L'hypnosedation, un nouveau mode d'anesthesie pour la chirurgie endocrinienne cervicale. Etude prospective randomisee.
Defechereux, Thierry ; ; et al
in Annales de Chirurgie (2000), 125(6), 539-46
Retrospective studies have confirmed the feasibility and safety of thyroid and parathyroid procedures performed under hypnoanesthesia (hypnosis, local anesthesia and minimal conscious sedation) as sole ... [more ▼]
Retrospective studies have confirmed the feasibility and safety of thyroid and parathyroid procedures performed under hypnoanesthesia (hypnosis, local anesthesia and minimal conscious sedation) as sole method of anesthesia. This very effective technique seems to provide physiological, psychological and economic benefits for the patient. STUDY AIM: To assess, by means of a prospective randomized study, the advantages of hypnosedation as an alternative to general anesthesia in terms of clinical and laboratory parameters. PATIENTS AND METHODS: Twenty patients operated under hypnoanesthesia were compared to 20 patients operated under conventional anesthesia. The two groups were compared in terms of inflammatory, neuroendocrine, hemodynamic and immunologic parameters and postoperative course (pain, fatigue, muscle strength and stress). RESULTS: No clinical or demographic differences were observed between the two groups. Operative times, bleeding, weight of specimens, and surgical comfort were similar. Significant differences in terms of inflammatory response and hemodynamic parameters were observed in favor of hypnoanesthesia. Neuroendocrine and immunological parameters were similar. Patients of the hypnoanesthesia group had significantly less postoperative pain. Postoperative fatigue syndrome and convalescence were significantly improved in these patients. CONCLUSION: This study confirms that, in our hands, hypnosedation presents real advantages over general anesthesia, in patients undergoing thyroid surgery. [less ▲]Detailed reference viewed: 57 (2 ULg)
Bilateral neck exploration under hypnosedation. A new standard of care in primary hyperparathyroidism?
Meurisse, Michel ; Hamoir, Etienne ; Defechereux, Thierry et al
in Annals of Surgery (1999), 229
OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of ... [more ▼]
OBJECTIVE: The authors review their experience with initial bilateral neck exploration under local anesthesia and hypnosedation for primary hyperparathyroidism. Efficacy, safety, and cost effectiveness of this new approach are examined. BACKGROUND: Standard bilateral parathyroid exploration under general anesthesia is associated with significant risk, especially in an elderly population. Image-guided unilateral approaches, although theoretically less invasive, expose patients to the potential risk of missing multiple adenomas or asymmetric hyperplasia. Initial bilateral neck exploration under hypnosedation may maximize the strengths of both approaches while minimizing their weaknesses. METHODS: In a consecutive series of 121 initial cervicotomies for primary hyperparathyroidism performed between 1995 and 1997, 31 patients were selected on the basis of their own request to undergo a conventional bilateral neck exploration under local anesthesia and hypnosedation. Neither preoperative testing of hypnotic susceptibility nor expensive localization studies were done. A hypnotic state (immobility, subjective well-being, and increased pain thresholds) was induced within 10 minutes; restoration of a fully conscious state was obtained within several seconds. Patient comfort and quiet surgical conditions were ensured by local anesthesia of the collar incision and minimal intravenous sedation titrated throughout surgery. Both peri- and postoperative records were examined to assess the safety and efficacy of this new approach. RESULTS: No conversion to general anesthesia was needed. No complications were observed. All the patients were cured with a mean follow-up of 18 +/- 12 months. Mean operating time was <1 hour. Four glands were identified in 84% of cases, three glands in 9.7%. Adenomas were found in 26 cases; among these, 6 were ectopic. Hyperplasia, requiring subtotal parathyroidectomy and transcervical thymectomy, was found in five cases (16.1%), all of which had gone undetected by localization studies when requested by the referring physicians. Concomitant thyroid lobectomy was performed in four cases. Patient comfort and recovery and surgical conditions were evaluated on visual analog scales as excellent. Postoperative analgesic consumption was minimal. Mean length of hospital stay was 1.5 +/- 0.5 days. CONCLUSIONS: Initial bilateral neck exploration for primary hyperparathyroidism can be performed safely, efficiently, and cost-effectively under hypnosedation, which may therefore be proposed as a new standard of care. [less ▲]Detailed reference viewed: 80 (15 ULg)
Hypnoanesthesia for endocrine cervical surgery: a statement of practice.
