Pneumoperitoneum In Laparoscopic Cholecystectomy Research Articles

Transumbilical laparoscopy for pneumoperitoneum establishment: a comprehensive multicentre evaluation affirming safety, feasibility, and a range of clinical benefits.

Transumbilical laparoscopy (TUL) has emerged as a promising technique for establishing pneumoperitoneum in laparoscopic cholecystectomy, offering potential safety, feasibility, and clinical benefits. This retrospective multicentre study aims to evaluate the efficacy and outcomes of TUL in the management of gallbladder diseases. A retrospective analysis was conducted on a cohort of 2,543 patients who underwent TUL between 2011 and 2021 across various medical institutions in Italy. Data collection included demographic, clinical, intraoperative, and postoperative parameters. Standardized protocols were followed for preoperative and postoperative management. The TUL technique involved precise anatomical incision and trocar placement. The study demonstrated favorable outcomes associated with TUL, including a low conversion rate to open surgery (0.55%), minimal intraoperative complications (0.16%), and short hospital stays (average 2.4 days). The incidence of incisional hernias was notably low (0.4%). Comparison with existing literature revealed consistent findings and provided unique insights into the advantages of TUL. Despite limitations, such as the absence of a control group and the retrospective nature of the study, the findings contribute valuable insights to the literature. They inform surgical decision-making and advance patient care in laparoscopic cholecystectomy for gallbladder diseases. Transumbilical laparoscopy shows promise as a safe and feasible technique for establishing pneumoperitoneum in laparoscopic cholecystectomy. The study's findings support its clinical benefits, including low conversion rates, minimal complications, and short hospital stays. Further research, including prospective studies with control groups, is warranted to validate these results and optimize patient outcomes.

A comparative study of low-pressure pneumoperitoneum versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy in tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard management of symptomatic cholelithiasis. We try to use low-pressure pneumoperitoneum (LPP) to study the effect of pneumoperitoneum in the duration of surgery, field of visualization with providing sufficient work space for surgeon, and post-operative shoulder pain and hospital stay in laparoscopic cholecystectomy. Aims and Objectives: The aims and objectives of the study are to compare outcomes in LPP versus standard-pressure pneumoperitoneum (SPP) with respect to duration of surgery, CO2 consumption, field of visualization, and surgical difficulties to convert SPP or open cholecystectomy and post-operative shoulder pain and hospital stay. Materials and Methods: The prospective randomized study was conducted in tertiary care center, Government Medical College, Banda, Uttar Pradesh from July 2021 to October 2022. All consented 100 patients after randomization were allotted into two groups. Results: In our study, the mean duration of surgery surgical difficulties to convert open and standard pressure and difficulty in field visualization insignificant is more in LPP as compared to SPP but CO2 consumption, post-operative shoulder pain, and mean hospital stay is less in LPP as compared to SPP. Conclusion: Laparoscopic cholecystectomy in LPP is safe and feasible. Field visualization, conversion rate, and duration of surgery are affected non-significantly because depend on the expertise of surgeon but shoulder pain, CO2 consumption, and hospital stay are less in LPP.

Comparative study of low-pressure versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy

Background A pressure range of 12–14 mmHg is used in standard-pressure pneumoperitoneum during laparoscopic cholecystectomy. Utilizing low-pressure pneumoperitoneum, which ranges between 7 and 10 mmHg, has become widespread as a way to reduce the effects of pneumoperitoneum on human physiology while still allowing for sufficient working space. Aim This study’s objective is to evaluate the outcome of laparoscopic cholecystectomy with low-pressure pneumoperitoneum against standard-pressure pneumoperitoneum. Patients and methods The study comprised 80 patients who underwent laparoscopic cholecystectomy and for symptomatic gallstone disease. The participants were divided into two groups of 40. During the procedure, 40 patients underwent standard-pressure pneumoperitoneum, while another 40 patients underwent low-pressure pneumoperitoneum. Operative time, intraoperative injuries or mortality, conversion to open surgery, alterations in blood pressure and heart rate during operation, incidence of postoperative shoulder tip pain, need for additional analgesia postoperatively, and incidence of postoperative nausea and vomiting were all recorded as outcome parameters. Results The mean time of operation in patients with low-pressure pneumoperitoneum was 65±10.6 min and with standard-pressure pneumoperitoneum was 61±9.7 min. Neither blood pressure nor heart rate changed in a way that was statistically significant when lower pressure pneumoperitoneum was used. Compared to the standard-pressure laparoscopic cholecystectomy group, the low-pressure group experienced statistically less postoperative shoulder pain (P<0.05). Nothing significantly different was seen in nausea and vomiting between the two groups (P=0.767). Conclusion While reduced intensity postoperative shoulder pain is a benefit of low-pressure pneumoperitoneum for the patient, it has no positive impact on intraoperative hemodynamics, operative time, intraoperative injuries, or mortality.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.
 Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.Methodology: This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).
 Results:A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.
 Conclusion:LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

