Postlaparoskopisches Schmerzsyndrom nach Pneumoperitoneum mit angewärmtem und kaltem CO2-Gas

Mecke, H.; Kroll, K.

doi:10.1055/s-1999-15637

Cited by 3 publications

(2 citation statements)

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“…These studies showed dierences in serum cytokine levels between laparoscopic and conventional surgery for IL-1 (1b [174]), IL-6 (1b [36,135,165,176,254,320,322]), CRP (1b [135,140,176,235,254,320], CRP (1b [133,138,174,233,252,318]) and cell-mediated immunity (1b [224]) that have not been con®rmed by other authors (1b [17,198], 2b [89]). In RCTs, postoperative immunological functions seemed to be better preserved after laparoscopic compared to conventional procedures (1b [13,45,151,176,235,276,284,308,321]): however, some trials found no dierences (1b [73,113,173,203,226,248,270,289,295]) and one trial even reported a more pronounced immunodepression after laparoscopy (1b [290]).…”

Section: Stress Response and Immunologic Parametersmentioning

confidence: 87%

“…In contrast, a double-blind RCT found an increase in shoulder tip pain after warming the insuation gas (1b [284]). Other groups found no clinically relevant eects of warming the insuation gas (1b [198,215,254,311]). Additional humidifying of warmed insuation gas seems to reduce postoperative pain but has no heat-preserving eect in brief laparoscopic procedures (1b [209]).…”

Section: Warming and Humidifying Of Insuation Gasmentioning

confidence: 97%

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The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

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