Laparoscopic Gynecologic Surgery Research Articles

A Comparative Study of Palonosetron with Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting (PONV) Following Laparoscopic Gynaecological Surgeries.

Incidence of postoperative nausea and vomiting (PONV) in susceptible patients can be unacceptably high (70-80% reported incidence). This study was designed to evaluate the effect of palonosetron and ondansetron in preventing PONV in high-risk patients undergoing gynaecological laparoscopic surgery. In this randomised, controlled, double-blind trial, nonsmoking females 18-70 years and weighing 40-90 kg, scheduled for elective laparoscopic gynaecological surgeries, were enrolled into the ondansetron (Group A, n=65) or palonosetron (Group B, n=65) group. Palonosetron (1 mcg/kg 4) or ondansetron (0.1 mg/kg 4) were administered just before induction. Postoperatively, incidence of nausea, vomiting, PONV (scored on a scale of 0-3), need for rescue antiemetic, complete response, patient satisfaction, and adverse effects were evaluated for up to 48 h following surgery. The overall PONV scores and postoperative nausea score during 0-2 h and 24-48 h were comparable, but PONV scores (P=0.023) and postoperative nausea scores (P=0.010) during 2-24 h were significantly lesser in Group B compared to Group A. There was no statistically significant difference in the postoperative vomiting score or retching during 0-48 h. The amount of first-line rescue antiemetic used during 2-24 h was significantly higher in Group A (56%) than in Group B (31%) (P=0.012; P<0.05). Complete response to the drug during 2-24 h was significantly higher (P=0.023) in Group B (63%) compared to Group A (40%), whereas response was comparable during 0-2 h and 24-48 h. Both groups had comparable incidences of adverse effects and patient satisfaction scores. Palonosetron has superior antinausea effect, less need of rescue antiemetics, and lesser incidence of total PONV in comparison to ondansetron during 2-24 h and comparable effect to ondansetron during the 0-2 h and 24-48 h postoperative periods in high-risk patients undergoing gynaecological laparoscopic surgery.

The effect of ultrasound-guided lung recruitment maneuvers on atelectasis in lung-healthy patients undergoing laparoscopic gynecologic surgery: a randomized controlled trial

BackgroundAtelectasis is the primary cause of hypoxemia during general anesthesia. This study aimed to evaluate the impact of the combination of recruitment maneuvers (RM) and positive end-expiratory pressure (PEEP) on the incidence of atelectasis in adult women undergoing gynecologic laparoscopic surgery using pulmonary ultrasound.MethodsIn this study, 42 patients with healthy lungs undergoing laparoscopic gynecologic surgery were randomly divided into the recruitment maneuver group (RM group; 6 cm H2O PEEP and RM) or the control group (C group; 6 cm H2O PEEP and no RM), 21 patients in each group. Volume-controlled ventilation was used in all selected patients, with a tidal volume of 6–8 mL·kg−1 of ideal body weight. When atelectasis was detected, patients in the RM group received ultrasound-guided RM, while those in the C group received no intervention. The incidence and severity of atelectasis were determined using lung ultrasound scores.ResultsA total of 41 patients were investigated. The incidence of atelectasis was lower in the RM group (40%) than in the C group (80%) 15 min after arrival in the post-anesthesia care unit (PACU). Meanwhile, lung ultrasound scores (LUSs) were lower in the RM group compared to the C group. In addition, the differences in the LUS between the two groups were mainly due to the differences in lung ultrasound scores in the posterior regions. However, this difference did not persist after 24 h of surgery.ConclusionsIn conclusion, the combination of RM and PEEP could reduce the incidence of atelectasis in patients with healthy lungs 15 min after arrival at the PACU; however, it disappeared within 24 h after surgery.Trial registration(Prospectively registered): ChiCTR2000033529. Registered on 4/6/2020.

