三种术式行胆总管切开取石术的对比研究

目的:比较完全腹腔镜手术、小切口手术及开腹手术行胆总管切开取石术的临床效果.方法:回顾性分析近5年胆囊结石合并胆总管结石手术治疗的217例患者的临床资料,其中,行腹腔镜胆囊切除(LC)+腹腔镜下胆总管切开取石术( LCBDE) 69例(腹腔镜组);行LC+小切口胆总管切开取石术85例(小切口组);行开腹胆囊切除+胆总管切口取石术63例(开腹组).对比3组间的相关临床指标.结果:腹腔镜组、小切口组在术中出血量、术后肠道功能恢复时间、术后疼痛、并发症发生率以及术后住院时间上明显优于开腹组(均P＜0.05),小切口组在手术时间及气腹时间上明显少于腹腔镜组(均P＜0.05).结论:LCBDE及辅助小切口手术都具有创伤小、恢复快、痛苦少等优点.与LCBDE相比,小切口手术减少了手术时间及术中气腹时间,尤其适用于不能耐受长时间气腹及心肺功能较差的年老患者.     

腹腔镜与小切口胆囊切除治疗胆囊结石的疗效探讨

目的比较腹腔镜胆囊切除术与小切口胆囊切除术两种术式治疗胆囊结石的临床疗效。方法选取2009年5月至2012年6月我院行手术治疗胆囊结石患者120例,其中60例行腹腔镜胆囊切除术作为实验组,小切口胆囊切除术手术治疗60例作为对照组。观察并比较两组临床疗效结果。结果实验组术中出血量少于对照组,手术时间、胃肠道功能恢复时间及术后住院时间短于对照组,两组比较,差异有统计学意义(P0.05);对照组、观察组术后并发症发生率分别为21.7%、8.3%,差异有统计学意义(P0.05)。结论腹腔镜胆囊切除术具有创伤小、恢复快、住院时间短和并发症少等优点,值得临床推广。     

腹腔镜胆囊切除术与小切口胆囊切除术的比较

目的：探讨胆囊切除术适应证患者的理想术式。方法：回顾219例腹腔镜胆囊切除术(LC)与107例小切口胆囊切除术(MC)的临床资料,从手术适应证、手术创伤、并发症、术后恢复经过等方面对比分析两者的优缺点。结果：两者比较,LC创伤小,术后并发症较多。MC手术适应证宽。两者术后恢复差异无显著性。结论：两种术式各有优缺点,其中一种术式并不适应所有胆囊切除适应证的患者。选择何种术式,应根据患者的具体情况决定。     

Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease

Background: Laparoscopic cholecystectomy (LC) has become firmly established as a procedure of choice for gallstone disease. The procedure usually necessitates general anaesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment secondary to the induction of pneumoperitoneum. There is a paucity of data in the literature on the procedure being performed under regional (epidural) anaesthesia, especially in patients with coexisting pulmonary disease and pregnancy, who are deemed high risk for general anaesthesia. We report our preliminary experience with LC using epidural anaesthesia in patients with chronic obstructive pulmonary disease (COPD). Methods: We performed LC in six patients (one man and five women), with a median age of 56 years (range, 38–74), under epidural anaesthesia over an 8-month period. All patients were ASA grade III/IV and the mean FEV₁/FVC was 0.52 (range, 0.4–0.68), due to chronic asthma (two cases) and COPD (four cases). They were admitted a day prior to surgery for pulmonary function tests, nebulisers, and chest physiotherapy. An epidural catheter was introduced at T10/11 intervertebral space, and a bolus of 0.5% Bupivacaine was administered. Depending on the patient's pain threshold and the segmental level of analgesia achieved, incremental doses of 2 ml of 0.5% Bupivacaine along with boluses of intravenous 100 mcg Alfentanil was given to each patient. The patients were breathing spontaneously. No nasogastric tube was inserted, and a low-pressure (10 mmHg) pneumoperitoneum was created. LC was performed according to the standard technique. Results: All the patients tolerated the procedure well and made an uneventful postoperative recovery. Median operating time was 50 min; average length of hospital stay was 2.5 days (range, 2–4). The epidural catheter was removed the morning after the operation. Only one patient required postoperative opioid analgesia. Two patients complained of persistent shoulder tip pain during surgery and required intraoperative analgesia (Alfentanil). There was no change in the patient's cardiorespiratory status, including pO₂ and pCO₂, and no complications occurred either intra- or postoperatively. Conclusions: LC can be performed safely under epidural anaesthesia in patients with severe COPD. Intraoperative shoulder tip or abdominal pain does not seem to be a major deterrent and can be effectively controlled with small doses of opioid analgesia.     

