increase in ALT led to an increase of 0.338 days in the length of intensive care stay and an increase of 0.345 days in the overall length of hospital stay. As the time to normalization of the AST value increased, the length of both intensive care stay and hospital stay increased. Each one unit increase in AST resulted in an increase of 0.316 days in the length of intensive care stay and an increase of 0.376 days in the overall length of hospital stay. Conclusion: Alternative retraction methods can be used safely in laparoscopic surgery for gastric cancer patients receiving neoadjuvant therapy. We are of the opinion that the Nathanson retractor should be used only during dissection of the relevant regions to shorten the intraoperative intermittent release or the time of use.

Effect of Carbondioxide Pneumoperitoneum on Liver Enzymes Following Laproscopic Cholecystectomy In Rural Indian Population

Introduction: Laparoscopic cholecystectomy, a minimal-access procedure for removing the gallbladder, has various benefits, including a significantly shorter hospital stay ,lower cost and a low patient comorbidity Materials and Methods:- this was a prospective study. The study was conducted on 60 patients of cholecystectomy ,who underwent laparoscopic cholecystectomy under constant intraperitoneal pressure of 15mmhg in GEMS medical hospital, ragolu, Srikakulam, Andhra Pradesh. This study was designed to evaluate the complications of carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy using the liver enzymes Results:- Total bilirubin pre-operative was 0.72±0.13 mg/dl, increased 24 h after surgery to 1.11 ± 0.30 mg/dl by 138% . Aspartate aminotransferase (AST) pre-operative was 19.523 ± 16 U/l increased 24 h after surgery to 30.12± 18.35 U/l by 154 %. Alanine aminotransferase (ALT) was 22.58 ± 5.09 U/l increased 24 h after surgery to 38.62 ± 12.15U/l by 171%. Alkaline phosphatase pre-operative values were 103.8 ± 23.32 U/ and after 24 h was 147.8 ± 36.54 U/l by 142 % Conclusion: laparoscopic operations produce a transient rise in serum liver enzymes ,our study too demonstrated bilirubin, AST, ALT, ALP elevated following laparoscopic cholecystectomy . when combined with data from earlier research These changes could be attributable to a decrease in portal venous flow caused by a pneumoperitoneum's high pressures.

Chemical composition of smoke produced by open versus laparoscopic surgery for cholecystectomy.

Smoke produced by traditional open surgery (TOS) has long been considered hazardous to medical staff. Compared with TOS, minimally invasive surgery under carbon dioxide pneumoperitoneum is associated with a faster recovery and less wound pain. However, the impact of oxygen-deficient environment on the chemical contents of smoke has not been comprehensively assessed. This research evaluated the chemical composition and volatile organic compound (TVOC) level in smoke produced by open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC) for gallbladder diseases. Smoke samples were collected and analyzed via gas chromatography-mass spectrometry. Chemical compounds were further grouped according to molecular weight and toxicity. Compared with the OC, LC had significantly higher halocarbon and TVOC levels but lower cycloalkene and aldehyde levels. No halocarbons were isolated from OC specimens. When stratified based on molecular weight, LC had a bimodal pattern (i.e., high levels of small-sized [<60 Da] and large-sized [>120 Da] compounds). There was no difference in terms of toxicity types, incidence, and severity associated with detected compounds between two groups. LC is associated with a higher TVOC level and proportion of low- and high-molecular-weight organic compounds. Further strategies of evacuating these health hazards and preventing smoke leakage through trocars should be considered.

Comparative study between true umbilical versus supra umbilical technique as an open access for pneumoperitoneum during laparoscopic surgery

Background: To start laparoscopic procedures, accessing the peritoneal cavity and establishing a carbon dioxide pneumoperitoneum are critical. The placement of the primary trocar is an important step in laparoscopic surgery. Many techniques have been reported in order to limit complications associated with the placement of the first trocar. In the study we describe a surgical method that offers quick, safe, and reliable preliminary entry into the peritoneal cavity with incredible functional and cosmetic results. Methods: A prospective randomised comparative study was conducted on 202 candidates for various laparoscopic surgery, comparing true umbilical versus supra umbilical open access for pneumoperitoneum from November 2021 to May 2022 in our surgical department. Results: There were 202 patients in the study, 109 (women) and 93 men. The port site entry per seconds was 41.3± 1.2 in true umbilical technique (group A) and 132.9± 5.5 in supra umbilical open technique (group B), and that was a statistically significant difference (p &lt; 0.0001). There was a statistically significant difference in the mean time of port site wound closure (&lt;0.0001) and port site gas leaking in the true umbilical access group compared to the supra umbilical access group (0.000161).

