American journal of surgery
-
Comparative Study
A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure.
Previous studies have suggested that diagnostic laparoscopy may be contraindicated in multiple trauma patients with closed head injuries because of the detrimental effects of carbon dioxide (CO2) pneumoperitoneum on intracranial pressure (ICP). In this study we compared the effects of two alternative inflation gases, helium (He) and nitrous oxide (N2O), against the standard agent used in most hospitals, CO2. ICP was monitored in experimental animals both with and without a space occupying intracranial lesion designed to simulate a closed head injury. ⋯ Peritoneal insufflation with He and N2O resulted in a significantly less increase in ICP as compared with CO2. That difference was most likely due to a metabolically mediated increase in cerebral perfusion (PaCO2) in the CO2 group. Further studies need to be conducted to determine the safety and efficacy of using He and N2O as inflation agents prior to attempting diagnostic or therapeutic laparoscopy in patients with potential closed head injuries.
-
Early decompressive fasciotomy is essential in the prevention of the sequelae of compartment syndrome. Many techniques have been described for the closure of the fasciotomy wound, and controversy exists as to which method is the best. ⋯ Gradual mechanical dermal apposition has been used with increasing frequency, and has been shown to be effective in the closure of fasciotomies, but often takes 7-10 days for closure. We present our experience with the STAR, a mechanical method of fasciotomy wound closure that is effective in 2-4 days, and is extremely simple to use.