Does propofol reduce vomiting after strabismus surgery in children?

Background: Previous studies have indicated that propofol anaesthesia may reduce the incidence of postoperative nausea and vomiting after strabismus surgery in children. This study was designed to investigate the incidence of vomiting after strabismus surgery at two different levels of propofol anaesthesia compared to thiopental/isoflurane anaesthesia. Methods: Ninety ASA class I or II children, aged 5–14 yrs were randomly assigned to one of three groups: Group T/I (n=30) induction with 5 mg kg^-1 of thiopental and maintenance with isoflurane, group P5 (n=31) induction with propofol 2 mg kg^-1, maintenance with propofol infusion 5 mg kg^-1 h^-1 or group P10 (n=29) induction with propofol 2 mg kg^-1, maintenance with propofol 10 mg kg^-1 h^_I. All received glycopyrrolate, vecuronium, fentanyl and controlled ventilation with O₂/N₂O 30/ 70. Ketorolac i.v. was given to prevent postoperative pain. If additional analgesia was needed, ibuprofen/acetaminophen or buprenorphine was given according to clinical need. Results: There were no differences between study groups with respect to age, weight, history of previous anaesthesia or emesis after previous anaesthesia, duration of anaesthesia, surgery or sleep after anaesthesia, or number of muscles operated. The incidence of vomiting was 37%, 29% and 28% in groups T/I, P5 and P10, respectively. There were no statistically significant differences between the three groups in the incidence of vomiting. The median age of patients who vomited was 7.5 (range 5.0–13.7) yrs while the median age of the patients who did not vomit was 9.1 (range 5.0–14.0) yrs (P < 0.01). Conclusion: In the present study, propofol anaesthesia compared to thiopental/isoflurane anaesthesia did not reduce the incidence of vomiting following strabismus surgery in children.     

Altersabhängige Korrelation zwischen EEG-Parametern und zunehmender Narkosetiefe unter Propofol Effekte von Fentanyl

This study was designed to determine the relationship between the electroencephalogram (EEG) and clinical signs of depth of anaesthesia during induction of anaesthesia by slow infusion of propofol (18?mg/kg·h). Methods. Four groups of 12 patients each were studied (groups I and II: 18–50 years; groups III and IV: >70 years). Groups II and IV were given 0.15?mg fentanyl before the infusion of propofol was started. The clinical signs recorded were: (1) loss of eyelash reflex; (2) respiratory insufficiency; (3) tolerance to painful stimuli; and (4) intubation. Cardiovascular reactions were documented. The dosage was calculated from the infusion time (time from start of infusion until specific clinical event). Bipolar electrodes were placed at the C4/P4 positions (10–20 placement system) to record the EEG, which was processed by a personal computer (Narkograph) using fast-fourier transformation. The Narkograph calculates multiparametric EEG stages ranging from A to F (according to Kugler) as well as median frequency and spectral-edge frequency 95% (SEF). Stage A represents alpha rhythm, stage F is equivalent to a burst suppression pattern. For statistical analysis a Student t-test was performed. Results. The infusion of propofol led to slowly developing anaesthesia with loss of eyelash reflex followed by loss of pain response, respiratory insufficiency, and intubation. In the younger patients the clinical signs coincided with well-differentiable EEG patterns. Above 70 years of age there were problems in distinguishing the EEG patterns, as there are alterations of the EEG with advanced age. The multiparametric EEG stage calculated by the Narkograph showed a better correlation with the clinical signs than median or SEF. Fentanyl shortened the induction time remarkably: less propofol was needed to achieve corresponding clinical signs when fentanyl was added. The EEG patterns typical for a specific clinical condition remained unchanged by fentanyl. Similar clinical situations showed equal EEG stages in all groups. Different clinical situations could be distinguished by significant changes in the EEG. The infusion times for tolerance to pain and respiratory insufficiency were not significantly different, and there were no significant differences between the EEG patterns and propofol doses for these two clinical parameters. Intubation was performed after 18.5±4.6?min in group I with a propofol dose of 5.6±1.4?mg/kg. This time was shortened by fentanyl in group II to 10.1±3.7?min and a propofol dose of 3.0±1.1?mg/kg. Conclusion. Different clinical signs corresponding to different levels of depth of anaesthesia could be differentiated by their EEG parameters. The EEG stage allowed better differentiation of the clinical conditions than the single-parameter EEG derivatives median and SEF. The results of this study show that EEG monitoring provides information about depth of anaesthesia.     

