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Prospective randomized trial of heated humidified versus cold dry carbon dioxide insufflation during laparoscopic gastric bypass 总被引:3,自引:0,他引:3
J.K. Champion M.D. Michael Williams M.D. 《Surgery for obesity and related diseases》2006,2(4):739-449
BACKGROUND: The replacement of cold dry carbon dioxide with heated humidified gas for insufflation during complex laparoscopic procedures has been reported to decrease hypothermia and peritoneal cell desiccation, with a resultant decrease in postoperative pain and narcotic use and a shortened recovery, but may prevent the paralysis of the peritoneal polymorphonuclear cell cytokine cascade and add to the cost of the procedure. We report our outcomes comparing carbon dioxide insufflation with different characteristics during laparoscopic gastric bypass. METHODS: Fifty consecutive patients were randomized to undergo laparoscopic gastric bypass with either cold-dry or heated-humidified carbon dioxide insufflation. Statistical analysis of variance between groups was determined by Levine's t test with the Greenhouse-Geisser correction, at a significance level of P <.05. RESULTS: The two groups were similar for preoperative gender, age, weight, body mass index, and baseline C-reactive protein. The intraoperative room and patient core temperature, liters of insufflation used, lens cleanings, operating time, recovery room time, and narcotics used were not significantly different. The postoperative subjective analog shoulder pain score was significantly less (P = .025) for the heated-humidified group at 18 hours, but not at 6, 12, 24, or 48 hours. The abdominal pain scores and overall narcotic use, postoperative C-reactive protein, and length of stay were not significantly different between the two groups. CONCLUSION: Heated-humidified insufflation resulted in a transient reduction in subjective shoulder pain at 18 hours postoperatively, but no reduction in abdominal pain or narcotics used. We were unable to verify any clinically significant difference between the two groups comparing heated-humidified and cold-dry insufflation after laparoscopic gastric bypass. 相似文献
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W. G. Mouton J. R. Bessell S. H. Millard P. S. Baxter G. J. Maddern 《Surgical endoscopy》1999,13(2):106-108
Background: We conducted a randomized controlled trial during laparoscopic cholecystectomy to determine the extent of heat preservation and postoperative pain reduction using humidified carbon dioxide (CO2) gas insufflation instead of standard dry insufflation gas. 相似文献
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Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass 总被引:8,自引:0,他引:8
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BACKGROUND: Roux-en-Y gastric bypass (RYGB) is an effective treatment of severe obesity and one of the fastest growing surgical procedures in the United States. METHODS: A single institution prospective database of patients undergoing outpatient laparoscopic (lap) RYGB over a 3-year period was reviewed. Study end points included hospital discharge within 23 hours, 30-day hospital readmission rate, early (<30 day) and late complication rates, and 30-day perioperative mortality. Variables assessed included surgeon experience, patient demographics, comorbidities, operative time, Roux limb pathway, intraoperative steroid bolus, and use of dexmedetomidine. RESULTS: Two thousand consecutive patients undergoing outpatient lap RYGB were identified, and 84% (n = 1669) were discharged within 23 hours. Of these, 1.7% (n = 34) were readmitted within 30 days. The overall early and late complication rates were 1.9% (n = 38) and 4.3% (n = 86), respectively. The 30-day mortality rate was 0.1% (n = 2), and neither patient was discharged before death. Univariate analysis demonstrated surgeon experience (<50 cases), age (<56 years), body mass index (<60 kg/m), weight (400 lbs), comorbidities (<5), and intraoperative steroid bolus as predictive of successful outpatient discharge. Multivariate analysis revealed surgeon experience, comorbidities, body mass index, and steroid bolus as predictive variables. CONCLUSIONS: These data suggest that outpatient lap RYGB can be performed with acceptable perioperative complication rates, hospital readmission, and mortality rates. Surgeon experience, careful patient selection, and the use of intraoperative steroid bolus predicted optimal patient outcomes. 相似文献