Defechereux, Thierry ; Meurisse, Michel ; Hamoir, Etienne et al
in Journal of Alternative & Complementary Medicine : Research on Paradigm, Practice, & Policy (1999), 5(6), 509-20
OBJECTIVES: To assess the feasibility of endocrine cervical surgery under hypnoanesthesia as a valuable, safe, efficient, and economic alternative to general anesthesia. METHODS: Between April 1994 and ... [more ▼]
OBJECTIVES: To assess the feasibility of endocrine cervical surgery under hypnoanesthesia as a valuable, safe, efficient, and economic alternative to general anesthesia. METHODS: Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnoanesthesia (HYP) using Erikson's method. Operative data and postoperative course of this initial series were compared to a contemporary population of patients (n = 119) clinically similar except that they declined HYP or were judged unsuitable for it, and who were therefore operated on under general anesthesia (GA). RESULTS: The surgeons all reported better operating conditions for cervicotomy using HYP. Conversion from hypnosis to GA was needed in two cases (1%). All patients having HYP reported a pleasant experience and, keeping in mind that the GA group is not a randomly assigned control group, both had significantly less postoperative pain and analgesic use. Hospital stay was also significantly shorter, providing a substantial reduction in the costs of medical care. The postoperative convalescence was significantly improved after HYP and a full return to social or professional activity was significantly quicker. CONCLUSION: From this study, we conclude that HYP is an effective technique for providing relief of intraoperative and postoperative pain in endocrine cervical surgery. The technique results in high patient satisfaction and better surgical convalescence. This technique can therefore be used in most well-chosen patients and reduces the socioeconomic impact of hospitalization. [less ▲]Detailed reference viewed: 68 (12 ULg)
Anesthesie generale versus anesthesie perimedullaire.
; Joris, Jean ; Lamy, Maurice
in Revue Médicale de Liège (1999), 54(7), 588-92
Perimedullary anesthetic techniques (epidural or spinal anesthesia), by themselves or combined with general anesthesia offer several advantages in the postoperative period when compared with general ... [more ▼]
Perimedullary anesthetic techniques (epidural or spinal anesthesia), by themselves or combined with general anesthesia offer several advantages in the postoperative period when compared with general anesthesia alone. The incidence of postoperative respiratory and cardiovascular complications is decreased. The physiologic stress reaction, with its associated hypercoagulable state and immune depression, is attenuated. Finally, the resumption of gastrointestinal function is hastened. These benefits of central neural blockade are noted most clearly when the techniques are used for several days postoperatively, most often by catheter based epidural analgesia. The use of local anesthetic agents in the analgesic mixture would appear to be important. This is likely because these substances inhibit the sympathetic nervous system and spinal reflex axes. The role of this inhibition in the advantages of perimedullary techniques is probably important. It is important to note that inhibition of the sympathatetic nervous system can be associated with indesirable consequences in certain patients. These techniques must therefore be used cautiously, and patients who benefit from them must receive careful surveillance. [less ▲]Detailed reference viewed: 74 (3 ULg)
Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.