Cost-effect evaluation of different variants of cholecystectomies

Short-term results of treatment and cost-effect rates were analyzed in three groups of patients undergone traditional cholecystectomy, laparoscopic cholecystectomy and cholecystectomy through minilaparotomy. It was demonstrated that frequency of complications was less after operations through laparoscopy and minilaparotomy. Traditional approach had the most costs due to more number of postoperative complications, hospital stay after surgery and more number of analgesics. Cholecystectomy through minilaparotomy is most cost-effective due to high clinical effectiveness, short hospital stay and rare complications. This procedure does not require expensive devices and can be performed with regional anesthesia only. It is concluded that minimally invasive methods of cholecystectomy must be used more widely.     

胆囊切除术对胃肠动力的影响

了解人胆囊切除术后早期胃肠运动的变化及自然恢复过程。方法:选择单纯胆囊结石病人20例,分为两组,分别在全麻或硬膜外麻醉下行胆囊切除。手术结束后采用胃肠测压法记录胃肠运动变化,持续至胃肠动力恢复正常。结果:两组病人术后早期、十二指肠移行性动力复合波(migrating motor complex,MMC)活动均消失,术后0.5～2h十二指肠MMC重新出现,胃MMC在术后5.5～14h恢复,术后22～43hMMC完全恢复正常。进食能使术后早期MMC转变为消化期活动形式。比较两组病人术后胃肠动力恢复的各项指标发现,在全麻或硬膜外麻醉下进行手术后胃肠动力的恢复过程无明显差异。结论:胆囊切除术完全消除了正常的胃肠运动,术后胃肠动力的恢复远较传统认为的快。在全麻或硬膜外麻醉下进行手术后胃肠动力的恢复过程无明显差异。     

Acute Rehabilitation Program after Laparoscopic Colectomy using Intravenous Lidocaine

Background: The concept of postoperative acute rehabilitation was introduced to accelerate postoperative recovery and improve outcome. We investigated whether intravenous lidocaine infusion, which decreases postoperative pain and speeds the return of bowel function, can be used instead of epidural analgesia in an acute rehabilitation protocol for patients undergoing laparoscopic colectomy.

Methods: Twenty eight consecutive patients scheduled for laparoscopic colectomy were prospectively included in this case series study. Segmental colectomy was performed only for benign pathology. Intraoperative opioid use was restricted. After a bolus injection of lidocaine 1.5 mgkg^-1, an infusion (2 mgkg-1h-1, IV) was started before pneu-moperitoneum. Balanced analgesia was used to reduce postoperative opioid consumption. Patients were allowed to drink 6 h postoperatively. The day after surgery, patients were allowed to eat a normal breakfast. Enforced mobilisation and ambulation were required from the patients. Our goal was to discharge patients within 3 days after surgery. Postoperative pain was measured. Time to first flatus, defecation, and hospital discharge were recorded. Results: Mean postoperative pain at rest and mobilisation remained below 30 mm on a 100 mm visual analogue scale. Time to first flatus, defecation, and hospital discharge were 29 ± 13 h, 38 ± 13 h, and 3.0 ± 1.0 days, respectively. Conclusion: Acute rehabilitation after laparoscopic colectomy using IV lidocaine gives similar outcomes to those reported using epidural analgesia.     