Review of Outcomes of Low Verses Standard Pressure Pneumoperitoneum in Laparoscopic Surgery.

Carbon dioxide pneumoperitoneum during laparoscopy changes cardiorespiratory physiology and contributes to post-op pain. We studied outcomes before and after implementing low-pressure pneumoperitoneum QI project. Forty-two patients were insufflated at standard pressures (15mmHg) while 41 were insufflated using low (8-12mmHg) during laparoscopic procedures. These variables were obtained from the patient chart: pain scores, intravenous morphine milligram equivalents (MME), peak inspiratory pressures (PIP), end-tidal CO2 (EtCO2), surgery duration, and patient demographics. The study was conducted after IRB approval. Low-pressure pneumoperitoneum is feasible and the surgeon can increase to 10-12mmHg as needed. The mean post-op IV MME was significantly decreased in the low-pressure group (11.75 ± 10.41) compared to the standard pressure group (17.36 ± 18.1) (t-test, P = .047). Mean peak inspiratory pressures during insufflation were significantly higher for procedures conducted at standard pressure (31.40 ± 4.82) compared to the 8mmHg (24.68 ± 4.19) and 12mmHg (27.33± 3.85) low pressure groups (one-way ANOVA, P < .0001). During insufflation, there was a significant increase in the average EtCO2 in the standard pressure group (42.07 ± 5.60) compared to the 8mmHg low pressure group (37.59 ± 5.05) (ANOVA, P = .0096). Constant flow insufflation was more likely to be performed at low pressure than demand mode (58% v. 33%). Low pressure pneumoperitoneum decreases PIP pressure and CO2 absorption evidenced by lower ETCO2 intra-operatively. Patients have significant improvement in postoperative pain evidenced by decreased narcotics needed. Low pressure pneumoperitoneum using a constant flow insufflator is safe and results in improved patient outcomes.

Effects of clonidine premedication on perioperative hemodynamic response, anesthetic requirements and postoperative analgesia for patients undergoing laparoscopic gynecological surgeries: A randomized study

The creation of carbon dioxide (CO) pneumoperitoneum is frequent in laparoscopy, but has significant effect on the cardiopulmonary function of the patient. Clonidine by its central sympatholytic action reduces perioperative hemodynamic instability and has several advantages in the postoperative period, hence we consider it to be an effective premedication to contain the stress response to intubation and laparoscopy. With informed consent, 56 patients scheduled for elective laparoscopic gynecological surgeries under general anesthesia were randomly allocated into two groups to receive premedication with either oral Clonidine 100 µg (Group I, n = 28) or Vitamin C as placebo (Group II, n = 28) 90 minutes prior to induction. A balanced general anesthesia was used to manage these patients. Hemodynamic parameters, Sevoflurane concentration, pain and sedation scores, time to request analgesics, 24hr cumulative analgesic requirements and adverse effects between the two groups were collected as data and compared using Two sample t-test and Fisher’s exact test.When compared to the control group, oral Clonidine was found to be considerably superior significantly (p =0.00) in terms of maintaining stable hemodynamics (i.e. In group I, Mean HR ranged from 76.11±12.21 to 94.57±13.75, while in group II, it ranged from 79.04±7.11 to 112.00±12.75 and MAP ranged from 83.07±6.50 to 93.64±14.09 in group I, while in group II, it ranged from 88.04±9.03 to 116.14±13.23), having a Sevoflurane sparing effect and having a longer time (6.5 ± 1.6 hours) between the first request for analgesia postoperatively. In patients undergoing laparoscopic gynecological surgeries, administration of oral Clonidine 100µg as a premedication improves perioperative hemodynamic stability and reduces the intraoperative anesthetic and post-operative analgesic requirements.

Comparison of the Effects of Propofol and Sevoflurane Anesthesia on Optic Nerve Sheath Diameter in Robot-Assisted Laparoscopic Gynecology Surgery: A Randomized Controlled Trial.

