Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Dec 1998
Comparative StudyA comparative study of the analgesia requirements following laparoscopic and open fundoplication in children.
To introduce a new procedure, careful evaluation of its effects must be undertaken to assess its impact. Laparoscopic procedures in children are a relatively new phenomenon. A reduction in analgesia is a frequently quoted benefit of a laparoscopic procedure. ⋯ The total amount of morphine analgesia required was similar for both laparoscopic and open surgery (0.432+/-0.28, 0.427+/-0.28 mg/kg). The period for which analgesia was required was significantly less in the laparoscopic group (1.2+/-0.46, 2.7+/-0.67 days; p = 0.03), yet the requirement for morphine during the first 24 hours was greater in the laparoscopic group (0.399+/-0.19, 0.22+0.11 mg/kg, p = 0.02) despite similar NSAID requirements (18+/-17.28, 18+/-20.16 mg/kg, respectively). The benefit of a laparoscopic over an open fundoplication would appear to be in the decreased duration of pain, as indicated by the decreased duration of analgesia following surgery.
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J Laparoendosc Adv Surg Tech A · Dec 1998
Endoscopic placement of nasoenteric feeding tubes in critically ill patients: a reliable alternative.
Spontaneous transpyloric passage of nasoenteric feeding tubes is often unsuccessful in critically ill patients due to gastric ileus. The purpose of this study was to evaluate the success rate of endoscopic placement of postpyloric nasoenteric tubes and the time required to achieve goal enteral nutritional support in critically ill patients with gastric ileus. Surgical ICU patients with gastric ileus, documented by recorded high gastric residual volumes via a nasogastric tube, were identified for placement of a nasoenteric postpyloric tube via esophagogastroduodenoscopy (EGD). ⋯ Tubes remained in place for a range of 6 to 37 days. Endoscopic placement of postpyloric enteral feeding tubes is highly successful, and allows for prompt achievement of goal enteral nutritional requirements. It has two main advantages: it eliminates the risk of patient travel to radiology for fluoroscopic placement, and allows for earlier initiation of enteral feedings because spontaneous passage of weighted nasoenteric tubes into the duodenum in critically ill patients is often unsuccessful.