Randomized trial of different insufflation pressures for laparoscopic cholecystectomy

Wallace, David H.; Serpell, Michael; Baxter, J. N.; O’Dwyer, P. J.

doi:10.1046/j.1365-2168.1997.02628.x

Cited by 93 publications

(57 citation statements)

References 7 publications

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“…Some studies have also shown that the shoulder tip pain is minimal if the initial insufflation rate is kept suboptimal, although this needs to be substantiated. Some studies have shown that the incidence and intensity of postoperative shoulder tip pain was significantly less in the low-pressure pneumoperitoneum group when compared with standard-pressure pneumoperitoneum groups [8,[11][12][13][14][15][16]. Our study, however, shows that the incidence of shoulder pain has no statistical difference between groups undergoing laparoscopic surgery at different pneumoperitoneal pressures.…”

Section: Discussioncontrasting

confidence: 72%

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Dey

Malik

2013

Indian J Surg

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The aim of this study was to determine the effect of low-pressure pneumoperitoneum and duration of surgery in laparoscopic cholecystectomy on postoperative shoulder tip pain. A total of 100 patients were assigned into two groups depending on the intraperitoneal pressure during laparoscopic cholecystectomy. Group A included patients in whom the intraperitoneal pressure was 13-15 mm of Hg and group B included patients who underwent surgery at 10-12 mmHg. Each group was then subdivided into two subgroups depending on the duration of surgery. In the first subgroup, the duration of surgery was less than 1 h and the next subgroup included patients who took more than 1 h. Presence or absence of shoulder tip pain was recorded within 4 h, at 24 h, and at 48 h. Total number of patients having shoulder tip pain in the lower pneumoperitoneal group was more than the higher pneumoperitoneal group in both subgroups, P values >0.05. More patients in the <1 h subgroup had shoulder tip pain as compared to the >1 h group at both pneumoperitoneal groups, P values >0.05. Shoulder tip pain was most at 24 h and gradually decreased thereafter. In our study, intra-abdominal pressures and shorter duration of surgery were factors unrelated to incidence of shoulder tip pain after laparoscopic cholecystectomy.

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Section: Discussioncontrasting

confidence: 72%

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Dey

Malik

2013

Indian J Surg

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“…The fall in cardiac index lasted longer (7 vs 2 minutes) and coincided with a slower rise in mean arterial pressure in the group with higher insufflation pressure. The authors felt that the hemodynamic effects of carbon dioxide are overshadowed by the mechanical effects of increased intra-abdominal pressure during laparoscopy [8]. Dexter et al found a moderate increase in heart rate after peritoneal insufflation which reached statistical significance for the high pressure group.…”

Section: Discussionmentioning

confidence: 96%

“…Only a few studies have dealt with comparison of cardiopulmonary parameters at different pressures of PP [7,8,12,20,21]. Wallace et al in a prospective, randomized doubleblinded study of 40 patients showed that there were no significant differences in intraoperative heart rate or cardiac index, although the latter fell significantly soon after insufflation in both groups.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Safety of Low Pressure Pneumoperitoneum for Laparoscopic Cholecystectomy: A Prospective, Randomized, Triple-Blinded Trial

Nitin¹,

Sharma²,

Gupta³

et al. 2017

JGPLD

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“…Some study define 'normal' insufflation pressure as 12-15 mmHg and a 'low' pressure as 5-7 mmHg [21] while a recent review arbitrarily considered anything less than 12 mmHg as low pressure [33]. Studies in healthy individuals have shown less pronounced decrease in cardiac index using low pressure peritoneal insufflation, while the pulmonary parameters have remained more or less similar in both the groups [13,34,35]. By and large, the low pressure groups have also reported less post-operative pain and diminished analgesic requirement, but such was always not the case [34].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

et al. 2010

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Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. Ever increasing number of patients with myriad of medical illness is being treated by this technique. However, significant concern prevails among the surgical community regarding its safety in patients with cardiac co-morbidity. Patients with significant cardiac dysfunction and multiple co-morbidities were prospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopic cholecystectomy was performed. Patient demographics, details of peri-operative management and post-operative complications were studied. Between March 2005 and January 2009, 28 patients (M:F= 21:7) with mean age of 60 years (range 26-78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy. Of these, 24 patients were in NYHA class-II, while 4 belonged to class-III. Left ventricular ejection fraction, as recorded by transthoracic echocardiography, was 20-30% in 13 (46%) patients and 30-40% in the rest 15 (54%). In addition, 13 (46%) patients had regional wall motion abnormalities, 11 (39%) patients had cardiomyopathy, 2 (7%) patients had valvular heart disease while 12 (43%) patients had prior cardiac interventions. Following laparoscopic cholecystectomy, hypertension (3), tachyarrhythmia (4) and bradycardia (1) were the commonest events encountered. One patient required laparotomy to deal with peritonitis in the immediate postoperative period and succumbed to myocardial infarction, but all other patients made an uneventful recovery. With appropriate cardiological support, laparoscopic cholecystectomy may be safely performed in patients with significant cardiac dysfunction.

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Randomized trial of different insufflation pressures for laparoscopic cholecystectomy

Abstract: Insufflation pressure significantly affects the haemodynamic changes and postoperative pain associated with laparoscopic cholecystectomy.

Cited by 93 publications

References 7 publications

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Shoulder Tip Pain Following Laparoscopic Cholecystectomy—a Randomized Control Study to Determine the Cause

Feasibility and Safety of Low Pressure Pneumoperitoneum for Laparoscopic Cholecystectomy: A Prospective, Randomized, Triple-Blinded Trial

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

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