Preoperative parenteral parecoxib and follow-up oral valdecoxib reduce length of stay and improve quality of patient recovery after laparoscopic cholecystectomy surgery

In this randomized, double-blinded, placebo-controlled study, we evaluated the effects of preoperative IV parecoxib sodium (parecoxib) followed by postoperative oral valdecoxib on length of stay, resource utilization, opioid-related side effects, and patient recovery after elective laparoscopic cholecystectomy. Patients were randomized to receive a single IV dose of parecoxib 40 mg (n = 134) or placebo (n = 129) 30-45 min before the induction of anesthesia. Six to 12 h after the IV dose, the parecoxib group received a single oral dose of valdecoxib 40 mg, followed by valdecoxib 40 mg once daily on postoperative Days 1-4 and then 40 mg once daily as needed on Days 5-7. Patients in the parecoxib/valdecoxib group had a shorter length of stay in the postanesthesia care unit (78 +/- 47 min) compared with those taking placebo (90 +/- 49 min; P < 0.05). Patients in the parecoxib/valdecoxib group also had reduced pain intensity and, after discharge, experienced a significant reduction in vomiting in the first 24 h, slept better, returned to normal activity earlier, and expressed greater satisfaction than placebo patients (P < 0.05). Preoperative parecoxib followed by postoperative valdecoxib is a valuable adjunct for treating pain and improving patient outcome after laparoscopic cholecystectomy. IMPLICATIONS: The administration of preoperative IV parecoxib followed by oral valdecoxib after surgery resulted in a shorter length of stay in the postoperative anesthesia care unit, a better quality of postoperative recovery, and a faster return to normal activity, with greater patient satisfaction, after laparoscopic cholecystectomy.     

Intravenöse Anästhesie mit Propofol versus Thiopental-/Enflurananästhesie

It may be possible to reduce costs in anaesthesia when there is a choice of drugs and methods. Two of the most widespread techniques are inhalation anaesthesia with enflurane following induction with thiopentone, and intravenous anaesthesia (IVA) with propofol. The aims of our study were to compare the costs, effectiveness and side effects of the anaesthetics involved in these two techniques, and to measure significant clinical parameters. Methods. After approval by the hospital ethics committee, 40 adult patients of ASA physical status?1 and 2 who had been scheduled for elective septorhinoplasty and had given informed consent were entered in our prospective, single-blind randomized study. In 20?patients anaesthesia was induced with thiopentone (4–5?mg/kg) and suxamethonium (1–1.5?mg/kg) and maintained with enflurane. The other 20?patients received an initial i.v. bolus of propofol (2–2.5?mg/kg) followed by a propofol infusion adjusted to their individual clinical needs. Ventilation was performed in both groups with 70% nitrous oxide in oxygen, using a nonrebreathing system. Muscle relaxation was maintained with atracurium. The amounts of anaesthetics, oxygen, nitrous oxide, and muscle relaxants used were measured and a record of the costs was kept. In addition, circulatory and respiratory parameters and quantitative and qualitative aspects of recovery from anaesthesia were recorded. Results. The biometric and clinical data did not differ significantly between the two groups. For induction, 382 (±55.9) mg thiopentone costing 1.24 Swiss francs (SFr), or 172 (±25.1) mg propofol costing 11.87 (SFr) was used. For maintenance, 28.3 (±6.4) ml enflurane costing 21.96?SFr/h, or 450.7 (±247) mg propofol costing 29.75?SFr/h was required. The need for muscle relaxants, oxygen, and nitrous oxide was also not significantly different in the two groups. Additional expenses were due to relaxation antagonists (1.91?SFr per patient in both groups) and to the perfusion pump system (8.60?SFr per patient in the IVA group only). Circulatory and respiratory parameters remained normal in both groups. In the propofol group, the heart rate tended to increase more at the beginning of anaesthesia, whereas later on it showed a tendency to lower values than in the thiopentone/enflurane group. Patients receiving IVA generally had a shorter awakening period, a higher degree of wellbeing during recovery, and needed less systemic analgesics (P<0.05). Conclusions. Costs of anaesthetic drugs in the IV group totalled 54.50?SFr during the first hour, i.e. 1.65 times the costs in the thiopentone/enflurane group for the same time. However, with continuing duration of anaesthesia this ratio declines to 1.43 in anaesthesia lasting 2?h. In addition, IVA patients had a noticeably faster and far more pleasant recovery. Minute ventilation, oxygen consumption, heart rate and CO₂ production indicated a less pronounced stress response and sympathetic activity during and after propofol. Quicker recovery of cognitive and psychomotor abilities, less postoperative pain and less impairment of respiratory function after IVA may lead to an earlier release from the postoperative recovery unit. This might be a cost-reducing factor that should be taken into account when these two anaesthetic regimens are concerned.     

