Changes In Intra-abdominal Pressure Research Articles

Deep breathing couples CSF and venous flow dynamics

Venous system pathologies have increasingly been linked to clinically relevant disorders of CSF circulation whereas the exact coupling mechanisms still remain unknown. In this work, flow dynamics of both systems were studied using real-time phase-contrast flow MRI in 16 healthy subjects during normal and forced breathing. Flow evaluations in the aqueduct, at cervical level C3 and lumbar level L3 for both the CSF and venous fluid systems reveal temporal modulations by forced respiration. During normal breathing cardiac-related flow modulations prevailed, while forced breathing shifted the dominant frequency of both CSF and venous flow spectra towards the respiratory component and prompted a correlation between CSF and venous flow in the large vessels. The average of flow magnitude of CSF was increased during forced breathing at all spinal and intracranial positions. Venous flow in the large vessels of the upper body decreased and in the lower body increased during forced breathing. Deep respiration couples interdependent venous and brain fluid flow—most likely mediated by intrathoracic and intraabdominal pressure changes. Further insights into the driving forces of CSF and venous circulation and their correlation will facilitate our understanding how the venous system links to intracranial pressure regulation and of related forms of hydrocephalus.

Percutaneous delivery of self-propelling hemostatic powder for managing non-compressible abdominal hemorrhage: a proof-of-concept study in swine

IntroductionNon-compressible intra-abdominal hemorrhage (NCIAH) is a major cause of preventable death on the battlefield and in civilian trauma. Currently, it can only be definitively managed with surgery, as there are limited strategies for controlling ongoing NCIAH in the prehospital environment. We hypothesized that a self-propelling thrombin-containing powder (SPTP) could increase survival in a swine model of NCIAH when delivered percutaneously into the closed abdomen using an engineered spray system. Materials and MethodsNineteen swine underwent surgical laparotomy followed by a Grade V liver injury that created massive hemorrhage, before closing the abdomen with sutures. Animals either received treatment with standard of care fluid resuscitation (n=9) or the SPTP spray system (n=10), which consisted of a spray device and a 14 Fr catheter. Using the spray system, SPTP was delivered into a hemoperitoneum identified using a focused assessment with sonography in trauma (FAST) exam. Lactated Ringer's solution was administered to all animals to maintain a mean arterial pressure (MAP) of >50 mmHg. The primary outcome was percentage of animals surviving at three hours following injury. ResultsIn the swine model of NCIAH, a greater percentage of animals receiving SPTP survived to three hours, although differences were not significant. The SPTP spray system increased the median survival of animals from 1.6 hr in the fluid resuscitation group to 4.3 hr. The SPTP spray system delivered a total mass of 18.5 ± 1.0 g of SPTP. The mean change in intra-abdominal pressure following SPTP delivery was 5.2 ± 1.8 mmHg (mean ± SEM). The intervention time was 6.7 ± 1.7 min. No adverse effects related to the SPTP formulation or the spray system were observed. SPTP was especially beneficial in animals that had either severely elevated lactate concentrations or low mean arterial pressure of <35 mmHg shortly after injury. ConclusionsThis demonstrates proof-of-concept for use of a new minimally invasive procedure for managing NCIAH, which could extend survival time to enable patients to reach definitive surgical care.

Intra abdominal pressure changes in meshplasty and abdominal wall plication techniques in abdominoplasty: a comparative study

Background: Measurement of intra abdominal pressures is used to identify patients at risk of intra-abdominal hypertension and abdominal compartment syndrome after abdominoplasty that may lead to tight closure of the abdomen. This comparative study was aimed at measuring the IAP of patients in groups of meshplasty and abdominal wall plication, intraoperatively and post operatively.Methods: A comparative study was conducted among 34 patients who underwent meshplasty and abdominal wall plication. Each group comprised of 17 patients. All preoperative blood investigations and pre anesthetic evaluations were done. The technique used is decided based on the soft tissue laxity, rectus diastasis and presence of ventral hernias. Intra operatively, IAP was measured soon after the placement of mesh or after Rectus plication and post operatively, IAP was measured within 24 hours. IAP was measured using the intra vesical technique using Foley’s Catheter.Results: Fifty percent of the total patients were in the age group 41-50yrs and 88.2% of the patients were females. No significant variations in IAP, either intraoperative (p=0.051) or post operative (p=0.202), was evidenced in both groups. Post operatively, patient developed minimal complications such as seroma collection, wound infection and respiratory complications, improving on symptomatic treatment and antibiotics.Conclusions: No significant intraoperative or postoperative IAP was found between the two study groups underwent meshplasty and abdominal wall placation techniques.