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BACKGROUND: Carbon dioxide is the preferred insufflating gas for laparoscopy because of greater safety in the event of intravenous embolism, but it causes abdominal and referred pain. Acidification of the peritoneum by carbonic acid may be the major cause of pain from carbon dioxide insufflation. Carbonic anhydrase is an enzyme that increases the rate of carbonic acid formation from carbon dioxide. Because acetazolamide inhibits carbonic anhydrase, the authors hypothesized that the pain caused by carbon dioxide insufflation may be decreased by the administration of acetazolamide. METHODS: A prospective, randomized, double-blind study of 38 patients undergoing laparoscopic surgery during general anesthesia was performed. Acetazolamide (5 mg/kg) or a saline placebo was administered intravenously during surgery. Pain was rated on a visual analog scale (0-10) at four times: when first awake, at discharge from the recovery room, when discharged from the hospital, and on the day after surgery. The site and quality of pain were recorded, as were medications and side effects. RESULTS: Initial referred pain scores were lower after acetazolamide (1.00 +/- 1.98; n = 18) than after placebo (3.40 +/- 3.48; n = 20; P = 0.014), and 78% of patients in the acetazolamide group had no referred pain; however, only 45% patients in the placebo group had no referred pain. Incisional pain scores were not statistically different, and referred pain scores were similar at later times. CONCLUSIONS: Acetazolamide reduces referred but not incisional pain after laparoscopic surgical procedures. The duration of pain reduction is limited to the immediate postsurgical period. 相似文献
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PURPOSE: Laparoscopic colorectal surgery is often prolonged and may cause hypothermia. It is uncertain if heated and humidified carbon dioxide (CO(2)) in laparoscopic colorectal surgery is beneficial. This is a prospective case-matched study on the use of heated and humidified CO(2) in patients undergoing laparoscopic colorectal surgery. METHOD: Twenty consecutive patients undergoing laparoscopic colorectal surgery with heated (36 degrees C) and humidified (95%) CO(2) were compared with 20 consecutive patients using standard CO(2) (30.2 degrees C). All procedures were performed by a single surgeon in an institution. The changes in core temperature during surgery, visual quality of images and the short-term clinical outcome were documented. RESULTS: The core temperature fell during surgery in both groups. Although the fall of core temperature was more in the control group, it was not statistically significant (P > 0.05). The passage of flatus was more delayed in heated and humidified group (P = 0.004), but it did not affect the hospital discharge. All the other parameters, including the quality of visual images and the postoperative pain, were similar in both groups. CONCLUSIONS: Despite better temperature maintenance (nonsignificant), pneumoperitoneum using heated and humidified CO(2) gas did not appear to have any clinical benefits in laparoscopic colorectal surgery. 相似文献
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Background: Intraoperative hypothermia is a common event during open and laparoscopic abdominal surgery. The aim of this study
was to compare changes in core temperature between laparoscopic and open gastric bypass (GBP). Methods: 101 patients with
a body mass index (BMI) of 40-60 kg/m2 were randomly assigned to open (n=50) or laparoscopic (n=51) GBP. Anesthetic technique was similar for both groups. An external
warming blanket and passive airway humidification were used intraoperatively. Core temperature was recorded at preanesthesia,
at baseline (after induction) and at 30-min intervals; intra-abdominal temperature was additionally measured at 30-min intervals
in a subset of 30 laparoscopic GBP patients.The number of patients who developed intraoperative and postoperative hypothermia
(<36°C) was recorded. Length of operation for both groups and the amount of CO2 gas delivered during laparoscopic operations were also recorded. Results: There was no significant difference between groups
with respect to age, gender, mean BMI, and amount of intravenous fluid administered. After induction of anesthesia, core temperature
significantly decreased in both groups; 36% of patients in the open group and 37% of patients in the laparoscopic group developed
hypothermia. This percentage increased to 46% in the open group and 41% in the laparoscopic group during the operation, and
then decreased to 6% in the open group and 8% in the laparoscopic group in the recovery-room. Core temperature increased during
the operative procedure to reach 36.5 ± 0.6°Cin the open group and 36.3 ± 0.5°Cin the laparoscopic group at 2.5 hours after surgical incision. Intra-abdominal temperature during laparoscopic GBP was significantly
lower than core temperature at all measurement points (p<0.05). Operative time was longer in the laparoscopic group than in
the open group (232 ± 43 vs 201 ± 38 min, p<0.01). Mean volume of gas delivered during laparoscopic GBP was 650 ± 220 liters.