INCIDENCE OF SHOULDER-TIP PAIN IN LAP. CHOLECYSTECTOMY NORMAL VERSUS LOW-PRESSURE PNEUMOPERITONEUM

Open cholecystectomy can lead to several post-operative complications. However, with the advent of minimal access surgery, these complications have decreased to a large extent. Nowadays, laparoscopic cholecystectomy is considered the gold standard for cholelithiasis. Similar to other surgeries, some post-operative complications are linked to laparoscopic surgery. One such complication is shoulder-tip pain. This study aimed to compare the intensity of post-op shoulder-tip pain after laparoscopic cholecystectomy at low pressure (10mmHg or less than 10mmHg) and standard pressure (12-14mmHg). Two groups of 30 patients each were made in this prospective randomized study. Group A patients underwent low-pressure pneumoperitoneum cholecystectomy (10mmHg or less than 10mmHg), while group B underwent standard-pressure pneumoperitoneum cholecystectomy (12-15mmHg). According to the verbal pain intensity score, post-op shoulder-tip pain was reduced in Group A compared to Group B at 6, 12, and 24 postoperative hours. This study showed that using low-pressure pneumoperitoneum in laparoscopic cholecystectomy reduces the intensity of post-operative shoulder pain and the need for analgesia.

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.

Intravenous Clonidine and Magnesium Sulphate in Attenuating Hemodynamic Response to Pneumoperitoneum During Laparoscopic Cholecystectomy: A Randomized Blinded Comparative Study

ABSTRACT Background: Conflicting data are demonstrating the superiority between Clonidine and Magnesium Sulphate in attenuating hemodynamic response to pneumoperitoneum. Methods and Methodology: This was a prospective randomized blinded trial comparing the efficacy of injection Clonidine 1.5 μg/kg (group A) and Magnesium Sulphate (MgSO4) 50 mg/kg (group B) done over six. Results: Sixty-eighty patients were included and assigned randomly to two groups of 34 (50.0%) patients. The mean (SD) age in groups A and B was 34.32 (11.35) and 37.20 (10.17) years respectively. Comparison of systolic blood pressure and mean arterial pressure were similar in both groups. The heart rate (HR) of patients in group A with group B, was almost the same at pre-induction and the end of infusion while HR was noted to be higher in group B, compared to group A at 5 minutes. Comparisons of EtCO2 (mm Hg) and SpO2 (%) between group A and group B were comparable in both the groups at pre-induction, at 5 min, 10 min, 15 min, 20 min, 25 min, 30 min, 35 min and 40 min. However, at the end of the infusion SpO2 levels were higher in Group A (p = 0.004). According to Modified Ramsay Sedation Score, half of the patients (50.0%) from group A were cooperative, oriented, and tranquil. In Group B, about one-third (38.2%) were cooperative, oriented, and tranquil. Immediate postoperative complications included nausea (8.8%) and vomiting (2.9%) which were comparable between both groups. Conclusion: Overall observations suggested that Clonidine (1.5 μg/kg) was equally effective as MgSO4 (50 mg/kg) in attenuating hemodynamic responses during pneumoperitoneum in laparoscopic cholecystectomy.

Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy.

Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.

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.

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.