Quality of life after single-incision laparoscopic cholecystectomy: A randomized,clinical trial

Background

Controversy continues as to whether single-incision laparoscopic cholecystectomy, with the somewhat larger incision at the umbilicus, may lead to a worse postoperative quality of life and more pain compared with the more classic 4-port laparoscopic cholecystectomy. The aim of this study was to compare single-incision and 4-port laparoscopic cholecystectomy from the perspective of quality of life.

Postoperative drowsiness and emetic sequelae correlate to total amount of carbon dioxide used during laparoscopic cholecystectomy

Background: After laparoscopy with carbon dioxide (CO₂) insufflation early postoperative recovery is often complicated with drowsiness and postoperative nausea and vomiting (PONV). Methods: 25 ASA I − II patients undergoing elective laparoscopic cholecystectomy under standardized anaesthesia were studied in a randomized, prospective study. The conventional CO₂ pneumoperitoneum was compared with the mechanical abdominal wall lift (AWL) method with minimal CO₂ insufflation with special reference to postoperative recovery. Results: Postoperative drowsiness was of a significantly longer duration with the conventional method (p < 0.001) compared with the AWL technique. There was a positive correlation with the total amount of CO₂ used and the duration of drowsiness (r = 0.75, p < 0.01). PONV was seen significantly more often in patients with CO₂ insufflation of more than 121 (p < 0.05). Conclusions: Avoiding excessive CO₂ is beneficial for smoother and more uneventful recovery after laparoscopic cholecystectomy. Received: 11 January 1996/Accepted: 29 May 1996     

Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy

BACKGROUND: Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism, and may have the potential to improve postoperative recovery. There are no data from randomized studies on postoperative clinical outcome after specific surgical procedures. This study evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy. METHODS: Ninety-four patients undergoing laparoscopic cholecystectomy were included in a randomized clinical trial. Patients were randomized to receive 800 ml of an iso-osmolar 12.5 per cent carbohydrate-rich beverage the evening before operation (100 g carbohydrate) and another 400 ml (50 g carbohydrate) 2 h before initiation of anaesthesia, or the same volume of a placebo beverage. The primary endpoint was general well-being the day after operation. Patients were evaluated from 5 days before to 5 days after operation. Daily scores of general well-being, fatigue, appetite and pain, computerized measurements of physical activity and sleep (actigraphy), and subjective sleep quality were recorded. Nausea and vomiting were assessed twice within the first 24 h after surgery. RESULTS: Data from 86 patients were available for statistical analysis, 43 in each treatment group. No significant intergroup differences in general well-being or any other outcome variable were found. CONCLUSION: A preoperative carbohydrate beverage did not improve clinical outcome after laparoscopic cholecystectomy.     

Efeitos da acupuntura para a prevenção de náuseas e vômitos após colecistectomia laparoscópica: estudo clínico randomizado

Background and objectivesPostoperative nausea and vomiting (PONV) is a common and undesirable complication observed after laparoscopic cholecystectomy (LC). We investigated the effects of auriculoacupuncture (AA) on the prevention of postoperative nausea and vomiting in the immediate postoperative period of uncomplicated laparoscopic cholecystectomy.MethodsSixty‐eight patients were randomly divided into two groups, auriculoacupuncture (n = 35) and control (n = 33) and then they were evaluated prospectively. The needle was placed before anaesthesia induction and remained for 20 minutes. Nausea intensity was evaluated using an analogic visual scale and PONV events were registered immediately after anaesthesia care unit admission and in the second, fourth and sixth hours after the surgery.ResultsThe auriculoacupuncture group had a significantly smaller incidence of nausea and vomiting than the control group throughout the whole postoperative period (16/35 vs. 27/33, p = 0.03 and 4/35 vs. 15/33, p = 0.005, respectively); the AA group had fewer nausea events 2 hours (p = 0.03) and 6 hours (p = 0.001) after surgery and fewer vomiting events 2 hours (p = 0.01) and 6 hours (p = 0.02) after surgery.ConclusionsAuriculoacupuncture can partially prevent postoperative nausea and vomiting when compared to metoclopramide alone after uncomplicated laparoscopic cholecystectomy. Auriculoacupuncture can be recommended as an adjuvant therapy for postoperative nausea and vomiting prevention in selected patients.     

