Cardiopulmonary Physiology and Pathophysiology as a Consequence Of Laparoscopic Surgery

Sharma, K.; Brandstetter, Robert D.; Brensilver, Jeffrey M.; Jung, Lance D.

doi:10.1378/chest.110.3.810

Cited by 190 publications

(139 citation statements)

References 57 publications

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“…It is important to remark that our patients were hemodynamically stable. In spite of the reported untoward hemodynamic effects attributed to laparoscopy, 18 obese patients tolerate the pneumoperitoneum surprisingly well, without experiencing a fall in cardiac output. 21 Intraoperative analgesia was provided with aliquots of fentanyl.…”

Section: Discussionmentioning

confidence: 93%

“…[15][16][17] We routinely used the Rapiscope to rule-out accidental bronchial intubation. 14 Abdominal inflation with CO 2 and head-down position may lead to impaired respiratory mechanics 18,19 and may cause hypoxemia, CO 2 retention and increased peak inspiratory pressures during mechanical ventilation. However, according to Sprung et al, 20 body position did not affect respiratory mechanics during laparoscopy in morbidly obese patients.…”

Section: Discussionmentioning

confidence: 99%

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Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures

et al. 2004

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Publications regarding anesthetic management for weight reduction surgery are scarce. We reviewed the records of 234 patients who underwent bariatric restrictive procedures (gastric bypass not included) from May 1999 to September 2000. Variables analyzed included demographics, anesthetic data and perioperative course. Patients were allocated into two groups: laparoscopic (LPG) and open procedures (OPG), comprising 167 and 67 patients respectively. Obstructive sleep apnea was present in 4.8% in LPG vs 6.1% in OPG. Awake fiberoptic intubation was performed in 3.6% in LPG and 1.5% in OPG. The other patients were anesthetized with rapid sequence induction (classic or modified). Grade III laryngoscopy was present in 6% in LPG and 7.1% in OPG. No intraoperative complications were encountered. Postoperative PACU follow-up time was similar. In both groups, i.v. meperidine was most frequently used for postoperative analgesia (in the PACU), as compared to the other analgesics employed (Po0.03). Early postoperative complications (prolonged mechanical ventilation, unplanned ICU admission, sepsis, reoperation) occurred more frequently in OPG, but the difference between the two groups was statistically insignificant (Po0.08). The length of hospitalization was 3.871.4 days in LPG and 6.276.6 in OPG (Po0.01). Mortality was zero. Anesthesia for restrictive bariatric surgery (both open and laparoscopic approaches) was associated with few complications. SUMMARY STATEMENT: We reviewed the records of 234 patients who underwent restrictive bariatric procedures (gastric bypass not included) from May 1999 to September 2000, in regard to perioperative complications. Anesthesia was associated with no intraoperative and few postoperative complications.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures

et al. 2004

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“…5,6,14 Bannister et al examined infants less than one year of age who underwent a variety of laparoscopic procedures. Average Cdyn decreased 48%, and VT decreased 33% with PNP 12-15 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…This, in turn, leads to intrapulmonary shunting with the development of hypoxemia and hypercapnia. 4,5 These effects have been well characterized in the adult population, 6,7 but there is limited information available in children. 8 The available studies in pediatric populations are limited by small sample sizes, heterogeneous procedures involving the upper and lower abdomen, variable positioning, and minimally controlled ventilatory techniques (manual and volume-controlled).…”

Section: Résumémentioning

confidence: 99%

“…8 The available studies in pediatric populations are limited by small sample sizes, heterogeneous procedures involving the upper and lower abdomen, variable positioning, and minimally controlled ventilatory techniques (manual and volume-controlled). 6,9 The aim of this study was to detail the changes in respiratory system compliance and other measures of pulmonary function resulting from introducing a 12 mmHg pneumoperitoneum (PNP12) and 20°Trendelenburg positioning (TDG20) under pressure-controlled mechanical Respiratory mechanics in pediatric pelvic laparoscopy 799 ventilation during general anesthesia in pediatric patients undergoing pelvic laparoscopic surgery for cryptorchidism. We hypothesized that induced PNP12 would produce significant and clinically relevant changes in respiratory system dynamic compliance in anesthetized pediatric patients using pressure-controlled ventilation, and that a further decrease in dynamic compliance would occur after the addition of TDG20.…”

Section: Résumémentioning

confidence: 99%

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The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study

