Laparoscopic Hypothermia

Ott, Douglas E.

doi:10.1089/lps.1991.1.127

Cited by 85 publications

(53 citation statements)

References 4 publications

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“…They have suggested that: a) the tissue trauma in the form of intraperitoneal manipulations-pulling of the gallbladder and mesentery-are similar in both methods 17 and b) the pneumoperitoneum is an aggravating factor on the surgical wound, because: 1) it causes acute dilatation of the peritoneum and irritation of the peritoneal nerve endings that activates receptors, permanent pressure on the diaphragm during surgery, CO2 absorption by the peritoneum, increased partial pressure in the blood and respiratory acidosis 17,18 and 2) the commercial CO2 used for creating the pneumoperitoneum is fluid and changes into its gaseous form at its boiling point of 21.1°C. 19 Thus, its prolonged use might cause a drop in body temperature, even though this is at least partially avoided by heating it at 30 to 30.5°C. 20 Other studies have suggested the effect of the pneumoperitoneum is not a major wound-aggravating factor because: a) a significant increase in CO2 and respiratory acidosis in laparoscopic cholecystectomy is observed only in patients with chronic cardiopulmonary failure and preoperative restrictive lung function, [21][22][23][24] b) with increasing surgical experience, the pneumoperitoneum is sufficient even at smaller pressures, 1,4,6 and c) the duration of surgery is now considerably briefer than that described in the earlier series.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. open abdominal surgery in male pigs: Marked differences in cortisol and catecholamine response depending on the size of surgical incision

Krikri¹,

Alexopoulos²,

Zoumakis³

et al. 2013

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ObJEcTIVE: Minimally invasive operations, such as laparoscopic cholecystectomy and adrenalectomy, result in a more rapid recovery of normal function, less physiological disturbances and less stress to the organism than similar open operations. The purpose of this study was to determine the stress response associated with minimally invasive abdominal surgery compared to conventional small or large incision laparotomy. METHODs: We compared the responses of the stress hormones cortisol and the catecholamines adrenaline and noradrenaline to elective conventional and laparoscopic cholecystectomy and unilateral adrenalectomy in male pigs. blood samples were taken from all animals at the same time, one day before surgery, at the beginning of the operation, every 15 minutes during surgery and on the first postoperative morning. rEsULTs: Plasma adrenaline and noradrenaline concentrations were significantly lower in both cholecystectomies (p<0.05) and adrenalectomies (p<0.01) during laparoscopic than during open surgery. Plasma cortisol levels were significantly lower in laparoscopic than in open adrenalectomies both during surgery and on postoperative day one (p<0.05), while no major differences in cortisol levels were observed between laparoscopic and open cholecystectomies. Thus, the stress-related benefit of laparoscopic surgery depended on the size of the surgical incision in the conventional operation. cONcLUsION: Laparoscopic surgery was associated with less surgical stress than open surgery and this difference was accentuated as the surgical abdominal wall trauma increased.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic vs. open abdominal surgery in male pigs: Marked differences in cortisol and catecholamine response depending on the size of surgical incision

Krikri¹,

Alexopoulos²,

Zoumakis³

et al. 2013

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“…A videolaparoscopia é um procedimento cada vez mais utilizado e indicado [14][15][16] . Várias pesquisas têm procurado avaliar seu efeito na formação de aderências e no desenvolvimento de hipotermia 12,17,18 .…”

Section: Discussionunclassified

“…A hipotermia no peroperatório é decorrente dos efeitos da anestesia que parecem modificar a temperatura corpórea pela alteração intrínseca dos mecanismos termorreguladores do hipotálamo associados a uma série de outros fatores como a temperatura da sala cirúrgica, a ventilação prolongada com gases secos, a infusão de líquidos frios e a exposição da cavidade abdominal 12, [14][15][16] .…”

Section: Gráfico 2 -Médias Da Temperatura Retal Por Grupo E Momentounclassified

Influência da irrigação intraperitoneal de solução salina em diferentes temperaturas na formação de aderências e prevenção de hipotermia após pneumoperitônio em ratos

Neto¹,

Silva²,

Júnior³

2000

Rev. Col. Bras. Cir.

