ABSTRACT: Hypercapnia can result from carbon dioxide pneumoperitoneum and adversely affect the postoperative period, particularly in morbidly obese patients. The purpose of the present study was to examine carbon dioxide homeostasis using a metabolic monitor in morbidly obese and normal weight patients during laparoscopic surgical procedures. The setting was a university hospital in Italy.
The data from 25 patients with a body mass index of 47.7 ± 5.5 kg/m(2) undergoing laparoscopic gastric mini-bypass were compared with the data from 25 normal weight patients undergoing laparoscopic cholecystectomy. The minute ventilation was adjusted to maintain a normal arterial partial pressure of carbon dioxide and normal end-tidal partial pressure of carbon dioxide throughout surgical procedures. The arterial partial pressure of carbon dioxide, end-tidal partial pressure of carbon dioxide, total exhaled carbon dioxide per minute, and arterial blood gas analysis were obtained at 10-minute intervals, along with other cardiorespiratory parameters.
The total exhaled carbon dioxide per minute increased by the same percentage in both groups (around 20%). In the laparoscopic cholecystectomy patients, a definite plateau in the total exhaled carbon dioxide per minute was observed within 20 minutes from the start of pneumoperitoneum but not in the morbidly obese patients. After desufflation, the total exhaled carbon dioxide per minute returned more rapidly to the baseline values in the laparoscopic cholecystectomy group than in the morbidly obese group (17.4 ± 6.2 and 24.1 ± 8.3 min, respectively).
The results of our study have shown that the load of carbon dioxide insufflated is well tolerated in morbidly obese patients, as well as in normal patients, with proper intraoperative ventilation adjustments. However, after pneumoperitoneum, the return to a normal total exhaled carbon dioxide per minute required a longer period in the morbidly obese group. Prolonged mechanical ventilation is therefore advisable in morbidly obese patients.
Surgery for Obesity and Related Diseases 07/2011; 8(5):590-4. · 3.93 Impact Factor
ABSTRACT: The choice in between the laparoscopic lateral transabdominal (LTA) or the posterior retroperitoneoscopic (PRA) approach for adrenalectomy is usually based on surgeon's preference, rather than on objective arguments. We compared the intraoperative and postoperative outcomes of LTA and PRA to determine whether there is a preferable approach.
Thirty-eight consecutive patients successfully underwent PRA for benign adrenal tumors </=6 cm. A case-control study including 38 patients who successfully underwent LTA was performed. Operative time, intraoperative ventilatory parameters (CO(2) production [Vco(2)], whole body oxygen consumption, arterial partial pressure of carbon dioxide [Paco(2)], and arterial partial pressure of oxygen [Pao(2)]), final histology, complications, postoperative stay, analgesic requirement, time to regain normal bowel function, and time to return to work were recorded and compared between the 2 groups.
The 2 groups did not differ in terms of operative time, analgesic requirement, time to first flatus, complication rate, duration of postoperative stay, or final histology. Patients in the LTA group showed significantly lower Paco(2), Pao(2), and Vco(2) at the end of the operation. Patients in the PRA group experienced a significantly faster return to work.
No procedure can be considered preferable overall. In cases of bilateral adrenalectomy and previous abdominal surgery, PRA may offer some advantages. Surgeon's preference and experience will continue to guide this choice.
Surgery 01/2009; 144(6):1008-14; discussion 1014-5. · 3.10 Impact Factor
ABSTRACT: In obese patients, concomitant use of clonidine and ketamine might be suitable to reduce the doses and minimize the undesired side effects of anesthetic and analgesic drugs. In this study, we evaluated the perioperative effects of administration of clonidine and ketamine in morbidly obese patients undergoing weight loss surgery at a university hospital in Rome, Italy.
A total of 50 morbidly obese patients undergoing open biliopancreatic diversion for weight loss surgery were enrolled. The patients were randomly allocated into a study group (n = 23) receiving a slow infusion of ketamine-clonidine before anesthesia induction and a control group (n = 27) who received standard anesthesia. The hemodynamic profile, intraoperative end-tidal sevoflurane and opioid consumption, tracheal extubation time, Aldrete score, postoperative pain assessment by visual analog scale, and analgesic requirements were recorded.
The patients in the study group required less end-tidal sevoflurane, lower total doses of fentanyl (3.8 +/- 0.3 gamma/kg actual body weight versus 5.0 +/- 0.2 gamma/kg actual body weight, respectively; P <.05) and had a shorter time to extubation (15.1 +/- 5 min versus 28.2 +/- 6 min, P <.05). The Aldrete score was significantly better in the postanesthesia care unit in the study group. The study group consumed less tramadol than did the control group (138 +/- 57 mg versus 252 +/- 78 mg, P <.05) and had a lower visual analog scale score postoperatively during the first 6 hours.
The preoperative administration of low doses of ketamine and clonidine at induction appears to provide early extubation and diminished postoperative analgesic requirements in morbidly obese patients undergoing open bariatric surgery.
Surgery for Obesity and Related Diseases 11/2008; 5(1):67-71. · 3.93 Impact Factor
ABSTRACT: Background: Obesity causes anesthesiologists a broad variety of perioperative theoretical and practical problems. The aim
of this study was to compare two protocols of anesthesia employing Isoflurane and Sevoflurane and evaluate the cardiorespiratory
parameters, postoperative recovery and analgesia. Methods: 90 patients underwent biliopancreatic diversion. 60 patients (group
A) received Isoflurane and 30 patients (group B) were anesthetized with Sevoflurane. Intraoperative monitoring consisted of
EKG, invasive arterial pressure, Sp02, EtCO2, Etanest, Spirometry, urinary output and TOF. Cardiorespiratory parameters and end tidal expiratory concentrations of volatile agents
were collected during specific phases of surgery: 1) before induction of anesthesia, 2) after intubation, 3) after skin incision,
4) after positioning of costal retractors, 5) in the reverse Trendelenburg position, 6) end of surgery. During the postoperative
period the Aldrete test was carried out to evaluate the recovery from anesthesia. VAS was administered for 6 hours after the
end of surgery to set the quality of analgesia. Results: No statistically significant differences in cardiorespiratory parameters
were found between the two groups. Extubation time was significantly less in the Sevoflurane Group than in the Isoflurane
(15 ± 7 min vs 24 ± 5 min, p< 0.05). The Sevoflurane Group showed an Aldrete score significantly higher than the Isoflurane
(8.8 ± 0.3 vs 8.1 ± 0.4, p < 0.05). VAS values did not show statistical differences. Conclusion: The introduction of Sevoflurane,
a volatile agent with rapid pharmacokinetic properties, seems to offer an interesting application in these patients.
Obesity Surgery 01/2001; 11(5):623-626. · 3.29 Impact Factor