Effects of low intraperitoneal pressure and a warmed, humidified carbon dioxide gas in laparoscopic surgery: a randomized clinical trial

Matsuzaki, Sachiko; Vernis, Lise; Bonnin, M.; Houlle, C.; Fournet-Fayard, A.; Rosano, Giuseppe; Lafaye, Anne Laure; Chartier, Christian; Barriere, Agnes; Storme, B.; Bazin, Jean-Étienne; Canis, Michel; Botchorishvili, R.

doi:10.1038/s41598-017-10769-1

Cited by 32 publications

(37 citation statements)

References 29 publications

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“…There are many factors affecting delirium after surgery, and pain is one of the factors [18]. Studies have shown that low IAP can reduce pain in patients during laparoscopic surgery [19][20][21]. Our study found that the IAP of patients in the group RALRP was signi cantly lower than that in the group LRP(12.72 ± 1.87 VS 13.37 ± 1.12 mmHg, P < 0.05), so the patients in group RALRP suffered less postoperative pain, resulting lower incidence of operative delirium.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Weidong

Mengda

et al. 2020

Preprint

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Background: Robot-assisted laparoscopic radical prostatectomy ( RALRP) has better effects than conventional laparoscopic radical prostatectomy (LRP). However, there were few research focus on the incidence and risk factors of postoperative delirium for patients with different procedures. Methods: Eighty-one cases of RLRP patients (group RALRP) and 71 cases of LRP patients (group LRP) under general anesthesia were collected from anesthesia information system from June 2013 to December 2019. Comparison of the time of preparation period before surgery(Tp), time of operation(To), time of anesthesia maintenance (Ta), time of anesthesia recovery(time from cessation of intravenous anesthetic to endotracheal extubation, Tr), time of endotracheal extubation(time from endotracheal extubation to discharge from post-anesthesia care unit, Te), dosage of anesthetic (propofol, sufentanil, remifentanil), PaCO2, plasma lactate level and airway pressure at different points (before pneumoperitoneum, post-pneumoperitoneum, after loosening pneumoperitoneum), the incidences of postoperative delirium and utilization of mannitol, IAP, dosage of vasoactive agents(ephedrine, methoxamine and atropine), fluid infusion volume, blood transfusion volume, blood loss, postoperative hospitalization time (Th) and overall cost. Results: The incidences of postoperative delirium and utilization of mannitol in group RALRP and LRP were (17.3% VS 32.4%, P=0.03;7.4% VS 21.1%, P=0.014), Tr was (31.52±9.89 VS 38.65±16.32 min; P=0.01,95%CI 2.72-11.54), IAP was (12.72±1.87 VS 13.37±1.12 mmHg; P=0.01, 95%CI 0.16-1.14), PaCO2 at post-pneumoperitoneum and after loosening pneumoperitoneum were (47.89±10.89 VS 38.65±16.32 mmHg; P <0.001, 95%CI 6.47-11.98; 40.77±5.34 VS 43.57±4.54 mmHg; P=0.001, 95%CI 1.17-4.37), the difference was statistically significant. Tp, To, Ta and overall cost of patients in the RLRP group were significantly longer than those in the LRP group (P <0.02). No statistical difference was found in other observation variables. The incidence of postoperative delirium was considered as the dependent variable for binary logistic regression analysis. The result showed the incidence of postoperative delirium increased 1.17 times (95%CI 1.06-1.17), 1.13 times (95%CI 1.03-1.24), and 1.66 times (95%CI 1.02-2.70) for each unit increase in Tr, post-pneumoperitoneum PaCO2 and IAP.Conclusion: Compared with group LRP, patients in group RALRP had lower IAP, lower incidence of postoperative delirium and shorter recovery time, but the overall cost was higher. IAP is the main factor affecting the incidence of postoperative delirium.

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Section: Resultsmentioning

confidence: 99%

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Weidong

Mengda

et al. 2020

Preprint

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“…This also causes abdominal pain because the carbon dioxide trapped between the liver and the right diaphragm stimulates the diaphragm [16,17]. In genetic studies, it has been hypothesized that the pneumoperitoneum, made of CO 2 , can adversely affect the gene expression of extracellular matrix, adhesion, and inflammatory cytokine signal molecules in peritoneal tissue [18]. As a result, increased peritoneal seeding, peritoneal tissue hypoxia, and postoperative adhesion formation have been demonstrated in animal studies [19,20].…”

Section: Discussionmentioning

confidence: 99%

Is the amount of carbon dioxide gas used in urologic laparoscopic surgeries associated with postoperative pain?

