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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  129. Kongress der Deutschen Gesellschaft für Chirurgie; 20120424-20120427; Berlin; DOC12dgch156 /20120423/
    Publication Date: 2012-04-24
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Postoperative Kohlendioxidresorption – Laparoskopische Cholezystektomie – Kapnoperitoneum ; Key words: Postoperative carbon dioxide resorption – Laparoscopic cholecystectomy – Capnoperitoneum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. After laparoscopic cholecystectomy, carbon dioxide (CO2) must be exhaled after resorption from the abdominal cavity. There is controversy about the amount and relevance of postoperative CO2 resorption. Without continuous postoperative monitoring, after laparoscopic cholecystectomy a certain risk may consist in unnoticed hypercapnia due to CO2 resorption. Studies exist on the course of end-expiratory CO2 (PeCO2) alone over a longer postoperative period of time in extubated patients during spontaneous breathing. The goal of this prospective study was to investigate the amount of CO2 resorbed from the abdominal cavity in the postoperative period by means of CO2 metabolism. Methods. After giving informed consent to the study, which was approved by the local ethics committee, 20 patients underwent laparoscopic cholecystectomy. All patients received general endotracheal anaesthesia. After induction, total IV anaesthesia was maintained using fentanyl, propofol, and atracurium. Patients were ventilated with oxygen in air (FiO2 0.4). The intraabdominal pressure during the surgical procedure ranged from 12 to 14 mm Hg. Thirty minutes after releasing the capnoperitoneum (KP), CO2 elimination (V˙CO2), oxygen uptake (V˙O2), and respiratory quotient (RQ) were measured every minute for 1 h by indirect calorimetry using the metabolic monitor Deltatrac according to the principle of Canopy. Assuming an unchanged metabolism, the CO2 resorption (ΔV˙CO2) at any given time (t) can be calculated from ΔV˙CO2 (t)=V˙CO2 (t)−RQ (preop) V˙O2 (t). It was thus necessary to define the patient's metabolism on the day of operation. The first data were collected before surgery and after introduction of the arterial and venous cannulae for a 15-min period. Measuring point 0 was determined after exsufflation of the KP and emptying of the remaining CO2 via manual compression by the surgeon at the end of surgery. Patient's tracheas were extubated and metabolic monitoring started 30 min after release of the KP for 60 min. Simultaneously, a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency (RF) were obtained by the Capnomac Ultima (Datex) and registered every minute as well. Values were averaged over four periods of 15 min each. An arterial blood gas sample was drawn at the end of every 15-min period. Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being. All data were analysed by the Friedman or Wilcoxon test;P〈0.05 was considered significant. Results. The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy (Tables 2 and 3, Fig. 1). Arterial CO2 as well as PeCO2 were elevated postoperatively (45 mm Hg vs. 36 mm Hg intraoperatively), while V˙CO2 and V˙O2 were unchanged when compared to the preoperative measuring period. The postoperative RF was comparable to preoperative values. Calculated ΔCO2 was lower than 10 ml/min and within accuracy of measurements. The postoperative pain index ranged between 3 and 4, and 3.75 – 15 mg piritramid was administered. All patients feld tired immediately after the operation, but scores improved slightly at the end of the 60-min period of metabolic monitoring. Conclusions. There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.
    Notes: Zusammenfassung. Das am Ende einer laparoskopischen Operation nicht vollständig aus der Abdominalhöhle abgelassene CO2 muß resorbiert und abgeatmet werden. Ziel dieser Untersuchung war es, postoperativ mit den Parametern des Kohlendioxidhaushaltes die CO2-Resorption zu beurteilen. Bei 20 Patienten nach laparoskopischer Cholezystektomie wurden ab der 30. Minute nach Exsufflation des Kapnoperitoneums (KP) für 1 h nach dem Canopyprinzip am spontan atmenden und extubierten Patienten die CO2-Abgabe (V˙CO2), die Sauerstoffaufnahme (V˙O2) und der respiratorische Quotient (RQ) minütlich ermittelt. Der endtidale CO2-Partialdruck (PeCO2) und die Atemfrequenz (RF) wurden kontinuierlich aufgezeichnet. Am Ende jeder 15 min wurde der arterielle CO2-Partialdruck (PaCO2) bestimmt. Die CO2-Resorption (ΔV˙CO2) zum Zeitpunkt t kann mit dem präoperativ bestimmten RQ berechnet werden: ΔV˙CO2 (t)=V˙CO2 (t)−RQ (präop) V˙O2 (t). Der arterielle und der endtidale CO2-Partialdruck sind postoperativ um ca. 9 mm Hg erhöht, aber die ΔV˙CO2 ist über den gesamten postoperativen Meßzeitraum unter 10 ml/min. Unter der Voraussetzung der bestmöglichen Entleerung des KP durch den Chirurgen werden CO2-Reste aus der Peritonealhöhle nach Ablassen des KP innerhalb der ersten 30 min resorbiert und abgeatmet. Ein 30 bis 90 min postoperativ noch erhöhter PeCO2 weist eher auf einen verminderten Atemantrieb als auf eine CO2-Resorption hin.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 49 (2000), S. S26 
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 49 (2000), S. S29 
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die zu Grunde liegende Pathophysiologie der neuromuskulären Übertragung sowie Zustände, bei denen es zu anästhesierelevanten Veränderungen der neuromuskulären Übertragung kommt, sollen im Folgenden betrachtet werden.