Joris, Jean ; Hamoir, Etienne ; Hartstein, Gary et al
in Anesthesia and Analgesia (1999), 88(1), 16-21
We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was ... [more ▼]
We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was used in all patients: a continuous infusion of sufentanil 0.5 microg x kg(-1) x h(-1) and isoflurane 0.4% (end-tidal) in 50% N2O/O2. Systolic arterial pressure was maintained between 120 and 160 mm Hg by adjusting an infusion of nicardipine, a calcium-channel blocker, while tachycardia (>100 bpm) was treated by 1-mg boluses of atenolol. Hemodynamics (thermodilution technique) and plasma catecholamine concentrations were measured before surgery, after the induction of anesthesia, after turning the patient to the lateral position, during pneumoperitoneum, during tumor manipulation, after adrenalectomy, and at the end of surgery. Two events resulted in significant catecholamine release: creation of the pneumoperitoneum and adrenal gland manipulation. As a consequence, a twofold increase in cardiac output was recorded. Adjustments of nicardipine infusion (2-6 microg x kg(-1) x min(-1)) minimized changes in mean arterial pressure. Beta-adrenergic blockade was necessary in six patients. In conclusion, laparoscopic adrenalectomy for pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Titration of a nicardipine infusion allowed easy and quick control of the hemodynamic aberrancies related to these processes. IMPLICATIONS: Pneumoperitoneum during laparoscopy, now used for adrenalectomy, may complicate anesthetic management of patients with pheochromocytoma. In this study, laparoscopic adrenalectomy was associated with catecholamine release during the creation of pneumoperitoneum and tumor manipulation. Adjustments of a nicardipine infusion readily attenuated the subsequent hemodynamic aberrancies. [less ▲]Detailed reference viewed: 106 (22 ULg)
Hypnosis with conscious sedation instead of general anaesthesia? Applications in cervical endocrine surgery.
Meurisse, Michel ; Defechereux, Thierry ; Hamoir, Etienne et al
in Acta Chirurgica Belgica (1999), 99(4), 151-8
Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative ... [more ▼]
Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP. All patients having HYP reported a very pleasant experience and had significantly less postoperative pain while analgesic use was significantly reduced in this group. Hospital stay was also significantly shorter, providing a substantial reduction of the medical care costs. The postoperative convalescence was significantly improved after HYP and full return to social or professional activity was significantly shortened. We conclude that HYP is a very efficient technique providing physiological, psychological and economic benefits to the patient. [less ▲]Detailed reference viewed: 101 (5 ULg)
Transplantation combinée du foie et du coeur chez un patient souffrant de thalassémie majeure
Detry, Olivier ; Defechereux, Thierry ; Honore, Pierre et al
in Médecine & Chirurgie Digestives (1999), 28(3), 109-110Detailed reference viewed: 56 (8 ULg)
L'hypnose et son application en chirurgie.
Faymonville, Marie ; Defechereux, Thierry ; Joris, Jean et al
in Revue Médicale de Liège (1998), 53(7), 414-8
Since 1992, we have used hypnosis routinely in more than 1400 patients undergoing surgery. We found that hypnosis used in patients as an adjunct to conscious sedation and local anesthesia was associated ... [more ▼]
Since 1992, we have used hypnosis routinely in more than 1400 patients undergoing surgery. We found that hypnosis used in patients as an adjunct to conscious sedation and local anesthesia was associated with improved intraoperative patient comfort, and with reduced anxiety, pain, intraoperative requirements for anxiolytic and analgesic drugs, optimal surgical conditions and a faster recovery of the patient. We reported our clinical experience and our fundamental research. [less ▲]Detailed reference viewed: 155 (5 ULg)
Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine.