Laparoscopic gynecological surgery under minimally invasive anesthesia: a prospective cohort study

The purpose of this study is to assess the feasibility and the perioperative outcomes of laparoscopic gynecological surgery in regional anesthesia (RA) from the point of view of the surgeon, anesthesiologist and patient. This is a prospective cohort study comprising sixty-six women planned to undergo gynecologic laparoscopy surgery for benign pathology at tertiary care gynecolgical center of the University Federico II of Naples. Women were assigned, according to their preference, to either RA (Group A) or general anesthesia (GA) (Group B). Surgical, anesthesiologic and postoperative recovery data were recorded. Postoperative pain was considered as the primary outcome. Secondary outcomes included mobilization, length of hospital stay, global surgeons and patient satisfaction, intraoperative pain assessment in Group A. Immediate postoperative pain was significantly lower in Group A 0 vs 2 (p < 0.001), with no significant differences at 24 h. The secondary outcome demonstrated early patient’s mobilization (p < 0.001) as well as early discharge (p < 0.001) and greater patient’s satisfaction for the Group A. In these patients, a maximum pain score of 3 points out of 5 was recorded through the entire surgery. RA showed to decrease the impact of surgical stress and to guarantee a quicker recovery without compromising surgical results. Although several surgical approaches can be employed to treat different conditions, RA technique could be a viable option for well-selected patients affected by gynecological diseases.

Pilot Study of Effects of Intermittent Pneumatic Compression in the Immediate Peri-Operative Period on Hemodynamic Parameters in Patients After Laparoscopic Gynecologic Surgery.

The randomized controlled study investigated the impacts of immediate peri-operative Intermittent pneumatic compression (IPC) on hemodynamic indicators in patients undergoing laparoscopic gynecologic surgery. Patients scheduled for elective laparoscopic gynecologic surgery were randomized to control (IPC not used), pre-operative IPC, post-operative IPC, and peri-operative IPC (performed both before and after surgery) groups. Systolic blood pressure (SBP), mean blood pressure (MBP) cardiac output (CO), heart rate (HR) and systemic vascular resistance (SVR) were measured at different time points. The results showed that SBP changes not obviously over time in the control and peri-operative IPC group. Compared with values before surgery, the pre-operative IPC group had a lower SBP (P < 0.01) at the end of PACU stay, whereas the post-operative IPC group had a higher SBP (P < 0.01) after surgery. All groups exhibited little or no variation in HR, CO and SVR. Conclusion is peri-operative IPC has no major adverse effects on hemodynamic parameters.

Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study.

Background: This study examined the relationship between the use of fentanyl-based intravenous patient-controlled analgesia (ivPCA) and the incidence of a clinically significant event (CSE), while considering both the analgesic effects and side effects in laparoscopic gynecological surgery. Methods: This study included 816 patients undergoing laparoscopic gynecological surgery under general anesthesia at Kyoto University Hospital between 2012 and 2018. The primary exposure was the use of fentanyl-based ivPCA. We defined an outcome measure—CSE—that integrates severe wound pain and vomiting assumed to negatively affect patient recovery. We performed multivariable logistic regression analysis to assess the independent relationship between ivPCA use and CSE. Results: Multivariable logistic regression analysis revealed that fentanyl-based ivPCA was independently associated with increased CSE (adjusted odds ratio (95% confidence interval): 1.80 (1.24–2.61), p = 0.002). Use of ivPCA was associated with a reduced incidence of postoperative severe wound pain (adjusted odds ratio (95% confidence interval): 0.50 (0.27–0.90), p = 0.022), but was also associated with an increased incidence of vomiting (adjusted odds ratio (95% confidence interval): 2.65 (1.79–3.92), p < 0.001). Conclusion: The use of fentanyl-based ivPCA in laparoscopic gynecological surgery is associated with increased CSE.

Feasibility of immediate removal of urinary catheter after laparoscopic gynecological surgery for benign diseases: Ameta-analysis of randomized controlled trials.