Intra-abdominal pressure for predicating extubation failure in mechanically ventilated patients: it does work

IntroductionReducing the extubation failure is vital to the early recovery of patients with mechanical ventilation(MV). We aimed to explore the predictive value of the change of intra-abdominal pressure(ΔIAP) before extubation on the extubation failure in MV patients.Material and methodsPatients undergone MV for more than 24 hours were selected. We used a urodynamic monitor to measure ΔIAP 30 minutes before extubation. The characteristics and prognosis of MV patients were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of ΔIAP for extubation failure.ResultsA total of 173 MV patients were included. The risks of extubation failure increased with the decrease of ΔIAP. The risk of extubation failure in ΔIAP≤21mmHg group was 5.7 times that of the ΔIAP≥38mmHg group (OR 5.7, 95%CI 1.5-22.0), the risk of extubation failure in ΔIAP 22～37 mmHg group was 3.8 times that of the ΔIAP≥38mmHg group (OR 3.8, 95%CI 1.0-15.3). The area under the curve (AUC) predicted by ΔIAP for extubation failure was 0.721, the cutoff value was 31mmHg with 82.8% sensitivity and 48.6% specificity. There were no significant differences in the duration of MV, length of ICU stay, and death in ICU of the three groups of patients (all P&gt;0.05).ConclusionsThe ΔIAP has good reference value for predicting extubation failure, which is negatively correlated with the risk of extubation failure in patients with MV. For MV patients with ΔIAP≤31mmHg, they may have higher risk of extubation failure, early alert and interventions are highlighted for those patients.

Acute Spinal Subarachnoid Hemorrhage: Case Report Cured by Continuous Cerebrospinal Fluid Drainage by Lumbar Puncture

Background: Spinal subarachnoid hemorrhage (SSH) is a rare condition that can lead to severe neurological deficits. Clinicians should consider SSH when neurological deficits such as low back pain, pain hyperalgesia, paraplegia, and urinary and fecal incontinence are present. There is much debate as to whether SSH should be treated surgically or conservatively. There are few reports in the literature about this disease. In this paper, we report a case of SSH in terms of etiology, clinical manifestations, diagnosis and treatment. Methods: A case of SSH in our hospital was retrospectively analyzed in terms of etiology, pathogenesis, clinical manifestations, diagnosis and treatment. Results: The possible etiology of SSH in this case was due to rapid changes in intra-thoracic and intra-abdominal pressure due to prolonged bending, which caused tearing of the blood vessels in the subarachnoid space. The patient has returned to normal life with continuous lumbar puncture for cerebrospinal fluid drainage. Conclusion: We report a case of SSH with typical symptoms of back pain, sensory, motor and autonomic dysfunction. MRI is used as the method of choice to diagnose SSH, which is typically characterized by the lumbar sedimentation sign. Lumbar puncture for continuous drainage of cerebrospinal fluid is simple and less invasive, and may be considered by neurosurgeons as the treatment of choice for SSH, with further surgical treatment considered if results are poor.

Exploring a New Management Option for Patients With Refractory Ascites: The PeriLeve Device

Abstract Cirrhosis of the liver is often accompanied by refractory ascites, a condition characterized by fluid buildup in the peritoneal cavity that does not respond to diuretics or recurs shortly after therapeutic paracentesis. There are several management strategies in practice including large-volume paracentesis, transjugular intrahepatic portosystemic shunts, peritoneovenous shunting, and liver transplant. However, each of these options come with limitations such as high cost, poor efficacy, and increased risk of complications. This article explores a new management strategy with a novel biopowered shunt, the PeriLeve device, that moves fluid from the peritoneal cavity to the urinary bladder using natural changes in intra-abdominal pressure (IAP). By doing so, PeriLeve shifts the current paradigm of care from the hospital to the home which reduces costs to healthcare providers and patients while improving quality of life. The basic design of the pump consists of two check (i.e., one-way) valves on either side of a fluid filled cavity which is separated from an air cavity by an elastomeric membrane. This article presents benchtop testing results of a prototype PeriLeve pump. The performance of the pump was analyzed along six parameters: change in intra-abdominal pressure, valve opening pressure, membrane thickness, membrane stiffness, membrane surface area, and air cavity volume. Initial results indicate that, with future optimizations, the pump can ultimately move a clinically significant volume of fluid.