Neira

Kovesi

Guerra

et al. 2015

Can J Anesth/J Can Anesth

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Purpose The aim of this study was to describe the changes in respiratory system compliance and other measures of respiratory mechanics associated with peritoneal insufflation (12 mmHg pressure) with carbon dioxide (PNP12) and 20°Trendelenburg positioning (TDG20) in pediatric patients undergoing laparoscopic surgery for abdominal cryptorchidism.Methods Twelve subjects with abdominal cryptorchidism undergoing orchiopexy were enrolled in the study. General anesthesia was conducted with sevoflurane/O 2 /air, fentanyl, and rocuronium. Pressure-controlled ventilation with a peak inspiratory pressure (PIP) of 10-15 cm H 2 O and a positive end-expiratory pressure of 5 cm H 2 O was titrated to achieve a tidal volume (VT/kg) of 6-10 mLÁkg -1 and end-tidal carbon dioxide (EtCO 2 ) of 35-40 mmHg. Adjustments of PIP and respiratory rate (RR) were made to maintain the initial VT/kg and EtCO 2 \ 50 mmHg. Measurements of weight-corrected dynamic compliance (Cdyn/kg), VT/kg, and EtCO 2 were recorded at baseline, after PNP12, at TDG20, and again after deflation and return to the level position. Results Adjustments in PIP were required in all subjects to maintain the target VT/kg. The Cdyn/kg decreased 42% (95% confidence interval [CI]: 30 to 51; P \ 0.001) after PNP12, and it remained below baseline until deflation. The Author contributions Victor M. Neira was the principal investigator for the study. Victor M. Neira, Thomas Kovesi, Luis Guerra, Nicholas Barrowman, and William Splinter contributed to the study design. Victor M. Neira and Luis Guerra contributed to data acquisition. Thomas Kovesi, Maria Campos, and Nicholas Barrowman contributed to the data analysis. Victor M. Neira, Thomas Kovesi, Luis Guerra, and Maria Campos contributed to data interpretation. Victor M. Neira was the principal author of the manuscript with contributions from Thomas Kovesi, Maria Campos, Luis Guerra, Nicholas Barrowman, and William Splinter. 123Can J Anesth/J Can Anesth (2015) 62:798-806 DOI 10.1007/s12630-015-0369-0 TDG20 caused only minimal additional reductions in Cdyn/kg (10% decrease; 95% CI: 0 to 19; P = 0.048). The VT/kg decreased 42% (95% CI: 31 to 52; P = 0.048) with PNP12, and after TDG20, it decreased a further 10% (95% CI: 4 to 19; P = 0.038). After deflation, the VT/kg increased by 56% (95% CI: 28 to 90; P = 0.001) and was then adjusted back to the initial values. Conclusion The PNP12 significantly decreases Cdyn/kg and VT/kg in pediatric patients. The use of TDG20 produces a relatively minor additional impact in respiratory mechanics. This study emphasizes the need to adjust ventilator settings to maintain normal gas exchange during this procedure. RésuméObjectif L'objectif de cette étude était de décrire les changements de compliance du système respiratoire et d'autres mesures de la mécanique respiratoire associés à une insufflation péritonéale (pression de 12 mmHg) à l'aide de dioxyde de carbone (PNP12) et d'une position de Trendelenburg à 20°(TDG20) chez les patients pédiatriques subissant une chirurgie par laparoscopie...

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Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

Lunardi,

Abou-Zamzam,

Florecki

et al. 2024

JAMA Surg

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ImportanceAlthough robotic surgery has become an established approach for a wide range of elective operations, data on its utility and outcomes are limited in the setting of emergency general surgery.ObjectivesTo describe temporal trends in the use of laparoscopic and robotic approaches and compare outcomes between robotic and laparoscopic surgery for 4 common emergent surgical procedures.Design, Setting, and ParticipantsA retrospective cohort study of an all-payer discharge database of 829 US facilities was conducted from calendar years 2013 to 2021. Data analysis was performed from July 2022 to November 2023. A total of 1 067 263 emergent or urgent cholecystectomies (n = 793 800), colectomies (n = 89 098), inguinal hernia repairs (n = 65 039), and ventral hernia repairs (n = 119 326) in patients aged 18 years or older were included.ExposureSurgical approach (robotic, laparoscopic, or open) to emergent or urgent cholecystectomy, colectomy, inguinal hernia repair, or ventral hernia repair.Main Outcomes and MeasuresThe primary outcome was the temporal trend in use of each operative approach (laparoscopic, robotic, or open). Secondary outcomes included conversion to open surgery and length of stay (both total and postoperative). Temporal trends were measured using linear regression. Propensity score matching was used to compare secondary outcomes between robotic and laparoscopic surgery groups.ResultsDuring the study period, the use of robotic surgery increased significantly year-over-year for all procedures: 0.7% for cholecystectomy, 0.9% for colectomy, 1.9% for inguinal hernia repair, and 1.1% for ventral hernia repair. There was a corresponding decrease in the open surgical approach for all cases. Compared with laparoscopy, robotic surgery was associated with a significantly lower risk of conversion to open surgery: cholecystectomy, 1.7% vs 3.0% (odds ratio [OR], 0.55 [95% CI, 0.49-0.62]); colectomy, 11.2% vs 25.5% (OR, 0.37 [95% CI, 0.32-0.42]); inguinal hernia repair, 2.4% vs 10.7% (OR, 0.21 [95% CI, 0.16-0.26]); and ventral hernia repair, 3.5% vs 10.9% (OR, 0.30 [95% CI, 0.25-0.36]). Robotic surgery was associated with shorter postoperative lengths of stay for colectomy (−0.48 [95% CI, −0.60 to −0.35] days), inguinal hernia repair (−0.20 [95% CI, −0.30 to −0.10] days), and ventral hernia repair (−0.16 [95% CI, −0.26 to −0.06] days).Conclusions and RelevanceWhile robotic surgery is still not broadly used for emergency general surgery, the findings of this study suggest it is becoming more prevalent and may be associated with better outcomes as measured by reduced conversion to open surgery and decreased length of stay.

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Cardiopulmonary Physiology and Pathophysiology as a Consequence Of Laparoscopic Surgery

Cited by 190 publications

References 57 publications

Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures

Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures

The impact of pneumoperitoneum and Trendelenburg positioning on respiratory system mechanics during laparoscopic pelvic surgery in children: a prospective observational study

Robotic Technology in Emergency General Surgery Cases in the Era of Minimally Invasive Surgery

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