1,721,005 research outputs found
Anestesia sequenziale con isoflurane e Propofol in pazienti obesi sottoposti ad intervento di diversione biliopancreatica
No full textN/
Determinants of hemodynamic compensation during veno-venous bypass in liver transplantation
No full textAirway management in obese patients
No full textThe well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes. Anesthesiologists confront a number of troubles, including rapid oxygen desaturation, difficulty with laryngoscopy/intubation and mask ventilation, and increased susceptibility to the respiratory depressant effects of anesthetic drugs. Preoperative assessment of the airways in the obese should include examination of specific predictors of difficult mask ventilation other than those for difficult intubation.
Difficulties in airway management are decreased after providing optimal preoxygenation and positioning ("ramped"). Other strategies may include
availability of alternative airway management devices, including new video
laryngoscopes that significantly improve the visualization of the larynx and
thereby facilitate intubation. If awake intubation is mandatory, it may be
performed with fibrobronchoscope after providing an adequate topical anesthesia
and sedation with short-acting drugs, such as remifentanil. Succinylcholine for rapid sequence induction might be replaced by rocuronium where sugammadex is available for reversal. A complete reversal of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient in the same position with airway equipment used for intubation
Carbon dioxide absorption during retroperitoneoscopic adrenalectomy: comparison between monolateral and synchronous bilateral approaches
No full textSynchronous posterior retroperitoneoscopic bilateral adrenalectomy (PR-BilA) is a novel technique proposed for the definitive cure of hypercortisolism when a surgical approach is indicated. The aim of the present prospective cohort study was to compare the carbon dioxide (CO2) absorption in patients undergoing PR-BilA with those undergoing single posterior retroperitoneoscopic adrenalectomy (PRA). Twenty-nine patients undergoing PR-BilA or PRA were consecutively enrolled. Anaesthesia was standardised. In both groups, CO2 elimination (VCO2), CO2 dissolved in arterial blood (PaCO2), end-tidal CO2 (EtCO2), and volume per minute (VM) were measured at the following time points: after anaesthesia induction and before CO2 insufflation (T1), 5 min after CO2 insufflation (T2), at the time of maximum VCO2 (T3), and at desufflation (T4). VCO2 was continuously measured using a metabolic monitor. ANOVA for repeated measures was used for statistical analysis. With respect to VCO2, a significant group × time interaction was found (p = 0.03). Post hoc analysis revealed that VCO2 was significantly increased at T4 compared with T1 in both groups (p = 0.02 and p = 0.0001 in the PRA and PR-BilA groups, respectively). Regarding PaCO2, ANOVA analysis showed a significant group effect (p = 0.01), with higher values in the PR-BilA group. EtCO2 and VM did not differ between the two groups. We found that the CO2 absorption was increased in both groups at the end of surgery, in the presence of a higher trend in PaCO2 values during PR-BilA. Therefore, PR-BilA may be considered a safe surgical approach with respect to CO2 absorption, when a mild degree of hypercapnia may be accepted
Factors affecting acute pain perception and analgesics consumption in patients undergoing bariatric surgery
No full textBackground: Previous studies performed in non-obese patients undergoing elective surgery have revealed that psychological factors may affect postoperative analgesic requirements. The aim of this observational prospective study was to investigate the extent to which psychopathological dimensions, including anxiety, depression and alexithymia, may influence postoperative pain intensity and analgesics consumption using patient-controlled analgesia (PCA) in patients undergoing bariatric surgery. Methods: 120 patients, aged 18-60 years, with an ASA physical status I-II, undergoing gastric bypass were enrolled. Anxiety and depression Hamilton scales, and Toronto Alexithymia scale, were administered to patients on the day before surgery. General anesthesia was standardized. After awakening, a PCA pump with intravenous tramadol was immediately made available for a 36-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi), and effective PCA requests number were postoperatively recorded. Pearson's correlations, Anova analyses and multiple linear regression were used for statistical purpose. Results: Positive correlations were found between anxiety, depression, alexithymia and all pain indicators (p < 0.01). Analyses of variance showed that anxious (p < 0.001), depressed (p < 0.001) and alexithymic (p < 0.05) patients had high pain indicators. VASr and VASi were predicted by anxiety and depression (p < 0.05), but not by alexithymia; effective PCA requests number was predicted by anxiety, depression and alexithymia (p < 0.001). Conclusions: Obese patients with high depression, anxiety and alexithymia levels rated their pain as more intense and required a larger amount of tramadol. Pain perception intensity was predicted by anxiety and depression but not by alexithymia, whereas analgesics consumption was predicted by all the investigated psychopathological dimensions
Minimally invasive, totally gasless video-assisted thyroid lobectomy
No full textBACKGROUND: Neck surgery is one of the newest fields of application of
video-assisted surgery. We developed a technique for minimally invasive, totally
gasless video-assisted thyroid lobectomy.
METHODS: The procedure was accepted by a patient with a follicular nodule of the
left lobe of the thyroid. We performed a left thyroid lobectomy through a single
20-mm horizontal skin incision, just above the sternal notch, after inserting a
5-mm 30 degrees laparoscope, by using both endoscopic and conventional
instrumentation.
RESULTS: The recurrent laryngeal nerve and the parathyroid glands were easily
identified and preserved. The operating time was 2.5 hours. No complication
occurred. The postoperative stay was 2 days. The cosmetic result was excellent
CONCLUSIONS: We concluded that our technique is feasible and safe. This makes us
optimistic about the future of minimally invasive, video-assisted thyroid
surgery
Pulmonary gas exchange during orthotopic liver transplantation
No full textThe aim of this study was to evaluate the efficiency of pulmonary gas exchange during the course of liver transplantation. We studied 25 adult cirrhotic patients undergoing transplantation, performed with venovenous bypass. A significant increase in PaO2, and a significant decrease in physiological shunt and alveolar-arterial partial pressure difference were observed just before the start of venovenous bypass. These changes were probably caused by modifications in respiratory mechanics, such as an increase in functional residual capacity. There were no other respiratory changes during the anhepatic and post-anhepatic phases
Haemodynamic changes detected during open prostatectomy and transurethral resection for benign prostatic hyperplasia
No full textTo detect possible intraoperative haemodynamic differences, 60 patients undergoing transurethral (n = 18) or open prostatectomy (n = 42) for benign prostatic hyperplasia were evaluated. The same type of general anaesthesia was used in the two groups. Data, including temperature and cardiac output, were collected at five standard times during the procedures. No significant differences were found between the two groups. However, in all patients, irrespective of the operation, significant decreases in cardiac output and increases in systemic resistance occurred during surgery. Body temperature showed a mild, insignificant decrease, which may play a role in determining the mild haemodynamic derangement observed in all patients. Our patients subjected to open prostatectomy and transurethral resection presented the same kind of haemodynamic derangement, with no significant differences. Therefore it seems unlikely that the kind of surgery could play a relevant role in the late mortality rate of these patients
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