Aufwachverhalten und kognitive Funktion nach Desfluran oder Isofluran

Desflurane is a new volatile anaesthetic with an extremely low blood/gas partition coefficient of 0.42. This should provide a rapid recovery from anaesthesia. Methods. We studied 100 adult patients, ASA class?I or II, undergoing elective orthopaedic surgery randomly assigned to anaesthesia with desflurane (n=50) or isoflurane (n=50) supplemented by nitrous oxide in oxygen. Clorazepat was given for premedication, fentanyl and thiopental for induction of anaesthesia, followed by maintenance with desflurane or isoflurane as clinically appropriate. Emergence from anaesthesia was measured as well as return of cognitive functions (extended Aldrete score, digit symbol substitution test, and visual analogue scales [VAS]). Results. While the demographic characteristics and administrated doses of fentanyl and thiopental were comparable, the recovery profiles in both groups were different. After discontinuation of the volatile anaesthetics, times to extubation and ability to follow simple commands were significantly shorter after desflurane than after isoflurane. Extended Aldrete scores, estimation of the patients' physical condition, results of the digit symbol substitution test, measuring cognitive functions, and rates of drowsiness and weakness on VAS showed better recovery with less impairment of cognitive function in the desflurane group than in isoflurane patients even 120?min after anaesthesia. VAS pain scores and doses of analgesic drugs given within the first 2 postoperative hours, however, showed no significant differences. Desflurane patients were also judged fit for discharge from the recovery room significantly faster. Conclusions. Our results demonstrate that desflurane anaesthesia, even when supplemented by premedication, intraoperative opioids, and nitrous oxide may offer clinical advantages over isoflurane as far as the post-anaesthetic recovery profile is concerned.     

Preoperative administration of controlled-release oxycodone as a transition opioid for total intravenous anaesthesia in pain control after laparoscopic cholecystectomy

Background  The complexity of pain from laparoscopic cholecystectomy and the need for treating incident pain provide rationale for multipharmacological analgesia. We investigated the preoperative administration of controlled-release (CR) oxycodone as transition opioid from remifentanil infusion for pain after laparoscopic cholecystectomy. Methods  Fifty consecutive patients undergoing laparoscopic cholecystectomy were randomly, double-blindly assigned to treatment group (n = 25, CR oxycodone: 1 h before surgery and 12 h after the first administration) or to the control group (n = 25, placebo: administered at the same intervals). General anaesthesia was maintained with propofol and remifentanil target-controlled infusions (TCIs). All patients received ketorolac 30 mg i.v. Tramadol i.v. was administered for patient-controlled analgesia (PCA) postoperatively. Numerical rating scale for pain at rest and at movement (NRSr and NRSi), tramadol consumption, times to readiness to surgery and awakening, times to modified Aldrete’s and modified Post-Anesthetic Discharge Scoring System (PADSS) >9 and side effects were evaluated. Results  All NRSr and NRSi and tramadol consumption were significantly lower in the treatment group. The oxycodone group showed higher modified Aldrete’s scores at each time and reached a PADSS >9 faster. Side effects and postoperative nausea and vomiting episodes were comparable. Conclusions  We demonstrated the success of a multipharmacological treatment including opioid premedication with CR oxycodone used as transition opioid for TCI remifentanil infusion; the treatment group showed lower pain scores and rescue analgesic consumption, shorter time to discharge from recovery room and from surgical ward, and the same incidence of side effects, comparably to controls. Sources of financial support for the work: University of Parma, viale Gramsci 14, 43100 Parma PR, Italy.     