A Study of the Safety and Morbidity Profile of Closed versus Open Technique of Laparoscopic Primary Peritoneal Access Port in Patients Undergoing Routine Laparoscopic Cholecystectomy at a Tertiary Care Hospital in Northeastern India.

Introduction Laparoscopic cholecystectomy (LC) is the gold standard operation for gallstone disease. Primary port placement into the abdomen is a blind procedure and is challenging with chances of unforeseen complications. The complication rate has remained the same during the past 25 years. Both closed/Veress and open/Hasson's techniques are commonly employed and have their typical indications for use. Materials and Methods This prospective study was carried out in the Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, from January 2014 to January 2016, with the aim to compare the safety profile of closed/Veress and open/Hasson's methods of access to the abdomen during laparoscopic cholecystectomy (LC). The study had 400 eligible cases undergoing LC who were randomly allotted into 2 groups with 200 cases each: group A: closed/Veress needle method and group B: open/Hasson's method. Results Closed/Veress and open/Hasson's method of establishing pneumoperitoneum in laparoscopic cholecystectomy is equally safe in terms of major complications. The closed/Veress method gives faster access to the abdomen as compared to the open method (5.62 ± 2.23 minutes and 7.18 ± 2.52 minutes, respectively, p value <0.0001). The open/Hasson's method is associated with more primary port site complications (9/200 vs. 0/200, p value 0.0036) and troublesome intraoperative gas leaks (39/200 vs. 2/200, p value <0.0001). The open technique for primary peritoneal access port for laparoscopic cholecystectomy does not impart any additional benefits in terms of safety and morbidity profile in patients undergoing LC. Conclusion The closed/Veress method of establishing pneumoperitoneum in laparoscopic cholecystectomy is equally safe in terms of major complications and gives quicker access to the abdomen as compared to the open method.

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

Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy.&#x0D; Design: Randomized controlled trial&#x0D; Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020.&#x0D; Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant.&#x0D; Results: The complication rate in VNI group were significantly greater than the DTI group (p &lt; 0.01), the duration of surgery between the two groups was not significantly different (p &gt; 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p &lt; 0.001).&#x0D; Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.

A Randomized Trial of Low-Pressure (08–10 mm Hg) vs. Standard-Pressure (13–15 mm Hg) Pneumoperitoneum in Laparoscopic Cholecystectomy

The reported incidence of shoulder tip pain after laparoscopic cholecystectomy was 30%–50%. The aim of the present randomized controlled study was to compare the effects of low-pressure (08–10 mm Hg) vs. standard-pressure (13–15 mm Hg) pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. One hundred patients between 18 and 70 years undergoing laparoscopic cholecystectomy were included. Group A and group B patients underwent low-pressure and standard-pressure pneumoperitoneum laparoscopic cholecystectomy respectively. Post-operative shoulder tip pain and post-operative abdominal pain were measured using visual analogue scale score at 2 h, 8 h, 24 h and 48 h after surgery. The primary outcome measures were the incidence and severity of post-operative shoulder tip pain, whereas secondary outcome measures were the incidence and severity of abdominal pain. Intergroup comparison of categorical and continuous variables was done using the chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively. The incidence and severity of post-operative shoulder tip pain at 2 h, 8 h, 24 h and 48 h was significantly higher in group B as compared to group A. The incidence of post-operative abdominal pain at 48 h was significantly higher in group B as compared to group A. The severity of post-operative abdominal pain at 24 h and 48 h was significantly higher in group B as compared to group A. Low-pressure laparoscopic cholecystectomy significantly decreases the incidence and severity of post-operative shoulder tip and abdominal pain. Routine use of low-pressure pneumoperitoneum for the alleviation of post-operative pain following laparoscopic cholecystectomy is recommended.

Can spiral-shaped abdominal wall lift replace pneumoperitoneum in laparoscopic cholecystectomy? A randomised study

Background: A new design of abdominal lift system for gasless laparoscopy has been introduced in rural areas. Aims and Objectives: To assess whether the new spiral design abdominal wall lift system has similar outcomes to standard pneumoperitoneum laparoscopic cholecystectomy. Materials and Methods: Sixty cases of symptomatic gallstone disease scheduled for laparoscopic cholecystectomy were randomly assigned to gasless spiral abdominal wall lift or to standard pressure pneumoperitoneum, followed by cholecystectomy. Post-operative abdominal and shoulder tip pain, duration and ease of surgery and surgical site complications were compared. Results: There was a significant difference in post-operative abdominal pain at 24 hours after surgery (P Conclusion: Abdominal lift may be a valid alternative to pneumoperitoneum cholecystectomy with comparable outcomes in resource constrained areas.