Seo

Lee

2020

Investig Clin Urol

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We measured how much CO 2 gas was used in urologic laparoscopic surgeries and studied whether the amount of gas was associated with postoperative pain. Materials and Methods: Four hundred sixty-three patients underwent urologic laparoscopic surgeries by a single surgeon. All surgeries were performed by a transperitoneal approach under a 15-mm Hg pneumoperitoneum using CO 2 gas. The amount of CO 2 was measured. Neuromuscular blockade with rocuronium was performed during the surgery and patient-controlled analgesia was also applied. Postoperative pain was assessed four times for 24 hours using a 10-point visual analogue scale. Results: The mean laparoscopic time was 75.65±38.19 minutes and the mean amount of CO 2 gas used was 415.70±190.68 L. The mean score on the postoperative pain scale was 6.37±1.48 for 12 hours (sum of measurements taken at 6 and 12 hours after the surgery) and 11.72±2.46 for 24 hours (sum of measurements at 6, 12, 18, and 24 hours). In the statistical analysis, there were no correlations between the amount of CO 2 used and pain scores for 12 and 24 hours postoperatively. There were no correlations between laparoscopic time and pain scores for 12 or 24 hours postoperatively. There were also no correlations between operative method and pain scores for 12 or 24 hours postoperatively. Conclusions: We recorded the amount of CO 2 gas used for each laparoscopic surgery. There was no correlation between the amount of CO 2 used and postoperative pain. The lack of correlation may have been because the surgery was performed under anesthesia with deep neuromuscular blockade.

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“…Interestingly, this receptor is not conserved in primates and humans, thus implying species-specific difference in the transduction efficacy of these capsids. On this line, new findings indicate that brain transduction in adult primates is not improved with PHP.B compared to AAV9 although only few animals have yet been tested 38,39 . Nonetheless, the PHP.B/eB receptor belongs to the large family of Ly6/uPar proteins, some of which are conserved in mammalian evolution and can be found in human brain endothelium, representing valuable targets for capsid engineering 40,41 .…”

Section: Discussionmentioning

confidence: 99%

Whole brain delivery of an instability-proneMecp2transgene improves behavioral and molecular pathological defects in mouse models of Rett syndrome

Luoni

Giannelli

Indrigo

et al. 2019

Preprint

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Rett syndrome (RTT) is an incurable neurodevelopmental disorder caused by mutations inthe gene encoding for methyl-CpG binding-protein 2 (MeCP2). Gene therapy for this disease presents inherent hurdles since MECP2 is expressed throughout the brain and its duplication leads to severe neurological conditions as well. However, the recent introduction of AAV-PHP.eB, an engineered capsid with an unprecedented efficiency in crossing the blood-brain barrier upon intravenous injection, has provided an invaluable vehicle for gene transfer in the mouse nervous system. Herein, we use AAV-PHP.eB to deliver an instability-prone Mecp2 (iMecp2) transgene cassette which, increasing RNA destabilization and inefficient protein translation of the viral Mecp2 transgene, limits supraphysiological Mecp2 protein levels in transduced neural tissues. Intravenous injections of the PHP.eB-iMecp2 virus in symptomatic male and female Mecp2 mutant mice significantly ameliorated the disease progression with improved locomotor activity, coordination, lifespan and normalization of altered gene expression and mTOR signaling. Remarkably, PHP.eB-iMecp2 administration did not result in severe toxicity effects either in female Mecp2 mutant or in wild-type animals. In contrast, we observed a strong immune response to the transgene in treated male Mecp2 mutant mice that was overcome by immunosuppression. Overall, PHP.eB-mediated delivery of the iMecp2 cassette provided widespread and efficient gene transfer maintaining physiological Mecp2 protein levels in the brain. This combination defines a novel viral system with significant therapeutic efficacy and increased safety which can contribute to overcome the hurdles that are delaying clinical applications of gene therapy for RTT. One Sentence Summary: Global brain transduction of the instability-prone Mecp2 transgene by systemic AAV-PHP.eB administration is both safe and effective in protecting male and female Mecp2 mutant mice from the RTT disease phenotype. WT KO -GFP KO-iMeCP2-10 11 vg 4 8 12 16 20 24 28 32 36 40 0 50 100 Weeks Percent survival WT KO-GFP KO-iMecp2-10 11 vg KO-iMecp2-10 11 vg + Csa KO-GFP +Csa

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Effects of low intraperitoneal pressure and a warmed, humidified carbon dioxide gas in laparoscopic surgery: a randomized clinical trial

Cited by 32 publications

References 29 publications

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Is the amount of carbon dioxide gas used in urologic laparoscopic surgeries associated with postoperative pain?

Whole brain delivery of an instability-proneMecp2transgene improves behavioral and molecular pathological defects in mouse models of Rett syndrome

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