The proper time for removing the urinary catheter after gynecologic laparoscopy is unclear. To assess the feasibility of immediate catheter removal after benign gynecologic laparoscopy. PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Wanfang Data were searched from inception to November 30, 2021. Only randomized controlled trials published in English or Chinese comparing immediate versus delayed catheter removal after gynecologic laparoscopy for benign diseases were included. The primary outcome was the incidence of postoperative urinary retention (PUR). A random effects model was used to calculate pooled relative risk (RR) and 95% confidence interval (CI). Six studies were included in this meta-analysis. There was no significant difference in PUR between immediate and delayed catheter removal (RR 1.51, 95% CI 0.37-6.18), but the evidence was of very low quality. Subgroup analysis according to the type of surgery showed a higher rate of PUR with immediate removal after hysterectomy than after other surgeries. Immediate removal was associated a lower incidence of urinary tract infection and a shorter time to mobilization compared with delayed removal. Immediate removal of the urinary catheter is feasible and beneficial after benign gynecologic laparoscopy.

Systematic review and meta-analysis of Veress needle entry versus direct trocar entry in gynecologic surgery

ObjectiveAlthough many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with...

The voiding VAS score is a simple and useful method for predicting POUR after laparoscopy for benign gynaecologic diseases: a pilot study

The aim of this study was to identify an appropriate scoring system for predicting postoperative urinary retention (POUR) after gynaecological laparoscopic surgery for benign disease. We analysed 99 patients who underwent gynaecological laparoscopic surgery for benign disease. All patients were asked to complete self-administered questionnaires, including the International Prostate Symptom Score (IPSS), voiding visual analogue scale (VAS), and Brief Pain Inventory-Korean version. Of the 99 patients, 27 (27.3%) experienced urinary retention at least once, while 72 (72.7%) did not. The preoperative and postoperative IPSS scores were not associated with the development of POUR. However, the voiding VAS score was significantly lower in patients that developed POUR (p = .014). In conclusion, our results show that the voiding VAS score is a simple and useful method for identifying patients at risk of POUR after gynaecologic laparoscopic surgery for benign disease. IMPACT STATEMENT What is already known on this subject? Postoperative urinary retention (POUR) is an often underestimated complication defined as inability to void during the postoperative period despite a full bladder. Undetected POUR may lead to complications such as urinary tract infection, bladder distention, and bladder dysfunction. Routine assessment of POUR by bladder ultrasonography in all surgical patients places a larger workload on the nursing staff. What do the results of this study add? Among the self-scoring assessment tools, the voiding VAS provided the most accurate reflection of POUR in patients undergoing gynaecologic laparoscopic surgery for benign disease. What are the implications of these findings for clinical practice and/or further research? As laparoscopy is the most widely employed surgical procedure in gynaecology, our findings could have significant implications for postoperative care in daily clinical practice.

Efficacy of Spinal Epidural Anesthesia and Sub Diaphragmatic Lidocaine with Spinal Anesthesia in reduction of shoulder pain: Randomized Clinical trial

To determine the efficacy of spinal anesthesia with sub diaphragmatic lidocaine for gynecological laparoscopic surgery at the commencement of the procedure to spinal anesthesia for get pain relief Methods: It was a randomized clinical trial conducted at Ali Medical Hospital in Islamabad. A total of 84 patients were given sub diaphragmatic lidocaine spinal anesthesia, only spinal epidural anesthesia and general anesthesia. During procedure, 2, 4, 6 and 12 hours after surgery, and before discharge, patients' pain perception was measured using Visual Analogue Scale (VAS) Results: Outcomes showed no significant difference in perception of pain at different time intervals in all three groups. (F 4, 77 = 0.38, p = 0.81). At all-time intervals following surgery, patients' pain levels were similar between groups (F 2, 77 = 0.53, p = 0.57). Conclusions: The use of sub diaphragmatic lidocaine at the onset of surgery together with the spinal anesthesia did not result in a prominent statistical difference in patients' postoperative VAS scores when compared to general anesthesia and spinal epidural anesthesia after and prenatal invasive techniques.

Zingiberaceae plants/curcumin consumption and multiple health outcomes: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials in humans.