Optic nerve sheath diameter (ONSD) is used as a surrogate parameter for intracranial pressure. This study was conducted to evaluate the effect of the anesthetics (sevoflurane and propofol) on ONSD in women undergoing robotic surgery. The 42 patients who were scheduled for robot-assisted gynecology surgery were randomly allocated to the sevoflurane group or the propofol group. ONSD was recorded at 10 min after the induction of anesthesia (T0); 5 min, 20 min, and 40 min after carbon dioxide pneumoperitoneum was induced and the patients were put in a steep Trendelenburg position (T1, T2, and T3, respectively); and at skin closure after desufflation of the pneumoperitoneum (T4). Patients were observed for postoperative nausea and vomiting (PONV) during the immediate postoperative period. The propofol group had significantly lower ONSD than the sevoflurane group at T3. Mean ONSD values continuously increased from T0 to T3 in both groups. Two patients in the sevoflurane group experienced PONV. This study suggests that propofol anesthesia caused a lower increase in ONSD than sevoflurane anesthesia.

Effect of Carbon Dioxide on Bispectral Index of EEG under Intravenous Target-Controlled Anesthesia Based on Intelligent Medical Treatment.

Laparoscopic surgery has the advantages of less trauma and quick recovery, and it is more and more favored by surgeons and patients in clinical practice. However, the impact of carbon dioxide pneumoperitoneum on the body during laparoscopic surgery has attracted the attention of many scholars. Pneumoperitoneum can cause increased cerebral blood flow and increased intracranial pressure, cerebral metabolic rate is highly correlated with blood carbon dioxide partial pressure, and cerebral metabolism without cardiopulmonary bypass is linearly correlated with the depth of anesthesia. Electroencephalographic (EEG) bispectral index (BIS) is a signal analysis method, which can directly measure the effect of drugs on the cerebral cortex and reflect the depth of anesthesia. Based on this, this study takes smart medical treatment as the background and uses the improved BP neural network as a tool to explore the effect of carbon dioxide on EEG bispectral index under intravenous target-controlled anesthesia. The main purpose is to observe the correlation between arterial blood carbon dioxide partial pressure and EEG bispectral index under propofol target-controlled anesthesia during retroperitoneal laparoscopic surgery. The experimental results show that the model proposed in this study can efficiently and accurately obtain the size of the influencing factors, which provides a clinical basis for the anesthesia management and anesthesia depth regulation of carbon dioxide pneumoperitoneum laparoscopic surgery.

Оцінка ефективності відеолапароскопічної апендектомії у вагітних

The purpose of the study is to assess the efficiency results of treatment of acute appendicitis in pregnant women by using laparoscopy at different periods of gestation on the basis of studying the effect of increased intra-abdominal pressure due to carbon dioxide pneumoperitoneum on the course of pregnancy, the state of the uterus and fetus, as well as improving the technique of performing the operation. Materials and methods. 73 pregnant women with acute appendicitis were examined. The average age of the surveyed was 25.9±0.7 years, ranged from 17 to 42 years. The gestation period ranged from 4-5 to 37-39 weeks. There were 26 (35.6%) pregnant women in the first trimester, 32 (43.8%) – in the second trimester, and 15 (20.5%) – in the third trimester. The intervention was performed using the Olympus OTV-SC endoscopic complex. Pneumoperitoneum with CO2 was created about 10-12 mm Hg. In all women, the parameters of body temperature and blood pressure were studied, and the postoperative restoration of the motor-evacuation function of the gastrointestinal tract was assessed. Laboratory research included the study of individual indicators of the leukocyte formula, changes in the hemostasis system and microbial contamination of tissues of trocar wounds. The results of the effect of increased intra-abdominal pressure during laparoscopy on the state of the fetus and uterus in the early postoperative period were assessed using the BMT-9141 (Germany) and FM-7 (England) fetal monitor in women with a gestational age of 32 - 39 weeks. Results and discussion. The study showed that laparoscopy is possible with good results in the treatment of acute appendicitis in pregnant women in the first, second and third trimesters but with few exceptions. The technical features of performing laparoscopy in pregnant women are associated with the increased size of the uterus during the development of pregnancy. When substantiating therapeutic measures for endoscopic interventions based on the study and assessment of signs of systemic inflammatory response syndrome like temperature reaction, individual indicators of leukocyte count, peripheral hemodynamics, as well as restoration of dysfunctions of the gastrointestinal tract, the revealed advantages of laparoscopic appendectomy. Removal of the appendix from the abdominal cavity in plastic containers reduced microbial contamination of wounds, leading to a decrease in the number of postoperative complications. Conclusion. Laparoscopic interventions are effective in acute appendicitis in pregnant women. They provide a mild intoxication syndrome, rapid physical rehabilitation of patients. Their advantages are the reduction of manifestations of uterus and fetal disorders, rapid postoperative recovery of gastrointestinal tract functions

Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery.

