Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting

2016 ◽  
Vol 24 (6) ◽  
pp. 415-421 ◽  
Author(s):  
Shreya Verma ◽  
Matthias W. Wichmann ◽  
Thomas Gunning ◽  
Eben Beukes ◽  
Guy Maddern
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Rural Setting ◽  
Intraoperative Cholangiogram

Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial

2021 ◽  
pp. 193758672098585
Author(s):  
Recai Dagli ◽  
Fatma Çelik ◽  
Hüseyin Özden ◽  
Serdar Şahin
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Tympanic Membrane ◽  
Randomized Study ◽  
Hvac Systems ◽  
Anesthesia Induction ◽  
Temperature Changes ◽  
Perioperative Hypothermia ◽  
Surgical Evaluation ◽  
Turbulent Airflow

Objectives: We aimed to compare tympanic membrane temperature changes and the incidence of inadvertent perioperative hypothermia (IPH) in patients undergoing laparoscopic cholecystectomy under general anesthesia in laminar airflow systems (LAS-OR) and conventional turbulent airflow systems (CAS-OR). Background: Different heating, ventilation, and air-conditioning (HVAC) systems are used in the operating room (OR), such as LAS and CAS. Laminar airflow is directed directly to the patient in LAS-OR. Does laminar airflow in ORs cause faster heat loss by convection? Methods: This is a prospective, randomized study. We divided 200 patients with simple randomization (1:1), as group LAS and group CAS, and took the patients into the LAS-OR or CAS-OR for the operation. Clinical trial number: IRCT20180324039145N3. The tympanic membrane temperatures of patients were measured (°C) before anesthesia induction ( T 0) and then every 15 min during surgery ( Tn). Changes (Δ n) between T 0 and Tn were measured. Results: In the first 30 min, there was a temperature decrease of approximately 0.8 °C (1.44 °F) in both groups. Temperature decreases at 45 min were higher in group LAS than in group CAS but not statistically significant, Δ45, respectively, 0.89 (95% confidence interval [CI] [0.77, 1.02]) versus 0.77 (95% CI [0.69, 0.84]; p = .09). IPH occurred in a total of 60.9% (112 of 184) of patients in the entire surgical evaluation period in group LAS and group CAS (58.9% vs. 62.8%, p = . 59). Conclusions: IPH is seen frequently in both HVAC systems. Clinically, the advantage of HVAC systems relative to each other has not been demonstrated during laparoscopic cholecystectomy.

Analysis of Endoscopic Retrograde Cholangiopancreatography after Positive Intraoperative Cholangiogram: Is it Necessary?

2016 ◽  
Vol 82 (10) ◽  
pp. 985-988
Author(s):  
John V. Gahagan ◽  
Steven Maximus ◽  
Matthew D. Whealon ◽  
Michael J. Phelan ◽  
Aram Demirjian ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Acute Cholecystitis ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Nationwide Inpatient Sample ◽  
Bile Duct Stone ◽  
Stone Extraction ◽  
Endoscopic Retrograde ◽  
Intraoperative Cholangiogram ◽  
Nationwide Inpatient Sample Database

The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction. A total of 73,508 patients who underwent cholecystectomy with IOC for a diagnosis of acute cholecystitis and found to have a bile duct stone were identified. Of these patients, 5915 underwent subsequent ERCP. In the patients that underwent subsequent ERCP, 1478 had a documented stone extraction during ERCP. The rate of stone extraction in the ERCP subset is 25 per cent, which is 2 per cent of all patients who had a positive IOC. The rate of stone extraction after positive IOC is low. Positive IOC may not warrant a routine postoperative ERCP. Our results suggest that clinical monitoring of patients with positive IOC is reasonable, as the majority of patients with a positive IOC ultimately have no stone extraction.

scholarly journals A randomized trial to evaluate a modified tracheal catheter with upper and lower balloons for anesthetic administration: effect on the cardiovascular, stress response, and comfort in patients undergoing laparoscopic cholecystectomy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuenong Zhang ◽  
Zhiwen Zeng ◽  
Guangwen Xiao ◽  
Weiqiang Zhang ◽  
Weixiong Lin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Heart Rate ◽  
Laparoscopic Cholecystectomy ◽  
Stress Response ◽  
Angiotensin Ii ◽  
Tracheal Intubation ◽  
Systolic Blood Pressure ◽  
Group A ◽  
Endotracheal Anesthesia

Abstract Background We aimed to evaluate a modified endotracheal tube containing upper and lower balloons for anesthetic administration among patients undergoing laparoscopic cholecystectomy. Methods Ninety patients scheduled to undergo laparoscopic cholecystectomy were randomly allocated to 3 equal groups: group A (conventional tracheal intubation without endotracheal anesthesia); B (conventional tracheal intubation with endotracheal anesthesia); and C (tracheal intubation using a modified catheter under study). Blood pressure, heart rate, angiotensin II level, blood glucose level, airway pressure before anesthesia (T1) were measured immediately after intubation (T2), 5 min after intubation (T3), and immediately after extubation (T4). The post-extubation pain experienced was evaluated using the Wong-Baker Face Pain scale. Adverse reactions within 30 min after extubation were recorded. Results Systolic blood pressure, diastolic blood pressure, angiotensin II, and blood sugar level in group C at T2, T3 and T4, and heart rate at T2 and T4 were significantly lower than those in group A (P < 0.05); systolic blood pressure and blood sugar at T4, and angiotensin II levels at T2, T3, and T4 were significantly lower than those in group B (P < 0.05). Patients in group C reported the lowest post-extubation pain (P < 0.05 vs. Group A), and the lowest incidence of adverse events such as nausea, vomiting, and sore throat than that in groups A and B (P < 0.05). Conclusion The modified endotracheal anesthesia tube under study is effective in reducing cardiovascular and tracheal stress response, and increasing patient comfort, without inducing an increase in airway resistance. Trial registration The clinical trial was retrospectively registered at the Chinese Clinical Trial Registry with the Registration Number ChiCTR1900020832 at January 20th 2019.

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