Conclusion: Perioperative hypothermia was a common event during both laparoscopic and open GBP. Despite a longer operative
time, laparoscopic GBP did not increase the rate of intraoperative hypothermia when efforts were made to minimize intraoperative
heat loss. 相似文献
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目的:总结腹部手术史患者行腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)的可行性及安全性。方法:回顾分析2011年1月至2013年10月89例LRYGB患者的资料。根据有无腹部手术史将患者分为腹部手术史组(n=19)与无腹部手术史组(n=70)。评估两组患者性别、年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)病情分级、腹腔粘连发生率及粘连松解率、手术时间、术中失血量、中转开腹率、术中及术后并发症发生率、住院时间等指标。结果:无腹部手术史组与腹部手术史组患者术中发现腹腔粘连率分别为7.1%与73.7%,其中需松解率分别为0与71.4%,无因松解粘连引发的并发症。腹部手术史组女性患者所占比例、ASA分级及年龄较无腹部手术史组高(P<0.05),腹部手术史与增加的手术时间、住院时间有关(P<0.05)。两组患者术中失血量、中转开腹率、术中与术后并发症发生率差异无统计学意义(P>0.05)。结论:腹部手术史并非LRYGB的手术禁忌证。然而有腹部手术史的患者往往年龄、ASA分级高,增加了手术风险,且术中粘连松解率较高,手术时间、住院时间较长。 相似文献
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Nestor de la Cruz-Muñoz Sarah E. Messiah Juan C. Cabrera Cristina Torres Melissa Cuesta Gabriela Lopez-Mitnik Kristopher L. Arheart 《Surgery for obesity and related diseases》2010,6(5):542-547
BackgroundExtreme obesity among U.S. adolescents is a serious problem and has disproportionally affected ethnic minorities. Recently, surgical intervention for morbid obesity in adolescents has gained increasing support. Little information is available on the long-term effectiveness of bariatric surgery among ethnic minority adolescents. We have reported the weight and body mass index (BMI) results for a large cohort of predominantly Hispanic adolescents who underwent bariatric surgery in a private practice setting.MethodsA retrospective medical chart analysis of 78 adolescents (77% Hispanic, 19% non-Hispanic white, 1% non-Hispanic black, and 3% other; 77% female; 16–19 years old), who had undergone gastric bypass or banding surgery from 2002 to 2009, was conducted. All patients had met the National Institutes of Health criteria for bariatric surgery. Repeated measures mixed linear modeling was used to assess the changes in weight/BMI from baseline to 4 years after surgery.ResultsNon-Hispanic whites had lost 104.81 lb and 17.29 BMI units at 1 year after surgery (P <.001 for both). Hispanics had lost 91.55 lb and 15.06 BMI units at 1 year after surgery (P <.001 for both). The non-Hispanic whites had lost 18.56 BMI units and Hispanics 16.15 units during the 4 year postoperative period. A weight loss plateau occurred at 12 months for the non-Hispanic whites and at 18 months for the Hispanics; both groups had maintained their weight loss at 4 years after surgery.ConclusionBariatric surgery resulted in significant weight loss that was maintained at 4 years postoperatively among obese ethnic minority adolescents. Our results have shown that bariatric surgery is a safe and effective treatment option for permanent weight improvements in this demographic. 相似文献
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Elise H. Lawson Myriam J. Curet Barry R. Sanchez Rob Schuster Ramon Berguer 《Journal of robotic surgery》2007,1(1):61-67
We hypothesized that a laparoscopic technique for Roux-en-Y gastric bypass surgery is associated with more musculoskeletal
discomfort and ergonomic strain than a robotic technique. This pilot project studied one surgeon while he performed four laparoscopic
and four robotic (da Vinci system) Roux-en-Y gastric bypass procedures. We measured musculoskeletal discomfort with body part
discomfort score (BPD) and ergonomic positioning with the rapid upper-limb assessment tool (RULA). At the end of the case,
the robotic cases were associated with more discomfort in the neck (median BPD scores 2.5 versus 1.0, P = 0.028), while the laparoscopic cases were associated with more discomfort in the upper back (median BPD scores 2.0 versus
1.0, P = 0.028). Both the right and left shoulders demonstrated more discomfort with the laparoscopic group (median BPD scores 3.0
versus 1.5, P = 0.057). The RULA analysis demonstrated that the upper arm (1.0 versus 2.25), lower arm (1.125 versus 2.125), wrist (2.5
versus 3.5) and wrist twist (1.25 versus 2) were held in less ergonomically correct positioning (higher score) in the laparoscopic
group compared to the robotic group (P = 0.029). In contrast, the trunk (1.5 versus 1.0) had a worse RULA score in the robotic group compared to the laparoscopic
cases. These pilot data suggest that robotic Roux-en-Y gastric bypass surgery may result in less musculoskeletal stress to
the upper extremities than standard laparoscopic technique. In contrast, robotic surgery seems to offer both postural advantages
and disadvantages for the neck and back region. More-detailed studies are needed to fully assess the potential postural advantages
of robotic surgical techniques over standard laparoscopy. 相似文献
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Nguyen NT Furdui G Fleming NW Lee SJ Goldman CD Singh A Wolfe BM 《Surgical endoscopy》2002,16(7):1050-1054
Background: Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been
shown to be effective in preventing hypothermia. It has now been proposed that using heated and humidified insufflation gas
can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in
patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine
whether using heated and humidified insufflation gas in addition to an external warming blanket would help to maintain intraoperative