Evaluation of the effects of medial saphenous venous pressures as an indirect method of measurement of intra-abdominal pressures in the horse.

To evaluate the effect of changes in intra-abdominal pressure (IAP) on medial saphenous venous pressure (MSVP) and hemodynamics in normal horses. Experimental, in-vivo study. University Teaching Hospital. Convenience sample of 7 mixed breed horses; 5 geldings, and 2 mares. Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intra-abdominal hypertension. The MSVP and vital parameters were recorded, along with direct arterial blood pressure from the transverse facial artery. As IAP increased, MSVP increased in a stepwise manner, in concert with changes in IAP. The consistency in measurement between MSVP and IAP was high (intraclass correlation coefficient=0.92; P<0.001) and repeated measures correlation was excellent (r=0.98; P<0.001). Heart rate was unchanged over the course of the experiment (P=0.09), however, respiratory rate increased with increasing IAP (P<0.001). Arterial blood pressure also increased with insufflation (P<0.001), with a significant difference at an IAP of 15mm Hg (P=0.04). This report provides preliminary data demonstrating a strong correlation between equine MSVP and changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this relationship, and to confirm these results in clinical patients.

Evaluation of the effects of intraabdominal hypertension on equine central venous pressure.

To evaluate the effect of changes in intraabdominal pressure (IAP) on central venous pressure (CVP) in normal horses. Experimental, in vivo study. University Teaching Hospital. Convenience sample of 7 mixed breed horses-5 geldings and 2 mares. Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20mm Hg over 30 minutes, and maintained at that pressure for 30 minutes to evaluate the effect of sustained intraabdominal hypertension. CVP was obtained from the cranial vena cava, concurrent with pressure obtained from the peritoneal cavity. CVP increased as IAP increased up to 12mm Hg, and declined as IAP increased further. The changes in CVP over time were significantly different (P< 0.03). Repeated measures correlation was positive, and highest, for mean CVP as IAP increased from 0 to 12mm Hg (r=.70; 95% CI, .43-.85; P< 0.0001). Correlation of mean CVP with insufflation pressure became negative as IAP increased further from 15 to 20mm Hg (r=-.47; 95% CI, -.66 to -.21; P= 0.0006). This report provides preliminary data demonstrating a biphasic trend in equine CVP caused by changes in IAP, similar to that observed in other species. Further investigations are needed to evaluate this trend and to confirm these results in clinical patients.

Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial

ObjectivesTo compare the effects of Liuzijue Qigong and conventional respiratory training on trunk control ability and respiratory muscle functions in patients at an early recovery stage from stroke. DesignA single-blind, randomized controlled trial. SettingA hospital. ParticipantsPatients (N=60) within 2 months poststroke. InterventionsThe experimental group (n=30) received conventional rehabilitation training combined with Liuzijue exercise, and the control group (n=30) received conventional rehabilitation training combined with conventional respiration training. The training in the 2 groups was conducted 5 times per week for 3 weeks. Main Outcome MeasuresTrunk Impairment Scale (TIS), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum expiratory mid-flow (MMEF), diaphragmatic movement, the change of intra-abdominal pressure (IAP), Berg Balance Scale (BBS), and Modified Barthel Index (MBI). All outcome measures were assessed twice (at baseline and 3 weeks). ResultsBoth groups significantly improved in TIS, MIP, FVC, PEF, and the change of IAP, BBS, and MBI when pre- and postassessments (P<.05) were compared. Compared with the control group, there was a significant difference in the experimental group in the static sitting balance subscale (P=.014), dynamic balance subscale (P=.001), coordination subscale (P<.001), TIS total scores (P<.001; effect size [ES]=0.9), MIP (P=.012; 95% confidence interval [CI], 2.23-17.69; ES=0.67), MEP (P=.015; 95% CI, 1.85-16.57; ES=0.65), change of IAP (P=.001), and MBI (P=.016; 95% CI, 1.51-14.16; ES=0.64). No significant differences were found between the 2 groups in FEV1 (P=.24), FVC (P=.43), PEF (P=.202), MMEF (P=.277), the diaphragmatic movement of quiet breathing (P=.146), deep breathing (P=.102), and BBS (P=.124). ConclusionsLiuzijue exercise showed more changes than conventional respiratory training in improving trunk control ability, respiratory muscle functions, and activities of daily living ability in patients at an early recovery stage from stroke.