Effects of remifentanil infusion bis-titrated on early recovery for obese outpatients undergoing laparoscopic cholecystectomy

BACKGROUND: In obese patients functional residual capacity comes down with a possible hypoxemia in postoperative period. In fact many studies has been begun to determine optimum ventilation regulation and the best position for these patients, but the question has not been solved. As remifentanil can reduce of 50% the inhalatory anaesthetic request and reverse Trendelemburg position is extremely useful for these patients, we hypothesized that use of a continuous remifentanil infusion during balanced anaesthesia with sevoflurane, BIS-titrated, associated to reverse Trendelem-burg position could facilitate emergence from anaesthesia in obese patients undergoing laparascopic cholecystectomy. METHODS: We studied 40 patients, ASA II class, with higher than 30 kg/m2 body mass index, undergoing to laparoscopic cholecystectomy. All the patients, in operating room, received standard monitoring and BIS sensor application. All the data were continuously collected. Induction of anaesthesia has been with a refracted bolus in 120 sec of remifentanil 1 mg/kg, followed by propofol 1.5 mg/kg and cisatracurium 0.15 mg/kg. Maintenance of anaesthesia has been by balanced anaesthesia with continuous remifentanil infusion, ventilating patients with sevoflurane in oxygen and air. Patients were randomized into two homogenous groups. Into the control group has been varied sevoflurane inspiratory concentration on the ground of BIS value (from 0.3% to 3%), while into remifentanil group remifentanil infusion has been varied (from 0.25 to 2 mg/kg/min) to maintain medium pressure values which don't stray more than 25% from basal values, on the ground of BIS values. On pre-established times of operation, respiratory mechanics and blood gases were examined. RESULTS: As it was to expect, sevoflurane concentration variations resulted very high in control group compared to remifentanil group. Awakening time, extubation, orientation and transfer to PACU (postanaesthesia care unit) resulted significantly lower than remifentanil group. CONCLUSIONS: Concluding, remifentanil infusion, BIS-titrated, facilitates awakening times from balanced anaesthesia with Sevoflurane in obese patients, submitted to laparoscopic cholecystectomy.     

经脐单孔腹腔镜手术35例初探

目的:总结经脐单孔腹腔镜手术的设备选择及手术适应证.方法:回顾分析2010年6月至2011年4月为35例患者行经脐单孔腹腔镜手术的临床资料.结果:35例手术均获成功,19例行经脐单孔胆囊切除术,11例行阑尾切除术,3例行胆囊联合阑尾切除术,2例行精索静脉高位结扎术,术后患者均恢复顺利.结论:经脐单孔腹腔镜手术可使用常规...     

Systemic Lidocaine to Improve Quality of Recovery after Laparoscopic Bariatric Surgery: A Randomized Double-Blinded Placebo-Controlled Trial

Background

Few multimodal strategies to minimize postoperative pain and improve recovery have been examined in morbidly obese patients undergoing laparoscopic bariatric surgery. The main objective of this study was to evaluate the effect of systemic intraoperative lidocaine on postoperative quality of recovery when compared to saline.

Methods

The study was a prospective randomized, double-blinded placebo-controlled clinical trial. Subjects undergoing laparoscopic bariatric surgery were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the quality of recovery 40 questionnaire at 24 h after surgery.

Results

Fifty-one subjects were recruited and 50 completed the study. The global QoR-40 scores at 24 h were greater in the lidocaine group median (IQR) of 165 (151 to 170) compared to the saline group, median (IQR) of 146 (130 to 169), P?=?0.01. Total 24 h opioid consumption was lower in the lidocaine group, median (IQR) of 26 (19 to 46)?mg IV morphine equivalents compared to the saline group, median (IQR) of 36 (24 to 65)?mg IV morphine equivalents, P?=?0.03. Linear regression demonstrated an inverse relationship between the total 24 h opioid consumption (IV morphine equivalents) and 24 h postoperative quality of recovery (P?<?0.0001).

Conclusions

Systemic lidocaine improves postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery. Patients who received lidocaine had a lower opioid consumption which translated to a better quality of recovery.