This umbrella review is to recapitulate and grade the available evidence of associations between consumption of Zingiberaceae plants/curcumin (Cur) and multiple health-related outcomes. This study included 161 meta-analyses of randomized controlled trials in 76 articles with 67 unique health outcomes. Data on heterogeneity and publication bias are considered to assess the quality of evidence. Based on the different impact of Zingiberaceae plants/Cur on human health, the advantages outweigh the disadvantages. Zingiberaceae plants/Cur can mainly improve metabolic syndrome, non-alcoholic fatty liver disease, cardiovascular disease, and some chronic inflammatory diseases, likewise, obviously relief the pain of osteoarthritis and related diseases. Ginger supplements have been shown to improve vomiting during pregnancy and to relieve nausea and vomiting caused by chemotherapy and surgery. The surgery is any type of surgery, including laparoscopic surgery, gynecological surgery and mixed surgery. Beneficial associations were found with Cur intervention in gastrointestinal, neurological and oral diseases. Zingiberaceae plants/Cur are generally safe and favorable for multiple health outcomes in humans. High-quality research is further needed to prove the observed associations.

Identification of the intraoperative antinociceptive effect of intravenous fentanyl using the Nociception Level (NOL) index versus clinical parameters in patients undergoing gynecological laparoscopic surgery: A secondary analysis of the NOLGYN study

BackgroundWhile we typically assess nociception balance during general anesthesia through clinical parameters such as heart rate (HR) and mean arterial pressure (MAP) variation, these parameters are not specific to nociception. ObjectiveWe hypothesized that using the Nociception Level (NOL) index to assess the analgesic effect of a fentanyl bolus would be superior to standard clinical parameters. DesignAncillary study of the NOLGYN study, a randomized controlled trial comparing intraoperative NOL-guided administration of fentanyl (NOL group) versus standardized care (SC group). SettingUniversity hospital in Montréal, Canada between November 2018, and December 2019. PatientsWomen undergoing gynecological laparoscopic surgery. InterventionIn our evaluation of intraoperative nociception, we analyzed the analgesic effect of fentanyl using three parameters: MAP, HR, and the Nociception Level (NOL) index. All fentanyl injection events were extracted from the database. Main outcome measureThe primary endpoint was the difference between values before and after each injection. ResultsThe median of the NOL index before fentanyl injection was 30.5 (IQR 19.4 to 40.7) versus 18.9 (IQR 11.5 to 27.4) after (P < 0.001). The median of MAP was 106.4 mmHg (IQR 99.9 to 113.4) before injection versus 103.2 mmHg (IQR 97.5–110.7) after (P < 0.001). The median of HR before injection was 74.2 (IQR 64.2–83.8) versus 72.4 (IQR 63.4–81.3) after (P < 0.001). ConclusionsThe NOL index, HR, and MAP all statistically discriminated the analgesic effect of fentanyl but only the NOL index proved clinically relevant to identify the analgesic effect of one fentanyl injection. Trial registrationwww.clinicaltrials.gov (NCT03776838) registered in October 2018.

The Effect of Mechanical Bowel Preparation on the Surgical Field in Laparoscopic Gynecologic Surgeries: A Prospective Randomized Controlled Trial

Purpose To evaluate the effects of mechanical bowel preparation (MBP) on the intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery in patients undergoing elective laparoscopic gynecological surgeries. Methods The patients randomized to a MBP group and a no preparation (NMBP) group. The senior surgeon remained blinded to the bowel regimen used by the patient. Intraoperative visualization of the surgical field, bowel handling, intestinal load, and overall ease of surgery were evaluated using a numeric rating scale (NRS). Results We enrolled 120 patients, of whom 109 completed the study, with 51 and 58 patients in the MBP and NMBP groups, respectively. The intraoperative visualization of the surgical field, intestinal load, and NRS scores for overall ease of surgery were better in the NMBP group (p = .03, p = .048, and p = .022, respectively). The results of the assessments also revealed no significant differences in surgical field visualization, ease of bowel handling, overall ease of surgery, or the time that patients experienced passage of flatus between obese (BMI > 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) patients in the two groups. Conclusions The current study revealed that MBP did not improve the intraoperative visualization of the surgical field or the overall ease of surgery. Moreover, MBP had no benefit when operating on patients who had a high BMI. Therefore, we do not recommend routine MBP before laparoscopic gynecological surgeries.