This is the second update of a Cochrane Review first published in 2013 and last updated in 2017. Laparoscopic surgery is now widely performed to treat various abdominal diseases. Currently, carbon dioxide is the most frequently used gas for insufflation of the abdominal cavity (pneumoperitoneum). Although carbon dioxide meets most of the requirements for pneumoperitoneum, the absorption of carbon dioxide may be associated with adverse events. Therefore, other gases have been introduced as alternatives to carbon dioxide for establishing pneumoperitoneum. To assess the safety, benefits, and harms of different gases (e.g. carbon dioxide, helium, argon, nitrogen, nitrous oxide, and room air) used for establishing pneumoperitoneum in participants undergoing laparoscopic abdominal or gynaecological pelvic surgery. We searched CENTRAL, Ovid MEDLINE, Ovid Embase, four other databases, and three trials registers on 15 October 2021 together with reference checking, citation searching, and contact with study authors to identify additional studies. We included randomised controlled trials (RCTs) comparing different gases for establishing pneumoperitoneum in participants (irrespective of age, sex, or race) undergoing laparoscopic abdominal or gynaecological pelvic surgery under general anaesthesia. We used standard methodological procedures expected by Cochrane. We included 10 RCTs, randomising 583 participants, comparing different gases for establishing pneumoperitoneum: nitrous oxide (four trials), helium (five trials), or room air (one trial) was compared to carbon dioxide. All the RCTs were single-centre studies. Four RCTs were conducted in the USA; two in Australia; one in China; one in Finland; one in Iran; and one in the Netherlands. The mean age of the participants ranged from 27.6 years to 49.0 years. Four trials randomised participants to nitrous oxide pneumoperitoneum (132 participants) or carbon dioxide pneumoperitoneum (128 participants). None of the trials was at low risk of bias. The evidence is very uncertain about the effects of nitrous oxide pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto odds ratio (OR) 2.62, 95% CI 0.78 to 8.85; 3 studies, 204 participants; very low-certainty evidence), or surgical morbidity (Peto OR 1.01, 95% CI 0.14 to 7.31; 3 studies, 207 participants; very low-certainty evidence). There were no serious adverse events related to either nitrous oxide or carbon dioxide pneumoperitoneum (4 studies, 260 participants; very low-certainty evidence). Four trials randomised participants to helium pneumoperitoneum (69 participants) or carbon dioxide pneumoperitoneum (75 participants) and one trial involving 33 participants did not state the number of participants in each group. None of the trials was at low risk of bias. The evidence is very uncertain about the effects of helium pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto OR 1.66, 95% CI 0.28 to 9.72; 3 studies, 128 participants; very low-certainty evidence), or surgical morbidity (5 studies, 177 participants; very low-certainty evidence). There were three serious adverse events (subcutaneous emphysema) related to helium pneumoperitoneum (3 studies, 128 participants; very low-certainty evidence). One trial randomised participants to room air pneumoperitoneum (70 participants) or carbon dioxide pneumoperitoneum (76 participants). The trial was at high risk of bias. There were no cardiopulmonary complications, serious adverse events, or deaths observed related to either room air or carbon dioxide pneumoperitoneum. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of nitrous oxide, helium, and room air pneumoperitoneum compared to carbon dioxide pneumoperitoneum on any of the primary outcomes, including cardiopulmonary complications, surgical morbidity, and serious adverse events. The safety of nitrous oxide, helium, and room air pneumoperitoneum has yet to be established, especially in people with high anaesthetic risk.

Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space.&#x0D; Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy.&#x0D; Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay.&#x0D; Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group.&#x0D; Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

Percutaneous Internal Ring Suturing is a Safe and Effective Method for Inguinal Hernia Repair in Young Adolescents.

