Chirurgia Bucharest
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Chirurgia Bucharest · Mar 2009
Randomized Controlled Trial Comparative Study[TIVA-TCI (Total IntraVenous Anesthesia-Target Controlled Infusion) versus isoflurane anesthesia for laparoscopic cholecystectomy. Postoperative nausea and vomiting, and patient satisfaction].
Numerous studies have shown that TIVA is followed by a significant reduction in the incidence of PONV in day-case surgery, including laparoscopic cholecystectomy, where the incidence of PONV can reach 70% according to some studies. TCI is the TIVA technique that maintain a constant plasma concentration due to pharmacokynetic models incorporated in TCI device that inject the anesthetic agent. Besides implementing TIVA-TCI in clinical practice in Romania, our study was designed to evaluate the impact of TIVA-TCI on postoperative outcome and our patient satisfaction after laparoscopic cholecystectomy. ⋯ Compared with Isoflurane, TIVA-TCI was followed by significantly lower incidence of PONV and significantly greater patients satisfaction.
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Chirurgia Bucharest · Sep 2008
Randomized Controlled Trial[Multimodal analgesia in elective laparoscopic cholecystectomy. A double-blind randomized controlled trial].
The aim of this study was to test the effects of preincisional parietal and intraperitoneal infiltration with ropivacaine (R) on postoperative pain after elective laparoscopic cholecystectomy. ⋯ Ropivacaine shows significant favorable effects on postoperative pain after laparoscopic cholecystectomy when using both parietal and intraperitoneal instillation in combination with perioperative i.v. paracetamol.
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Chirurgia Bucharest · Mar 2008
Randomized Controlled Trial Comparative StudyEnhanced suppression of hormonal and metabolic responses to stress by application of combined spinal-epidural and general anaesthesia compared with combined spinal general anaesthesia during colorectal surgery.
The aim of the study was to determine the impact of combined spinal-epidural and general anesthesia (CSEGA) on the suppression of the hormonal and metabolic response to surgical stress and to compare it with the technique of combined spinal and general anesthesia (CSGA). Sixteen patients referred for elective colorectal surgery randomly divided into two groups on the basis of anesthesia (CSEGA and CSGA). Mean arterial blood pressure, heart rate, haemoglobin saturation, serum glucose, serum cortisol and urinary catecholamines (adrenaline, noradrenaline and dopamine) were determined at four distinct peri-operative time points. ⋯ Biochemical analysis revealed that in the sera of patients that received CSEGA the concentration of both glucose and cortisol was elevated to a lesser degree than that observed in the sera of patients that received CSGA. Furthermore, a significant reduction in post-operative urinary catecholamine (adrenaline and noradrenaline) excretion was apparent in the CSEGA group. We conclude that CSEGA is a more suitable form of combined anaesthesia for colorectal surgery with a clear advantage of a blunted surgery-mediated neuro-endocrine stress response.
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Chirurgia Bucharest · Nov 2007
Randomized Controlled Trial Comparative StudyA comparison of sevoflurane-fentanyl and neuroleptic anaesthesia for laparoscopic cholecystectomy of mildly obese patients.
The current study was formulated to evaluate the advantages and disadvantages of sevoflurane-fentanyl and neuroleptic anaesthesia for laparoscopic cholecystectomy surgery of mildly obese patients. Laparoscopic cholecystectomy was performed using either sevoflurane-fentanyl or neuroleptic anaesthesia. Intra-operative haemodynamic stability, surgical duration, awakening time, severity of post-operative pain and hormonal stress parameters (serum and urinary cortisol, serum insulinlike growth factor and serum insulin) were determined. ⋯ The serum and urinary cortisol concentrations were significantly increased in post-operative patients that received neuroleptic anaesthesia whereas the insulin-like growth factor-I concentration in both study groups significantly decreased post-operatively. Our results clearly show that neuroleptic anaesthesia attenuates the stress response to laparoscopic cholecystectomy to a lesser extent than sevoflurane-fentanyl. The latter anaesthesia is recommended for laparoscopic cholecystectomy of mildly obese patients.
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Chirurgia Bucharest · May 2006
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial[A comparison between systolic pressure variations under mechanical ventilation and classic pressure parameters in predicting fluid responsiveness in patients after coronary surgery].
Evaluation of the value of the systolic pressure variations (SPV) under mechanical ventilation and of its components (delta down and delta up) in predicting fluid responsiveness in patients after coronary surgery by comparison with classic parameters. A prospective,randomized study, on 50 patients who underwent CABG surgery, in the early postoperative period (the first two hours). We assessed the following parameters: CO, CI, CVP, PCWP, SAP, DAP, MAP, SVP, delta down and delta up. ⋯ Results Both parameters provided by SPV analysis are able to predict the fluid responsiveness with a great accuracy: the positive predictive value of a SPV > 12 mmHg is above 92,85% and of a delta down > 5 mm Hg is above 96,42%; the negative predictive value of a SPV < or = 12 mmHg is above 90,90% and of a delta down = 5 mm Hg is above 95,45%. None of the "classic" pressure parameters (MAP, CVP, PCWP) used in hemodynamic assessment have revealed a statistical significant variation. The SVP method's parameters are superior to classic pressure parameters (MAP, CVP, PCWP) in predicting fluid responsiveness in patients after coronary surgery.