core temperature or decrease postoperative pain. Methods: Twenty patients were randomized to receive either standard carbon
dioxide (CO2) gas (control, n = 10) or heated and humidified gas (heated and humidified, n = 10). After the induction of anesthesia,
an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal
temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale,
and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative
urine output, and hemodynamic data were also recorded. Results: There was no significant difference between the two groups
in age, length of operation, or volume of CO2 gas delivered. Compared with baseline value, mean core temperature increased
by 0.4°C in the heated and humidified group and by 0.3°C in the control group at 1.5 h after surgical incision. Intraabdominal
temperature increased by 0.2°C in the heated and humidified group but decreased by 0.5°C in the control group at 1.5 h after
abdominal insufflation. There was no significant difference between the two groups in visual analog pain scale (5.4 ± 1.6
control vs 4.5 ± 2.8 heated and humidified), morphine consumed (27 ± 26 mg control vs 32 ± 19 mg heated and humidified), urine
output, lens-fogging episodes, or hemodynamic parameters. Conclusion: Heated and humidified gas, when used in addition to
an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce
postoperative pain. 相似文献
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Nelskylä K Yli-Hankala A Sjöberg J Korhonen I Korttila K 《Acta anaesthesiologica Scandinavica》1999,43(10):974-978
BACKGROUND: Hypothermia is a known side effect of laparoscopic operations. It may increase the sympathetic activity of the autonomic nervous system (ANS), which can be evaluated noninvasively by heart rate variability (HRV). We tested the hypothesis that warming of the delivered CO2 insufflation gas helps to maintain the normal body temperature. METHODS: Thirty-seven healthy women undergoing laparoscopic hysterectomy were randomized into heated (37 degrees C, n=18) or unheated (24 degrees C, n = 19) gas insufflation groups. Anesthesia was induced with propofol and maintained with sevoflurane in O2-air. Tympanic (ttymp) temperature was recorded before, during and after the operation. Nasopharyngeal (tnaso) temperature was recorded only during operation. Electrocardiograms were recorded and stored to evaluate changes in HRV. The individual changes in HRV were compared after decibel (dB) transformation. RESULTS: A median decrease in tympanic temperatures during the operation was 0.7 degrees C in the heated and 0.3 degrees C in the unheated group (P = 0.01 between groups), and in nasopharyngeal 0.3 degrees C and 0.1 degrees C (P = 0.03), respectively. Preanesthetic tympanic values were reached within 90 min after anesthesia. After dB transformation, HRV high frequency power differed between the groups. It was better preserved in the patients receiving unheated gas. CONCLUSION: The heating of insufflation gas does not prevent a decrease in body temperature and is thus unnecessary during laparoscopic hysterectomy. 相似文献
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Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial 总被引:9,自引:0,他引:9
Nguyen NT Lee SL Goldman C Fleming N Arango A McFall R Wolfe BM 《Journal of the American College of Surgeons》2001,192(4):469-76; discussion 476-7
BACKGROUND: Impairment of pulmonary function is common after upper abdominal operations. The purpose of this study was to compare postoperative pulmonary function and analgesic requirements in patients undergoing either laparoscopic or open Roux-en-Y gastric bypass (GBP). STUDY DESIGN: Seventy patients with a body mass index of 40 to 60 kg/m2 were randomly assigned to undergo laparoscopic (n = 36) or open (n = 34) GBP. The two groups were similar in age, gender, body mass index, pulmonary history, and baseline pulmonary function. Pulmonary function studies were performed preoperatively and on postoperative days 1, 2, 3, and 7. Oxygen saturation and chest radiographs were performed on both groups preoperatively and on postoperative day 1. Postoperative pain was evaluated using a visual analog scale and the amount of narcotic consumed was recorded. Data are presented as mean +/- standard deviation. RESULTS: Laparoscopic GBP patients had significantly less impairment of pulmonary function than open GBP patients on the first three postoperative days (p < 0.05). By the 7th postoperative day, all pulmonary function parameters in the laparoscopic GBP group had returned to within preoperative levels, but only one parameter (peak expiratory flow) had returned to preoperative levels in the open GBP group. On the first postoperative day, laparoscopic GBP patients used less morphine than open GBP patients (46 +/- 31 mg versus 76 +/- 39 mg, respectively, p < 0.001), and visual analog scale pain scores at rest and during mobilization were lower after laparoscopic GBP than after open GBP (p < 0.05). Fewer patients after laparoscopic GBP than after open GBP developed hypoxemia (31% versus 76%, p < 0.001) and segmental atelectasis (6% versus 55%, p = 0.003). CONCLUSION: Laparoscopic gastric bypass resulted in less postoperative suppression of pulmonary function, decreased pain, improved oxygenation, and less atelectasis than open gastric bypass. 相似文献
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