Joris, Jean ; ; Canivet, Jean-Luc et al
in Journal of the American College of Cardiology (1998), 32(5), 1389-96
OBJECTIVES: We investigated endocrine correlates of the hemodynamic changes induced by carbon dioxide pneumoperitoneum (PNO). We then studied whether clonidine might modulate the hemodynamic changes ... [more ▼]
OBJECTIVES: We investigated endocrine correlates of the hemodynamic changes induced by carbon dioxide pneumoperitoneum (PNO). We then studied whether clonidine might modulate the hemodynamic changes induced by PNO by reducing release of catecholamines and vasopressin. BACKGROUND: Both mechanical and neurohumoral factors contribute to the hemodynamic changes induced by carbon dioxide PNO. Several mediators have been proposed, but no study has correlated hemodynamic changes with changes in levels of these potential mediators. METHODS: We conducted two studies, each including 20 healthy patients scheduled for elective laparoscopic cholecystectomy. In the first study serial measurements of hemodynamics (thermodilution technique) were done during laparoscopy and after exsufflation. Plasma concentrations of cortisol, catecholamines, vasopressin, renin, endothelin and prostaglandins were measured at the same time points. In the second study patients were randomly allocated to receive 8 microg/kg clonidine infused over 1 h or placebo before PNO. Hemodynamics and plasma levels of cortisol, catecholamines and vasopressin were measured during PNO and after exsufflation. RESULTS: Peritoneal insufflation resulted in a significant reduction of cardiac output (18+/-4%) and increases in mean arterial pressure (39+/-8%) and systemic (70+/-12%) and pulmonary (98+/-18%) vascular resistances. Laparoscopy resulted in progressive and significant increases in plasma concentrations of cortisol, epinephrine, norepinephrine and renin. Vasopressin plasma concentrations markedly increased immediately after the beginning of PNO (before PNO 6+/-4 pg/ml; during PNO 129+/-42 pg/ml; p < 0.05). The profile of vasopressin release paralleled the time course of changes in systemic vascular resistance. Prostaglandins and endothelin did not change significantly. Clonidine significantly reduced mean arterial pressure, heart rate and the increase in systemic vascular resistance. Clonidine also significantly reduced catecholamine concentrations but did not alter vasopressin and cortisol plasma concentrations. CONCLUSIONS: Vasopressin and catecholamines probably mediate the increase in systemic vascular resistance observed during PNO. Clonidine before PNO reduces catecholamine release and attenuates hemodynamic changes during laparoscopy. [less ▲]Detailed reference viewed: 48 (1 ULg)
Surgical management of amiodarone-associated thyrotoxicosis: too risky or too effective?
Hamoir, Etienne ; Meurisse, Michel ; Defechereux, Thierry et al
in World Journal of Surgery (1998), 22(6), 537-42542-3
Amiodarone-associated thyrotoxicosis, often clinically mild and resolutive after amiodarone discontinuation or under medical therapy, is sometimes drug unresponsive and not uncommonly follows a dramatic ... [more ▼]
Amiodarone-associated thyrotoxicosis, often clinically mild and resolutive after amiodarone discontinuation or under medical therapy, is sometimes drug unresponsive and not uncommonly follows a dramatic, even fatal course. Therefore, we considered a surgical solution in 15 severely amiodarone-associated thyrotoxic patients. Twelve men and three women (mean age 68 years, range 50-84 years) underwent radical thyroidectomy for clinical and biologically proved amiodarone-associated thyrotoxicosis. In six surgery was the first-line therapeutic option. In the other nine thyroidectomy seemed unavoidable considering the unresponsiveness to medical therapy and rapid deterioration of the patients' clinical condition, with life-threatening cardiac failure in three. In every patient surgery was conducted without immediate or delayed complications. Total thyroidectomy proved uniformly, definitively, and rapidly effective in controlling thyrotoxicosis in all patients, with a spectacular reversal of cardiac failure in the three most critical cases. Surgery was beneficial to our 15 patients and undoubtedly life-saving in the three most worrying cases. These results suggest that thyroidectomy should be more liberally regarded as an interesting alternative to conventional, but unpredictably effective, medical therapies. [less ▲]Detailed reference viewed: 21 (0 ULg)
Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients.