Effect of injection pain and withdrawal movement of propofol and rocuronium in the induction of anaesthesia on postoperative pain outcomes in gynaecological laparoscopic surgery: a prospective observational study.

The experience and perception of pain may vary among individuals.This prospective cohort study aimed to determine the impact of injection pain/withdrawal movement of propofol and rocuronium in the induction of anaesthesia on postoperative pain outcomes in gynaecological laparoscopic surgery. A total of 100 patients aged 19-60 years received propofol and rocuronium injections for the induction of anaesthesia. The incidence of propofol injection pain (PIP) and rocuronium-induced withdrawal movement (RIWM), postoperative pain scores and total opioid consumption were evaluated, and the associations between PIP/RIWM and postoperative pain outcomes were determined. Visual analogue scale (VAS) for pain after surgery and total opioid consumption after surgery were significantly higher in patients with PIP or RIWM than in patients without PIP or RIWM. The correlations of PIP/RIWM with VAS at 1 h, VAS at 24 h and total opioid consumption were significant and weakly positive ( r = 0.249, r = 0.234, r = 0.22 and r = 0.234, respectively). The RIWM correlated more positively with pain score compared to PIP at 1 h ( r = 0.408 vs. r = 0.234), PIP at 24 h ( r = 0.398 vs. r = 0.227) and with total opioid consumption for 48 h after surgery ( r = 0.457 vs. r = 0.234). During anaesthesia induction, the occurrence of PIP and RIWM may predict the severity of postoperative pain and total opioid consumption, with RIWM emerging as a stronger predictor than PIP.

The Gynecologic Laparoscopic Surgery: Experience of Center of Fertility and Reproductive Medicine at St. Paul’s Hospital Millennium Medical College

Background: Recent data suggests that up to 80% of gynecologic surgeries can be accomplished laparoscopically. However, laparoscopy does not come without risks – specifically risks of injury to the bowel, urinary tract, and vasculature. This study assesses the indications for, as well as the complications and outcomes of laparoscopic surgery at the Center of Fertility and Reproductive Medicine at St Paul’s Hospital Millennium Medical College. Methods and Materials: This is a cross sectional retrospective study using data abstracted from medical records between April 2019 to September 2020. We included all gynecologic laparoscopies done during this date range. The data was collected with Open Data Kit (ODK) software and then transferred to Microsoft Excel for analysis. We set statistical significance at P &lt;0.05. Results: There were 135 gynecologic surgeries performed, with a mean patient age of 32.4 years. About two-thirds of them presented with primary infertility, and 30% had a previous laparotomy or laparoscopy. Twenty percent had previously been diagnosed with tuberculosis. The main indication for laparoscopy was hydrosalpinx which accounted for 51.1% of surgeries. For patients who underwent surgery for a diagnosis of hydrosalpinx, the majority (54%) underwent bilateral salpingectomy. Our complication rate was 3.7% and rate of conversion to laparotomy was 5.2%. Conclusion: Our complication rate was higher than previously published laparoscopic complication rates from Asia and Europe. The majority of our complications were bladder and bowel injuries. Complications were managed predominately by conversion to laparotomy. Keywords: gynecology, laparoscopy, complications, Saint Paul’s Hospital Millennium Medical College.