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Recebido em 5/2/99 Aceito para publicação em 6/12/99 Trabalho realizado no Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. RESUMO:Este estudo experimental em ratos avalia a influência da irrigação da cavidade peritoneal com solução salina isotônica (0,9 %), em diferentes temperaturas, na formação de aderências peritoneais e prevenção de hipotermia após pneumoperitônio. Foram utilizados 80 ratos divididos em quatro grupos de 20 animais: grupo controle (G 1 ) sem irrigação, grupos com irrigação a temperatura ambiente 22,0°C (G 2 ), a 35,0°C (G 3 ) e a 45,0°C (G 4 ). A análise da hipotermia foi realizada através da monitorização da temperatura retal em três diferentes momentos: após a anestesia (T 1 ), cinco minutos depois da insuflação de dióxido de carbono (T 2 ) e cinco minutos após a irrigação com solução salina (T 3 ). Os animais foram sacrificados no 28 o dia de pós-operatório. Observaram-se aderências nos grupos com irrigação, sendo que, com salina à temperatura de 45,0ºC houve maior formação de aderências (30,0%) , porém, esta diferença não foi significante. No G 2 ocorreu uma queda significante na temperatura média retal quando comparada aos demais grupos, demonstrando que a hipotermia na cirurgia laparoscópica pode ser reduzida com o uso de solução salina aquecida.Unitermos: Aderência, Laparoscopia, Hipotermia recomendadas para prevenir a hipotermia, porém, estudo experimental mostrou que a utilização de líquidos a temperaturas elevadas contribuiria para maior formação de aderências 10 .A hipotermia nas laparotomias provavelmente resulta da vasodilatação provocada pelos anestésicos, perda de calor para o ambiente, infusão de soluções frias e pela exposição dos órgãos abdominais. Ainda que este último item não faça parte nas videolaparoscopias, a ocorrência de hipotermia é ainda assunto controverso, pois, o dióxi-do de carbono (CO 2 ) utilizado na criação e manutenção do pneumoperitônio poderia desencadeá-la 12, 13 . Assim, a irrigação da cavidade peritoneal com substâncias líquidas aquecidas poderia ser um dos meios para sua prevenção. INTRODUÇÃOA formação de aderências peritoneais permanece como um importante problema ainda não resolvido uma vez que constitui causa frequente de obstrução intestinal 1-3 . Neste sentido, vários estudos propõem métodos de prevenção 4-6 , utilizando a administração de diferentes substâncias como soluções de cristalóides na cavidade peritoneal 7,8 .O uso de salina isotônica (0,9%) para irrigar a cavidade peritoneal é um procedimento comum em cirurgia, pois, ajuda a remoção de coágulos sanguíneos e tecidos desvitalizados que podem atuar como adjuvantes na gê-nese de aderências 9-11 . Infusões aquecidas são também

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“…Endtidal CO 2 monitors may also be used, as most patients will be endotracheally intubated. Pneumoperitoneum with carbon dioxide likely contributes to intraoperative hypothermia [ 65 ]. Therefore, patients should routinely be covered with upper-body forced-air heating devices to maintain normothermia.…”

Section: Patient Monitoringmentioning

confidence: 99%

Perioperative Assessment

Kvasnovsky

Bafford²

2014

Minimally Invasive Approaches to Colon and Rectal Disease

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Key Points• Pneumoperitoneum leads to increased cardiac preload and afterload, hypotension, increased airway pressures, increased end-tidal CO 2 , and decreased urine output.• Laparoscopic colorectal surgery is associated with decreases in postoperative pain, ileus, length of hospital stay, and wound complications, and improved cosmesis when compared to open surgery.• Oncologic outcomes and IBD recurrence rates are similar after laparoscopic and open colectomy.• Routine laboratory studies are recommended prior to laparoscopic colorectal surgery. More intensive cardiopulmonary testing should be reserved for symptomatic patients and those with signifi cant risk factors.• Laparoscopic surgery can be safely performed in elderly and obese patients as well as in certain cases of emergency and reoperative surgery.• Bowel preparation should generally be used in order to improve maneuverability of the bowel and to allow for intraoperative endoscopy.• Colorectal tumors should be localized with 4-quadrant tattooing and Crohn's lesions with imaging and endoscopy prior to surgery.• Patients should be securely positioned with arms tucked and legs apart (for left colon and rectal procedures).• Judicious fl uid administration, early feeding and mobilization, and minimization of narcotics should be part of postoperative care. Physiologic Effects of LaparoscopyPneumoperitoneum is the sine qua non of laparoscopic surgery. Insuffl ation of the abdomen has both mechanical and physiologic effects. These changes become especially relevant in colorectal surgery, where positioning varies steeply over the course of operations. Colorectal operations may also be prolonged, which can further amplify effects. Although less than ideal, carbon dioxide (CO 2 ) is currently the primary gas being used in laparoscopic surgery. The ideal gas would be noncombustible, colorless, and have limited physiologic effects. Because electrocautery is commonly used in laparoscopic surgery, combustible gases are absolutely contraindicated [ 1 ]. This precludes the use of oxygen, room air (which is 21 % oxygen), and nitrous oxide. Meanwhile, helium and argon as inert gases would fulfi ll the requirement of nonfl ammability; however, they have lower thresholds for toxicity. CO 2 remains the gas of choice. Transperitoneal absorption of CO 2 results in increased dissolved CO 2 in the blood, which can create a mild acidosis and hypercapnia.Pneumoperitoneum causes further physiologic effects that may infl uence decision-making in colorectal surgery. The majority of these changes will be well tolerated in ASA I and II patients (Table 1.1 ). For those with higher ASA grades, the effect is highly variable and often more problematic. Cardiovascular EffectsThere are many cardiovascular and hemodynamic changes during laparoscopic surgery as well as concomitant changes with positioning (Table 1.2 ). These do not usually affect

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Laparoscopic Hypothermia

Cited by 85 publications

References 4 publications

Laparoscopic vs. open abdominal surgery in male pigs: Marked differences in cortisol and catecholamine response depending on the size of surgical incision

Laparoscopic vs. open abdominal surgery in male pigs: Marked differences in cortisol and catecholamine response depending on the size of surgical incision

Influência da irrigação intraperitoneal de solução salina em diferentes temperaturas na formação de aderências e prevenção de hipotermia após pneumoperitônio em ratos

Perioperative Assessment

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