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  • 5
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Balanced anaesthesia – Laparoskopische Cholezystektomie – Psychomotorische Erholung – Postoperative Übelkeit – Total(e) intravenöse Anästhesie-TIVA ; Key words: Balanced anaesthesia – Laparoscopic cholecystectomy – Psychomotor recovery – Postoperative nausea – Total intravenous anaesthesia – Propofol – Isoflurane – Methohexitone – Nitrous oxide – Outpatient anaesthesia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane. Patients and methods. After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I, II) were investigated in a prospective study. Patients were randomised to receive either isoflurane, methohexitone, or propofol. Perioperative management with regard to premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia was carried out identically for all groups. Postoperative vigilance, pain, and nausea scores were assessed 15, 30, 60, 120, and 360 min after extubation with a visual analogue scale (VAS). At the same points, psychomotor recovery was investigated with the following assays: sedation as shown in Table 1; orientation with ten questions as to person, time, and location; memory as expressed by the patient's ability to repeat five words; a calculation test with five subtractions of the number 7 beginning from 100; and word generation by the number of words with an initial "m" given within 1 min and with animal names. Data were analysed with Kruskal Wallis' test for multiple comparisons between the groups and with Friedman's test for repeated measurements. All values are given as medians (interquartile range) or ranges. Results. There was no difference between the groups' physical condition (Table 2). All intraoperative parameters compared well between groups; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics. Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group, as indicated by sedation score, orientation, memory and calculation tests (Table 4), word generation tests (Fig. 4), and subjective vigilance score (Fig. 3). The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance. The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane (24%, P〈0.05) as compared to TIVA with either propofol (53%) or methohexitone (41%). However, there were only minor differences between the groups; the ability to cooperate and be mobilised was not limited. Discussion. Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy. Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery, opioid-supplemented propofol anaesthesia is well established. Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery.
    Notes: Zusammenfassung. Die totale intravenöse Anästhesie (TIVA) wird in der Tageschirurgie zunehmend eingesetzt, weil schnelleres Erwachen und eine raschere Wiederherstellung der psychomotorischen Funktionen erwartet werden. In einer randomisierten Doppelblindstudie an 51 Patienten zur laparoskopischen Cholezystektomie wurde das Aufwachverhalten nach einer TIVA mit Propofol, einer TIVA mit Methohexital und einer balanced anaesthesia mit Isofluran in den ersten 6 Stunden postoperativ anhand der Aufwachzeit, der Orientiertheit, der Merkfähigkeit, eines Rechentests und der Wortgenerierungsfähigkeit untersucht. Die Befindlichkeit wurde mit einer visuellen Analogskala für Schmerz, Übelkeit und Müdigkeit beurteilt. Nach der TIVA mit Propofol erwachten die Patienten schneller als nach Methohexital und auch geringfügig schneller als nach Isofluran. Mit dem Verzicht auf Lachgas ist die Quote der Patienten, die über Übelkeit klagten, auch nach Isofluran erstaunlich klein (24%). Die Unterschiede in den drei Gruppen sind insgesamt gering, insbesondere sind die Kooperationsfähigkeit und die Mobilisierbarkeit der Patienten in keiner Gruppe eingeschränkt. Für die laparoskopische Cholezystektomie können alle drei untersuchten Anästhesieverfahren als gut geeignet angesehen werden.
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