Neuroaxial Verses General Anesthesia for Gynecological Surgeries

Objective: To evaluate the anaesthetic effects, patient satisfaction, and the Oxidative Stress Index between neuroaxial anaesthesia (NA) and general anaesthesia (GA) during gynecologic laparoscopic surgery. Study Design: Prospective randomized study Place and Duration: Lady Reading Hospital Peshawar.1st Jan, 2021 to 30 June, 2021. Methods: The research involved ninety women between the ages of 20 and 55 who were scheduled to undergo diagnostic laparoscopy and hysteroscopy for unexplained infertility and had an ASA I-II physical status.Age, BMI and laparotomy indication were documented after obtaining informed written permission from each patient. Patients were equally divided in two groups group I received neuroaxial anesthesia and group II received general anesthesia. Post-operative outcomes among both groups were compared. SPSS 22.0 was used to analyze complete data. Results:Mean age of the patients in group I was 33.4±11.32 years and had mean BMI 25.4±7.81 kg/m2 while in group II mean age was 30.7±14.63 years with mean BMI 22.8±9.52 kg/m2. In group I 28 (62.2%) cases had ASA class I and in group II 30 (66.7%) cases had ASA class I. Diagnostic laparoscopy was majority in numbers among both groups 29 (64.4%) in group I and 26 (57.8%) in group II. Among both groups paratubal cystectomy was most common symptom found in 6 (13.3%) cases and 7 (15.6%) cases. Mean operative time in neuroaxial group was lower 45.3±6.52 minutes as compared to group II was 54.8±11.42 minutes. Mean time of anesthesia was also lower in group I as compared to group II with p value &lt;0.003. Mean pain score was significantly reduced in group I 3.6±8.61 as compared to group II 6.8±11.92. Heart rate and arterial pressure was lower in group I. Post-operative Oxidative Stress index among patients of group II was higher 1.9±4.45 as compared to group I 0.9±0.42. Conclusion:We concluded in this study that the use of neuroaxial anesthesia undergoing gynecologica laparoscopy was effective and useful as compared to general anesthesia in terms of less pain score and oxidative stress index. Except this frequency of adverse events were also lower in neuroaxial group. Keywords: Laparoscopy, Nueroaxial Anesthesia, General Anesthesia, Complication, Pain score

Effect of additional equipotent fentanyl or sufentanil administration on recovery profiles during propofol-remifentanil\u2013based anaesthesia in patients undergoing gynaecologic laparoscopic surgery: a randomized clinical trial

BackgroundIn clinical practice, sufentanil has a stronger sedative effect on patients than fentanyl at equivalent doses. This study hypothesized that, at equivalent doses, patients undergoing gynaecologic laparoscopic surgery (GLS) receiving fentanyl would have an earlier emergence from anaesthesia (EA), a shorter time to extubation (TE), and a better degree of wakefulness. Therefore, this study evaluated the effects of equipotent doses of fentanyl and sufentanil on the quality of emergence in patients undergoing GLS. MethodsOne hundred seven patients scheduled for GLS under general anaesthesia were randomly divided into two groups and were induced with 0.35 µg/kg sufentanil (Group S; n = 55) or 3.5 µg/kg fentanyl (Group F; n = 52). When the GLS was almost over, the patient's abdominal cavity was flushed with warm saline, and 5 µg of sufentanil or 50 µg of fentanyl in a double-blind manner was intravenously injected into the patients. The primary outcomes of the study included EA, TE, the rate of leaving the surgical bed voluntarily and the incidence of endotracheal tube tolerance. The Ramsay Sedation Scale (RSS), and Verbal Rating Scale (VRS) scores at 15 and 30 min in the postanaesthesia care unit (PACU), as well as other adverse events, including nausea and vomiting, itching, delirium, dizziness, chills, and respiratory depression (SpO2 < 95%) in the PACU, were evaluated as secondary outcomes.ResultsThere were no statistically significant dissimilarities between the two groups with respect to baseline characteristics. For recovery, the EA (9.0 ± 4.8 min vs. 8.9 ± 3.0 min; P = 0. 146), TE (9.5 ± 4.7 min vs. 9.0 ± 3.0 min; P = 0.135), rate of leaving the surgical bed voluntarily (31.18% vs. 38.46%; P = 0.976), and incidence of endotracheal tube tolerance (94.55% vs. 96.15%; P = 0.694) were not significantly different between the two groups. In the PACU, the 15-min RSS score (2.07 ± 0.38 vs. 2.15 ± 0.36; P = 0.125), the 30-min RSS score (2.02 ± 0.13 vs. 2.04 ± 0.19; P = 0.207), the 15-min VRS score (0.50 ± 0.57 vs. 0.67 ± 0.55; P = 0.295), and the 30-min VRS score (0.45 ± 0.50 vs. 0.75 ± 0.52; P = 0.102) were not significantly different between Groups S and F. No adverse events, such as nausea, vomiting, pruritus, delirium, and tremors, occurred in either group. The rates of respiratory depression (1.82% vs. 1.92%; P = 0.968) and dizziness (0.00% vs. 4.85%; P = 0.142) were not different between Groups S and F in the PACU.ConclusionsThe majority of patients scheduled for GLS were able to rapidly and smoothly emerge from anaesthesia. After surgery, similar outcomes, including EA, TE, the incidence of endotracheal tube tolerance, the rate of leaving the surgical bed voluntarily, RSS scores, VRS scores, and adverse events in the PACU, were achieved for the patients between the two anaesthetic protocols.