Joris, Jean ; ; et al
in British Journal of Anaesthesia (1998), 80(3), 283-8
We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese ... [more ▼]
We have compared severely obese patients (body mass index > 35 kg m-2) undergoing laparoscopic or open gastroplasty (n = 15 in each group) to determine if laparoscopy results in any benefit in the obese. Postoperative pain, measured on a 100-mm visual analogue scale, and opioid consumption were recorded during the first two days after operation. Tests of pulmonary function were performed and SpO2 was measured 4 h after surgery and on days 1, 2 and 3 after operation. Pain at rest was similar in the two groups, but in the laparoscopy group, requirements for postoperative opioid were 50% less (P < 0.05). Pain intensity during mobilization and on coughing was significantly less after laparoscopy (differences between mean pain scores in both groups ranged from 20 to 32 mm during mobilization and from 32 to 34 mm during coughing). Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were reduced significantly less after laparoscopic gastroplasty than after open gastroplasty (on day 1 forced vital capacity was reduced by 50% compared with 64%, forced expiratory volume in 1 s was reduced by 50% compared with 66% and peak expiratory flow rate by 45% compared with 60%). SpO2 values were significantly greater in the laparoscopy group (day 1: mean 95 (SD 2)% vs 91 (5)%; day 3: 97 (1)% vs 94 (3)%). This study suggests that the beneficial effects observed after laparoscopic gastroplasty in morbidly obese patients were similar to those reported after laparoscopic cholecystectomy in non-obese patients. [less ▲]Detailed reference viewed: 19 (0 ULg)
La chirurgie sous hypnosedation. Une nouvelle approche therapeutique pour l'hyperparathyroidie.
Defechereux, Thierry ; Faymonville, Marie ; Joris, Jean et al
in Annales de Chirurgie (1998), 52(5), 439-43
The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general ... [more ▼]
The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients. [less ▲]Detailed reference viewed: 50 (2 ULg)
Psychological Approaches During Conscious Sedation. Hypnosis Versus Stress Reducing Strategies: A Prospective Randomized Study
Faymonville, Marie-Elisabeth ; ; Joris, Jean et al
in Pain (1997), 73(3), 361-7
Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological ... [more ▼]
Stress reducing strategies are useful in patients undergoing surgery. Hypnosis is also known to alleviate acute and chronic pain. We therefore compared the effectiveness of these two psychological approaches for reducing perioperative discomfort during conscious sedation for plastic surgery. Sixty patients scheduled for elective plastic surgery under local anesthesia and intravenous sedation (midazolam and alfentanil upon request) were included in the study after providing informed consent. They were randomly allocated to either stress reducing strategies (control: CONT) or hypnosis (HYP) during the entire surgical procedure. Both techniques were performed by the same anesthesiologist (MEF). Patient behavior was noted during surgery by a psychologist, the patient noted anxiety, pain, perceived control before, during and after surgery, and postoperative nausea and vomiting (PONV). Patient satisfaction and surgical conditions were also recorded. Peri- and postoperative anxiety and pain were significantly lower in the HYP group. This reduction in anxiety and pain were achieved despite a significant reduction in intraoperative requirements for midazolam and alfentanil in the HYP group (alfentanil: 8.7 +/- 0.9 microg kg(-1)/h(-1) vs. 19.4 +/- 2 microg kg(-1)/h(-1), P < 0.001; midazolam: 0.04 +/- 0.003 mg kg(-1)/h(-1) vs. 0.09 +/- 0.01 mg kg(-1)/h(-1), P < 0.001). Patients in the HYP group reported an impression of more intraoperative control than those in the CONT group (P < 0.01). PONV were significantly reduced in the HYP group (6.5% vs. 30.8%, P < 0.001). Surgical conditions were better in the HYP group. Less signs of patient discomfort and pain were observed by the psychologist in the HYP group (P < 0.001). Vital signs were significantly more stable in the HYP group. Patient satisfaction score was significantly higher in the HYP group (P < 0.004). This study suggests that hypnosis provides better perioperative pain and anxiety relief, allows for significant reductions in alfentanil and midazolam requirements, and improves patient satisfaction and surgical conditions as compared with conventional stress reducing strategies support in patients receiving conscious sedation for plastic surgery. [less ▲]Detailed reference viewed: 55 (7 ULg)
L'abord coelioscopique des pheochromocytomes est-il acceptable? Reflexions a propos d'une etude prospective de 6 cas personnels.
