A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum

Shoar, Saeed; Naderan, Mohammad; Ebrahimpour, Hossein; Soroush, Ahmadreza; Nasiri, Sara; Movafegh, Ali; Khorgami, Zhamak

doi:10.1016/j.ijsu.2016.02.043

Cited by 11 publications

(7 citation statements)

References 25 publications

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“…[ 22 , 23 ] Increased catecholamine level further activates the renin-angiotensin aldosterone system (RAAS) and some characteristic hemodynamic alterations, including decreased cardiac output, elevated arterial pressure, and increased systemic/pulmonary vascular resistance. [ 24 , 25 ] Vasopressin also results in elevation of arterial pressure and systemic vascular resistance. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Zhang

Wang²,

Xu³

et al. 2018

Medicine

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Background:The impact of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy. Meta-analysis is performed using the random-effect model.Results:Four RCTs involving 208 patients are included in the meta-analysis. Overall, compared with control group in laparoscopic cholecystectomy, intravenous magnesium sulfate is associated with systolic blood pressure at 30 minutes [Std. MD = −1.34; 95% confidence interval (95% CI) = −1.86 to −0.82; P < .00001], diastolic blood pressure at 30 minutes (Std. MD = −1.40; 95% CI = −1.86 to −0.94; P < .00001), mean arterial pressure at 30 minutes (Std. MD = −1.19; 95% CI = −1.91 to −0.46; P = .001), systolic blood pressure at 10 minutes (Std. MD = −1.61; 95% CI = −2.08 to −1.13; P < .00001), diastolic blood pressure at 10 minutes (Std. MD = −1.54; 95% CI = −2.68 to −0.40; P = .008), heart rate at 30 minutes (Std. MD = −2.09; 95% CI = −2.87 to −1.32; P < .00001), but results in prolonged extubation time (Std. MD = 0.96; 95% CI = 0.18–1.74; P = .02).Conclusion:Magnesium sulfate can reduce blood pressure, but with the increase in extubation time for laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Zhang

Wang²,

Xu³

et al. 2018

Medicine

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“…Anesthesia and postoperative analgesia only partially relieve the stress response after surgery, which negatively affects the quality of life of patients [21]. However, laparoscopic surgery causes a less stable acute phase and an immune response against open procedures, as well as a reduction in postoperative pain and the length of hospital stay [22,23].…”

Section: Discussion Of Research Resultsmentioning

confidence: 99%

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

Bielykh

Georgiyants

Vysotska

et al. 2021

SR:MS

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The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001). In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery. According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001). On the fifth postoperative day, no significant differences in baseline values between the Luria test and the MMSE scale were detected. Conclusions. The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient. According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period

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“…Significant research work has been dedicated to identifying methods to reduce operative time and frequency and intensity of postoperative pain after laparoscopic surgery. It has been shown that low CO 2 insufflation pressure reduces pain frequency and intensity after laparoscopy [ 6 , 20 ]. However, a major disadvantage of using a low-pressure pneumoperitoneum is that exposure of the surgical field may be inadequate compared to standard pressure [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective randomized controlled trial on comparison of standard CO2 pressure pneumoperitoneum insufflator versus AirSeal®

Luketina

Antoniou

et al. 2020

Surg Endosc

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Background AirSeal® is a valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and CO 2 recirculation during laparoscopic surgery. Comparative evidence on the use of AirSeal® and standard CO 2 insufflator in laparoscopic general surgery procedures is scarce. The aim of this study was to compare surgical outcomes between AirSeal® and standard CO 2 insufflators in patients undergoing the most frequently performed laparoscopic procedures. Methods One hundred and ninety-eight patients undergoing elective laparoscopic cholecystectomy, colorectal surgery and hernia repair were randomized to either AirSeal® (group A) or standard pressure CO 2 insufflator (group S). The primary endpoints were operative time and level of postoperative shoulder tip pain (Visual Analog Scale). Secondary outcomes included Clavien-Dindo grade complications, surgical side effect and length of hospital stay. Results Patients were randomized to either group A (n = 101) or group S (n = 97) and were analyzed by intention-to-treat. There was no significant difference in mean operative time between the groups (median [IQR]; 71 min [56-94] in group A vs. 69 min [52-93] in group S; p = 0.434). Shoulder tip pain levels were significantly lower in group S (VAS 0 [0-3] in group S vs. 2 [0-4] in group A; p = 0.001). There was no significant difference in complications, surgical side effects (subcutaneous emphysema was not observed in any group) and length of hospital stay. Conclusion This randomized controlled trial showed that using the AirSeal® system did not reduce operative time and was associated with a higher postoperative shoulder tip pain compared to standard CO 2 insufflator for short elective surgeries. ClinicalTrials.gov (NCT01740011).

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A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum

Abstract: Our study did not reveal any alteration in systemic stress response with reduction in intra-abdominal pressure of pneumoperitoneum in LC. RCT REGISTRATION: irct.ir ID: IRCT201110072982N5.

Cited by 11 publications

References 25 publications

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy

Stress response and state of cognitive functions in the perioperative period in elderly patients during laparoscopic cholecystectomy

Prospective randomized controlled trial on comparison of standard CO2 pressure pneumoperitoneum insufflator versus AirSeal®

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