A comparative study of magnesium sulphate and clonidine in attenuating hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy

A comparative study of magnesium sulphate and clonidine in attenuating hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy

Effectiveness of Intravenous Dexmedetomidine vs. Fentanyl for Attenuation of Haemodynamic Response to Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomised Double Blind Study

Introduction: Laparoscopy is a widely performed minimal invasive surgical procedure, wherein various haemodynamic changes are faced by anaesthesiologists during Pneumoperitoneum (PNP). Aim: To compare the effectiveness of dexmedetomidine vs fentanyl for attenuating the haemodynamics response to PNP in Laparoscopic Cholecystectomy (LC). Materials and Methods: A total of 84 patients of 18-50 years age, American Society of Anaesthesiologists (ASA) Class I/II of either sex for elective LC were included. The patients were divided into two groups (A, B) of 42 patients each. Group A received dexmedetomidine and Group B received fentanyl. Both the drugs were given as loading dose of one μg/kg over ten min followed by maintenance 0.2 μg/kg/h throughout the surgery. Haemodynamic parameters were recorded at different time intervals throughout the surgery. In recovery room patients were observed for postoperative analgesia by using Visual Analogue Scale (VAS), sedation level using RAMSAY Sedation score at every 30 minutes till the time of giving first rescue analgesia and side effects, if any. Results: Intraoperatively, throughout the period of PNP, Group A showed statistically better attenuation of haemodynamic responses in comparison to Group B (p&lt;0.05). After creating PNP, rise in Mean Arterial Pressure (MAP) was observed in both group A and group B, 99.38±6.32 and 103.43±9.81, respectively but this rise was more in group B which was statistically significant (p&lt;0.05) throughout the surgery except 40 minutes after PNP creation. Time to first rescue analgesia or mean duration of postoperative analgesia (VAS&gt;3) was significantly longer in dexmedetomidine group (102.14±32.50 minutes) than fentanyl group (42.86±15.03 minutes). There was better control of pain but more sedation in Group A than in Group B. Conclusion: This study concludes that intravenously administered dexmedetomidine shows better attenuation of haemodynamic responses to CO2 insufflation as compared to fentanyl. Dexmedetomidine also provides better sedation and has more analgesic sparing effect.

Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (&lt;12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain.&#x0D; Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum&#x0D; Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. &#x0D; Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = &lt;0.001).&#x0D; Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study

Background and Aim: Pneumoperitoneum (PP) for laparoscopic surgery is known to induce a pressor response. It can be attenuated by drugs, like opioids, vasodilators, beta blocking agents and alpha-2 agonists, but these drugs have their side effects. This study investigated the efficacy of magnesium sulphate to attenuate hemodynamic response associated with pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.Methodology: This randomized, double blind, prospective study was carried out at Department of Anesthesiology, Maharishi Markandeshwar University, Mullana, Haryana (India). A total of 60 patients of ASA grade I or II, aged 20-60 y, of either sex, undergoing laparoscopic cholecystectomy, were randomly allocated into one of the two groups of 30 each. Standardized general anesthesia was administered to all patients. Group 1 patients received magnesium sulphate (30 mg/kg) intravenously as a bolus before induction of PP and Group 2 patients received same volume of 0.9% normal saline. Hemodynamic variables, e.g. heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial pressures (MAP) were recorded from the start of surgery till extubation. Statistical analysis: SPSS version 17.0 for windows was used and p value of &lt; 0.05 was considered significant.Results: Mean HR was 81.50 ± 8.44 vs. 93.03 ± 6.93/min, SBP was 126.37 ± 13.03 vs. 150.20 ± 10.45 mmHg, DBP was 82.50 ± 11.20 vs. 94.73 ± 8.33 mmHg, and MAP 98.43 ± 10.29 vs.113.27 ± 9.16 mmHg in Group 1 and Group 2, respectively, at 10 min after PP. Statistically significant fall in HR, SBP, DBP, MAP was seen in Group 1 at 10 min after PP till extubation. (p &lt; 0.05).Conclusion: Intravenous magnesium sulphate effectively attenuates the hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy under general anesthesia.Citation: Bansal K, Santpur MU, Garg U, Goel K, Vijay D, Tatineni Bansal. Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study. Anaesth pain &amp; intensive care 2019;23(3):290-294

Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

To compare the changes in hepatic enzymes and comfort level of the surgeon in low-pressure pneumoperitoneum laparoscopic cholecystectomy (LPPLC, 7 mm Hg) with that of normal pressure pneumoperitoneum laparoscopic cholecystectomy (NPPLC, 14 mm Hg). Eighty-two patients were randomly divided into 2 groups (LPPLC and NPPLC). Serum levels of bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, alkaline phosphatase, and lactate dehydrogenase were measured before the operation, at the time of reversal from anesthesia, 24 hours after the operation, and on day 7. Serious adverse events, intra-operative complications, surgeon's comfort level of dissection, operative time, conversion rates to an open procedure, or normal pressure pneumoperitoneum were recorded. Of the 41 patients randomized for LPPLC, 8 patients were converted to NPPLC due to difficulty in dissection and 1 converted to open in each group. There was statistically significant fall in mean serum bilirubin level in both the groups in the immediate postoperative period (P<0.05). Statistically significant increase in its level was observed after 24 hours in the NPPLC group only (P<0.05). Levels of mean serum serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, and lactate dehydrogenase increased significantly (P<0.05) in immediate postoperative period and a further increase was observed after 24 hours (P<0.05) in the NPPLC group only. The comfort level of surgeon was found to be significantly better in the NPPLC group. LPPLC is a safe procedure, especially in the hands of an experienced surgeon with clinically insignificant systemic effects. But the comfort level of surgeon is better in normal pressure when compared with low pressure. In patients with deranged hepatic functions undergoing advanced laparoscopic procedures, it is advisable to start the surgery with low-pressure pneumoperitoneum. Pressure may be escalated further as per the surgeon's comfort.

Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy.

ABSTRACTBackgroundLaparoscopic cholecystectomy is the gold standard procedure for cholelithiasis. Pneumoperitoneum is created using carbon dioxide (CO2) which is usually maintained at a range of 12-14 mm Hg. An emerging trend has been the use of low-pressure pneumoperitoneum in the range of 7-10 mm Hg in an attempt to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. Our study proposes to compare the effects of low-pressure pneumoperitoneum with the use of standard pressure of pneumoperitoneum.Aims and objectiveTo compare and analyze various factors like blood pressure, heart rate, end-tidal CO2 and postoperative shoulder tip pain in cases undergoing laparoscopic cholecystectomy using standard pressure versus low pressure.Materials and methodsThis is a prospective randomized study carried out at Santosh Medical College and Hospitals, Ghaziabad from September 2017 to December 2018. This study included 60 patients of cholelithiasis which were divided into two groups of 30 patients each. Group I was offered laparoscopic cholecystectomy under standard pressure pneumoperitoneum and group II underwent laparoscopic cholecystectomy using low-pressure pneumoperitoneum. Patients in each group were evaluated for various intraoperative physiological changes and postoperative shoulder tip pain.Observations and resultsCholelithiasis is commonly seen in middle-aged females. There is no significant difference in duration of surgery between the two groups. However, various factors like systolic blood pressure, heart rate, end-tidal CO2 were significantly better in the low-pressure group. Postoperative shoulder tip pain (measured by VAS scoring system) was significantly less in the low-pressure group during the first 24 hours.ConclusionLaparoscopic cholecystectomy under low-pressure pneumoperitoneum causes minimal physiological changes and less postoperative shoulder tip pain.How to cite this articleGoel A, Gupta S, et al. Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy. Euroasian J Hepatogastroenterol 2019;9(1): 5-8.