Intra-abdominal Pressure Screening of Horses With Colic

The objective of this study was to evaluate changes in intra-abdominal pressure (IAP) in horses with colic by associating the underlying etiologies with directly acquired IAP values and survival rate. This is a 2-year cohort study (2014–2016). Horses with clinical signs of colic were admitted to the veterinary teaching hospital during the period 2014–2016. Twenty-eight horses, of different breeds, males (stallions and geldings) and females, aged between 2 and 20 years, and weighing from 300 to 450 kg presenting with clinical signs of colic, were included in the study. IAP was directly acquired at the right flank (standing under sedation) and at the linea alba (supine position under general anesthesia). Twenty IAP measurements were recorded at end expiration for each recording site. IAP values >0.0 mmHg, obtained at the upper right flank in the standing position, were associated with surgical treatment (P < .05). In these cases, signs of colic were associated with strangulated obstructions of the large colon, and a greater likelihood of death as a result of colic (P < .001). Intra-abdominal pressure varied considerably in horses with colic, even for the same underlying etiologies. Horses with colic related to strangulating obstructions of the large intestine had IAP >.0 mmHg, at the upper right flank. These horses were also considerably more likely to require surgical intervention (P < .05) and death/euthanasia was more likely in this group of horses (P < .001).

The Relation Between the Distance of Rectus Plication and the Intra Abdominal Pressure Changes before and Immediately After Abdominoplasty

Abstract Background tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating and abdominal profile that is smoother and firmer. Diastasis recti means the belly sticks out because the space between left and right belly muscles has widened. The most notable symptom of anterior abdominal wall weakness or diastasis recti is a noticeable protrusion in the stomach. This protrusion is caused by weakness and separation of the muscles in the mid-abdomen. Objective It was to evaluate the relationship between the distance of recto-fascial or recto-fascial diastasis placation and intra-abdominal pressure changes during and immediately after abdominoplasty. Patient and Methodology In this study we demonstrated if there was relation between rectus diastasis width and the increase of intra-abdominal pressure, to evaluate this correlation before and immediately after the plication of anterior rectus sheath in abdominoplasty. Seventy five meeting the inclusion criteria were selected. Results This study enrolled 75 healthy female patients, the study took place at Al-Jamila Hospital, performed in a period of 10 months, starting from March 2017 till December 2017.

Factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery.

The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9±14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients" data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intraabdominal pressure as Group 1 (≥12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio =0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio=0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra-abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.

Intra-abdominal pressure may be elevated in patients with open abdomen after emergent laparotomy.

To estimate the change in intra-abdominal pressure (IAP) among critically ill patient who were left with open abdomen and temporary abdominal closure after laparotomy, during the first 48h after admission. A cohort study in a single ICU in a tertiary care hospital. All adult patients admitted to the ICU after emergent laparotomy for acute abdomen or trauma, who were left with temporary abdominal closure (TAC), were included. Patients were followed up to 48h. IAP was routinely measured at 0, 6, 12, 24, and 48h after admission to ICU. Thirty-nine patients were included, 34 were operated due to acute abdomen and 5 due to abdominal trauma. Seventeen patients were treated with skin closure, 13 with Bogota bag, and 9 with negative pressure wound therapy (NPWT). Eleven patients (28.2%) had IAP of 15mmHg or above at time 0, (mean pressure 19.0 ± 3.0mmHg), and it dropped to 12 ± 4mmHg within 48h (p < 0.01). Reduction in lactate level (2.4 ± 1.0 to 1.2 ± 0.2mmol/L, p < 0.01) and increase in PaO2/FiO2 ratio (163 ± 34 to 231 ± 83, p = 0.03) were observed as well after 48h. This is the first large report of IAP in open abdomen. Elevated IAP may be measured in open abdomen and may subsequently relieve after 48h.

Intra-abdominal Pressure Changes During Hip Arthroscopy: A Prospective Multicenter Study

To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P<.01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. Level IV, therapeutic case series.

