Purpose LSG surgery is used for surgical treatment of morbid obesity. Obesity, anesthesia, and pneumoperitoneum cause reduced pulmoner functions and a tendency for atelectasis. The alveolar "recruitment" maneuver (RM) keeps airway pressure high, opening alveoli, and increasing arterial oxygenation. The aim of our study is to research the effect on respiratory mechanics and arterial blood gases of performing the RM in LSG surgery. Materials and Methods Sixty patients undergoing LSG surgery were divided into two groups (n = 30) Patients in group R had the RM performed 5 min after desufflation with 100% oxygen, 40 cmH 2 O pressure for 40 s. Group C had standard mechanical ventilation. Assessments of respiratory mechanics and arterial blood gases were made in the 10th min after induction (T1), 10th min after insufflation (T2), 5th min after desufflation (T3), and 15th min after desufflation (T4). Arterial blood gases were assessed in the 30th min (T5) in the postoperative recovery unit. Results In group R, values at T5, PaO 2 were significantly high, while PaCO 2 were significantly low compared with group C. Compliance in both groups reduced with pneumoperitoneum. At T4, the compliance in the recruitment group was higher. In both groups, there was an increase in PIP with pneumoperitoneum and after desufflation this was identified to reduce to levels before pneumoperitoneum. Conclusion Adding the RM to PEEP administration for morbidly obese patients undergoing LSG surgery is considered to be effective in improving respiratory mechanics and arterial blood gas values and can be used safely.
Aim: Transversus Abdominis Plan (TAP) block is an interfascial plane block, commonly used as an analgesic technique in abdominal surgeries. The aim of this study is to investigate the postoperative analgesic efficacy of bilateral ultrasonography (US) guided TAP block in patients scheduled for laparoscopic sleeve gastrectomy.Method: In this randomized prospective study; 48 patients, 18-65 years, ASA I-II, morbidly obese (BMI>35), underwent laparoscopic sleeve gastrectomy were included. The patients randomized into two groups: TAP block Group (group TAP) and Control Group (group C). At the end of the operation, bilateral TAP block were performed to 24 patients in Group TAP with a total 40 ml of local solution. 20 ml of local solution was injected into the trocar incision lines of all patients. Patient-controlled analgesia was administered to all patients at a dose of 5 mg/ml tramadol. Tramadol consumption, visual analogue scores (VAS) and the need of rescue analgesia (paracetamol) of the patients at postoperative first 24th hours were recorded.Results: There is no statistical difference in terms of demographic data. Total tramadol consumption and VAS were significantly higher in the Group C (p<0.01). No complications were found in either group.Conclusions: US-guided TAP block provides effective analgesia in patients underwent laparoscopic sleeve gastrectomy surgery.
Obezite toplumda sık görülen ve ciddi komplikasyonlarla seyreden bir sağlık sorunudur. Tedavisinde medikal ve cerrahi yöntemler kullanılabilir. Cerrahi tekniklerden laparoskopik sleeve gastrektomi (LSG) yaygın olarak kullanılmaktadır. LSG hem mevcut olan obezitenin hem de uygulanan laparoskopi tekniğinin yol açtığı etkiler nedeniyle yüksek riskli bir operasyondur. Preoperatif muayeneden, perioperatif yönetim ve postoperatif bakıma kadar anestezi planı dikkatli bir şekilde yapılmalıdır. Hastanemizde ilk kez uygulanan LSG operasyonunda anestezi deneyimimizi sizlerle paylaşmayı amaçladık. Anahtar Sözcükler: Obezite, bariatrik cerrahi, recruitment, yüksek akım oksijen tedavisi Obesity is a common health problem with serious complications. Medical and surgical methods can be used in treatment. Laparoscopic sleeve gastrectomy (LSG) is a widely used surgical procedure. LSG is a high-risk surgery because of the effects of both existing obesity and the applied laparoscopic technique. Anesthesia plan from preoperative examination to perioperative management and postoperative care should be done carefully. We aimed to share our experience in the anesthetic management of a patient who underwent a LSG operation which was performed for the first time in our hospital.
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