Background: Percutaneous internal ring suturing (PIRS) is a laparoscopic procedure that has demonstrated its safety and efficacy as a method of hernia repair in younger children but without evidence among the adolescent population. The aim of this study was to determine the success of PIRS outcomes for hernia repair in the adolescent population. Methods: All adolescents who were operated on using the PIRS method for inguinal repair during the 5-year study period in a single center were included in a prospective cohort study. The main outcome of the study included treatment outcomes in a term of recurrence rate. The secondary outcomes include other treatment outcomes such as complications, conversion to an open procedure, and reoperation rates, as well as duration of anesthesia and surgery, duration of hospital admission, and the level of carbon dioxide pneumoperitoneum. Results: In 51 adolescents (72.5% males) with a median age of 13 years and median follow-up of 44 months, a total of 57 PIRS procedures were performed. There were 30 (58.8%) right hernia repairs, 15 (29.4%) left hernia repairs, and 6 (11.8%) bilateral hernia repairs. The median surgical time was 10 minutes for unilateral and 18 minutes for bilateral hernia repair. The median length of hospital stay was 24 hours. Only one (1.95%) intraoperative complication occurred during surgery, an inferior epigastric vein injury. No complications or recurrences were observed during the follow-up period. Conclusions: PIRS has proven to be simple, safe, and effective method for groin hernia repair in adolescent population. This method provides excellent overall and cosmetic outcomes. There is a low incidence of complications and recurrences. According to our results, PIRS could be considered to become a possible approach for groin hernia repair in adolescents.

A Comparative Study between IV Clonidine 1.5Mcg/Kg and IV Lignocaine 1.5 Mg/Kg as Premedication for Attenuation of Hemodynamic Responses to Pneumoperitoneum in Laparoscopic Surgeries

Laparoscopy, has emerged as the main stay for most of the commonly performed surgeries. Pneumoperitoneum and different positions of the patient during laparoscopy contribute to adverse cardiovascular effects like elevated arterial pressure, increased systemic and pulmonary vascular resistance and reduced cardiac output. This randomised controlled double blind prospective study was conducted to compare the efficacy of intravenous(I.V) Lidocaine and I.V. Clonidine in providing hemodynamic stability in patients undergoing laparoscopic surgeries. Methods: Seventy five adult patients of ASA grade 1 and 2, scheduled for elective laparoscopic surgery with a mean duration of 30- 90 minutes, were randomly allocated to one of the three groups. Group A: Clonidine group (n=25) - received injection Clonidine 1.5 mcg/kg 15 minutes prior to induction of anaesthesia. Group B: Lidocaine group (n=25) - injection Lidocaine 1.5 mg/kg 90 seconds prior to induction of anaesthesia. Group C: Control group (n=25) - received 10 ml normal saline intravenously. Results: There is no statistically significant difference between lidocaine and control group regarding mean HR, SBP, DBP, MAP during the entire period of pneumoperitoneum. Whereas, there is significant increase of blood pressures (SBP, DBP, MAP) in the lidocaine and control groups compared to the clonidine group from intubation, throughout the period of pneumoperitoneum. Clonidine also decreases the requirement of propofol for induction. Conclusion: I.V Clonidine 1.5mcg/kg premedication is more effective than Lidocaine 1.5mg/kg at preventing changes in hemodynamic parameters induced by carbondioxide pneumoperitoneum. Keywords: Pneumoperitoneum, I.V Clonidine, I.V Lignocaine, Hemodynamic parameters.

Evaluation of blood electrolyte alterations in cats during elec-tive laparoscopic ovariectomy

In a clinical setting, we tested the hypothesis of whether hypercapnia developed during carbon dioxide pneumoperitoneum is associated with changes in blood electrolytes. This prospective study involved ten female cats that underwent elective laparoscopic ovariectomy. Venous blood samples for assessment of electrolytes were collected in the following sequence: T1- before anaesthesia induction, T2 - 10 minutes after anaesthesia induction, T3 - 30 minutes of pneumoperitoneum and T4 - at the end of pneumoperitoneum. Statistical analysis revealed AB disturbances associated with general anaesthesia and pneumoperitoneum, manifested with decreased blood pH, whereas blood PvCO2, PO2 and BE were increased. A constant increase of K+ concentration was recorded in all animals during pneumoperitoneum (P&lt;0.05), whereas iMg registered a significant increase only at T3 (P&lt;0.05). Correlations were recorded between blood pH and Na+, iCa, iMg, as well as between Na+ and Cl¯ at different time points during anaesthesia. No correlations were noted between pH and K+ or PvCO2 and K+. In conclusion, electrolyte imbalance represents a possible complication associated with laparoscopic surgery in healthy cats. However, further studies should investigate the causes involved in K+ concentration elevation.