Intra-abdominal hypertension in obese patients undergoing coronary surgery: A prospective observational study

BackgroundCoronary artery bypass grafting surgery has an increased risk of adverse events in obese patients. This increased risk might be explained in part by an increased intra-abdominal pressure and the development of intra-abdominal hypertension. Therefore, the objective of this study was to investigate the correlation between obesity and intra-abdominal hypertension and to evaluate its possible impact after coronary artery bypass grafting. MethodsA total of 50 consecutive patients scheduled to undergo coronary artery bypass grafting at a single center were selected prospectively before undergoing elective coronary artery bypass grafting. Based on the body mass index, 25 obese (body mass index ≥ 30) patients were matched with 25 control patients. Each patient had intra-abdominal pressure taken at baseline followed by one measurment every 4 hours until 24 hours after coronary artery bypass grafting. The serum markers for liver and kidney functions were collected once a day for 7 days after coronary artery bypass grafting. ResultsObese patients had a greater (mean ± SD) peak intra-abdominal pressure (15.4 ± 1.6 mm Hg versus 10.6 ± 1.6 mm Hg; P = .011) and mean change of intra-abdominal pressure from baseline (5.1 ± 3.3 mm Hg versus 2.2 ± 2.4 mm Hg; P = .001). The mean abdominal perfusion pressure was less in the obese group (63.0 ± 8.0 mm Hg versus 70.1 ± 11 mm Hg; P = .017). The liver dysfunction, as determined by the Schindl liver function scoring system between the obese and control groups, was not statistically significant (28% vs 8%; P = .066). More patients in the obese group developed renal injury based on the calculated glomerular filtration rate (32% vs 8%; P = .034). Obesity was highly associated with developing intra-abdominal hypertension (odds ratio: 2.99; 95% confidence interval: 1.92–3.53; P < .001). ConclusionObesity is associated with the development of intra-abdominal hypertension after coronary artery bypass grafting. This effect might indirectly impair the renal and liver functions through a decrease in the abdominal perfusion pressure.

Assessement of the Correction of Rectus Abdominis Muscles Diastasis Using Two Different Techniques

Introduction: The technique used for correction of rectusabdominis diastasis has been a debatable issue since theoriginal description of abdominoplasty. The aim of this studyis to assess the durability of the correction of midline diastasesdone by two different techniques (the rectus abdominis myofascialrelease technique and the conventional midline plication)and their effect on waist enhancement and its safety inthe terms of the intraabdominal pressure changes and respiratoryaffection that occur after plication.Patients and Methods: The study was conducted on 12females with body mass index less than 30, having Rohrichtype IV B deformities. The patients were divided randomlyinto two groups based on the technique used for plication ofanterior rectus sheath: Group (A) 6 patients underwent myofascialrelease technique, while group (B) 6 patients underwentconventional midline plication. The two groups were comparedas regards; 1- The width of rectus diastasis using computedtomography of their anterior rectus abdominis sheath pre-andpost-operatively at 1 and 6 and as regards 3 points: (A) Atthe umbilicus, (B) Midway between umbilicus and xiphoidprocess and (C) Midway between umbilicus and symphysispubis 2- Waist hip ratio pre-and post-operatively at 1 and 6months. 3- Evaluation of ventilatory function using spirometryand intraoperative measurement of intra-abdominal pressurebefore and after plication.Results: Post-operative follow-up time averaged 8 months(range 6-10 months). Group A showed significant decline inthe diastasis distance and increase in WHR than group B.There was a significant reduction in spirometry values andincrease in IAP in group A rather than group B after surgerybut there was no clinical differences in the respiratory functionbetween both groups.Conclusion: Plication of the anterior rectus sheath usingmyofascial repair technique showing nonsignificant residualdiastasis six months post operatively and has a better effecton the waist enhancement than the conventional plicationwith no respiratory complication.

Ability of mini-fluid challenge to predict fluid responsiveness in obese patients undergoing surgery in the prone position.