Association between intraoperative end-tidal carbon dioxide and postoperative nausea and vomiting in gynecologic laparoscopic surgery

Gynecologic laparoscopic surgery has a high incidence of postoperative nausea and vomiting (PONV). Studies suggest that low intraoperative end-tidal carbon dioxide (EtCO2) is associated with an increased incidence of PONV, but the results have not been consistent among studies. This study investigated the association between intraoperative EtCO2 and PONV in patients undergoing gynecologic laparoscopic surgeries under general anesthesia. This retrospective cohort study involved patients who underwent gynecologic laparoscopic surgeries under general anesthesia at Kyoto University Hospital. We defined low EtCO2 as a mean EtCO2 of < 35 mmHg. Multivariable modified Poisson regression analysis examined the association between low EtCO2 and PONV during postoperative two days and the postoperative length of hospital stay (PLOS). Of the 739 patients, 120 (16%) had low EtCO2, and 430 (58%) developed PONV during postoperative two days. There was no substantial association between low EtCO2 and increased incidence of PONV (adjusted risk ratio: 0.96; 95% confidence interval [CI] 0.80–1.14; p = 0.658). Furthermore, there was no substantial association between low EtCO2 and prolonged PLOS (adjusted difference in PLOS: 0.13; 95% CI − 1.00 to 1.28; p = 0.816). Intraoperative low EtCO2, specifically a mean intraoperative EtCO2 below 35 mmHg, was not substantially associated with either increased incidence of PONV or prolonged PLOS.

Comparison of health-related quality of life of women undergoing robotic surgery, laparoscopic surgery or laparotomy for gynecologic conditions: A cross-sectional study.

To assess and compare the health-related quality of life of women undergoing robotic gynecologic surgery, laparoscopic gynecologic surgery or laparotomy for benign and cancerous conditions. Cross-sectional study design was used. The present study was carried out with 240 women, who underwent gynecologic surgery (robotic 48, laparoscopic 96, and laparotomy 96) in a tertiary care hospital. Instruments included a participant description questionnaire and Medical Outcomes Study Short Form-36. The data were collected 4 weeks after surgery, at the first postoperative visit of women to the clinic. Pearson χ2 test, one-way analysis of variance, and regression analysis were used to assess the data. Over half of the women in each group had surgery because of gynecologic cancer. All the subscale scores of Medical Outcomes Study Short Form-36 were significantly higher in the robotic group than the other surgical groups (P< 0.05). Women in the robotic group had better quality of life in terms of both the physical component and the mental component after surgery. Knowledge of health-related quality of life in the recovery period after surgery is important for healthcare providers to provide adequate preventive measures, information, and follow up.

Study on the Application of Aromatherapy Bag Combined with Ear Point Embedding Bean in Preventing Nausea and Vomiting after Gynecological Laparoscopic Operation

Study on the Application of Aromatherapy Bag Combined with Ear Point Embedding Bean in Preventing Nausea and Vomiting after Gynecological Laparoscopic Operation

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.