Pulse pressure variation (PPV) and stroke volume variation (SVV) can predict fluid responsiveness effectively. However, high Body Mass Index (BMI) can restrict their use due to changes in respiratory system compliance (CS), intra-abdominal pressure, and stroke volume (SV) in the prone position. Therefore, we aimed to investigate the effectiveness of mini-fluid challenge (MFC) in predicting fluid responsiveness in obese (BMI ≥30 kg/m2) patients in the prone position. A total of 33 patients undergoing neurosurgery were included. After standardized anesthesia induction, patients' PPV, SVV, stroke volume index (SVI) and CS values were recorded in the prone position (T1), after the infusion of 100 mL of crystalloid named as MFC (T2) and after fluid loading was completed with additional 400 mL of crystalloid. Patients whose SVI increased more than 15% after the fluid loading were defined as volume responders. Fifteen (45%) patients were responders to 500 mL fluid loading. After the 100 mL fluid load, a higher percentage increase in SVI was observed among responders (P<0.001), with values of 6.6% (6.2-8.6%) and 3.5% (1.7-4.8%) in responders and non-responders, respectively. Areas under the receiver operating characteristic curves of MFC, PPV, and SVV were 0.967 (95% CI: 0.838-0.999), 0.683 (95% CI: 0.499-0.834), and 0.709 (95% CI: 0.526-0.853), respectively. The area under the curve of MFC was significantly higher than that of PPV (P=0.003) and SVV (P=0.005). The increase in SVI after a rapid infusion of 100 mL crystalloid could predict fluid responsiveness in patients with BMI ≥30 kg/m2 in the prone position.

The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty

Background: Abdominoplasty surgery involves excisionof redundant abdominal skin flap and, in most cases, involvesrestoring weakened anterior abdominal wall muscles creatingan abdominal profile that is smoother and firmer. Diastasisrecti caused by anterior abdominal wall weakness. It happensbecause the space between left and right recti muscles hasbeen widened. Surgical correction for diastasis during theabdominoplasty can be considered as a definitive way forcorrection of diastasis by performing a plication or foldingof the linea alba, this results in a tighter abdominal wall.Aim of Work: Is to evaluate the relationship between thedistance of recto-fascial plication and intra-abdominal pressure(IAP) changes before and immediately after abdominoplasty.Patient and Methods: This study included 75 femalepatients, ageing between 24-57 years old, with mean age of43.3 years. Patients complained of abdominal redundancyafter childbirth, or post massive weight loss, with weak anteriorabdominal wall muscles. The diastasis width was measuredintraoperatively at three levels (3cm above the umbilicus, atthe umbilicus, and 3cm below the umbilicus) before performingrecto-fascia plication. Recto-fascial plication have beenperformed for all patients during their abdominoplasty procedurein two layers. Intra-abdominal pressure (IAP) variation,before and immediately after rectus sheath plication weremeasured using U-tube technique. Statistical analysis of allmeasurements were done.Results: Statistical analysis showed that the mean valueof diastasis above and at the umbilicus didn't differ significantly,however it was significantly lower below the umbilicuscompared with the other two levels. Comparing the pre andpostoperative IAP showed non-statistically significant increaseof IAP postoperative. Most importantly, statistics showed thatthere is a statistically significant positive correlation betweenthe IAP immediately after surgery and the distance of rectofascialplication especially above the umbilicus. Complicationrate in the current study was 2.6%.Conclusion: As a result of our current study, rectus diastasiswidth is significantly correlated with the IAP immediatelyafter abdominoplasty, therefore the larger the width of therectus diastasis, the more increase of IAP that would happenimmediately after abdominoplasty.

Abdominal Compliance and Laparoscopy: A Review

Background and Objectives:Creating and maintaining a pneumoperitoneum to perform laparoscopy is governed by gas laws and the limiting physical constraints of the abdomen.Methods:A review of how gas, biomechanical and physical properties affect the abdomen and a systematic structured Medline and PubMed search was conducted to identify relevant studies related to the topic.Results:Abdominal compliance is a measure of ease of abdominal expansion and is determined by the elasticity of the abdominal wall and diaphragm. It is the change in intra-abdominal volume per change in intra-abdominal pressure. Caution should be exercised with pressures exceeding 12 millimeters mercury since this is defined as intra-abdominal hypertension.Conclusions:Abdominal compliance has its limits, is unique for each patient and pressure-volume curves cannot be easily predicted. Using the lowest possible pressure to accomplish the surgical task without compromising surgical outcome is the desired goal. The clinical importance is caution and knowing there is a point where more pressure does not increase working space and only increases pressure.

The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty

The Relation between the Distance of Recto-Fascial Plication and the Intra-Abdominal Pressure Changes before and Immediately after Abdominoplasty