Hamoir, Etienne ; Defechereux, Thierry ; Nguyen Dang, Delphine et al
in Annales d'Endocrinologie (1997), 58(1), 65-74
Today, laparoscopy is for us the technique of choice for approaching presumed benign adrenal tumors. With regards to pheochromocytoma however, two major questions must be addressed. First, is it ... [more ▼]
Today, laparoscopy is for us the technique of choice for approaching presumed benign adrenal tumors. With regards to pheochromocytoma however, two major questions must be addressed. First, is it acceptable to resect potentially multifocal tumors with such a targeted approach? Second, can peroperative hemodynamic changes be anticipated and controlled by the anesthetist, taking into account the additional effects of pneumoperitoneum and catecholamine release on the cardiovascular system? The present prospective study attempts to answer these two questions. From November 1993 to November 1995 we operated on four women and two men, with ages ranging from 33 to 71 years (mean of 47) and a mean Body Mass Index of 25 kg/m2 (range 17-35). Four patients were assigned ASA (American Society of Anesthesiologists) physical status 2, one grade 1 and one grade 3. Comprehensive preoperative work-up, including a CT scan and an I131 MIBG Scan in all, a C11 Hydroxyephedrine PET Scan in 4 and a MRI in one patient, showed a solitary lesion in each case. There were four right-sided and two left-sided tumors, ranging from 30 to 60 mm in diameter. Laparoscopy was always performed transperitoneally. Systemic and pulmonary hemodynamics were thoroughly assessed. Epinephrin and norepinephrin concentrations were measured at the 10 key-time of surgery. Use of continuous intravenous infusion of nicardipine allowed tight control of hemodynamics despite impressive increases in circulating catecholamines. The mean operative time was 76 minutes (range 59-130). Blood loss was minimal. We observed neither mortality nor morbidity. Mean hospital stay ranged from 3 to 13 days (median = 3). All patients are normotensive without drug after a follow-up of 9 to 33 months. In conclusion, we think that laparoscopic removal of selected cases of pheochromocytoma may be performed safely from both the hemodynamical and oncological standpoints. [less ▲]Detailed reference viewed: 57 (1 ULg)
Transplantation combinée du foie et du coeur chez un patient souffrant de thalassémie majeure
Detry, Olivier ; Defechereux, Thierry ; Honore, Pierre et al
in Revue Médicale de Liège (1997), 52(8), 532-4Detailed reference viewed: 43 (8 ULg)
Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.
Joris, Jean ; ; et al
in CHEST (1997), 111(3), 665-70
STUDY OBJECTIVE: Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines ... [more ▼]
STUDY OBJECTIVE: Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines pressure support ventilation and positive end-expiratory pressure via a nasal mask, could allow alveolar recruitment during inspiration and prevent expiratory alveolar collapse, and therefore limit the postoperative pulmonary restrictive syndrome. This study investigated the effect of BiPAP on postoperative pulmonary function in obese patients after gastroplasty. DESIGN: Prospective controlled randomized study. SETTING: GI surgical ward in a university hospital. PATIENTS: Thirty-three morbidly obese patients scheduled for gastroplasty were studied. INTERVENTION: The patients were assigned to one of three techniques of ventilatory support during the first 24 h postoperatively: O2 via a face mask, BiPAP System 8/4, with inspiratory and expiratory positive airway pressure set at 8 and 4 cm H2O, respectively, or BiPAP System 12/4 set at 12 and 4 cm H2O. Pulmonary function (FVC, FEV1, and peak expiratory flow rate [PEFR]) were measured the day before surgery, 24 h after surgery, and on days 2 and 3. Oxygen saturation by pulse oximeter (SpO2) was also recorded during room air breathing. RESULTS: Three patients were excluded. After surgery, FVC, FEV1, PEFR, and SpO2 significantly decreased in the three groups. On day 1, FVC and FEV1 were significantly improved in the group BiPAP System 12/4, as compared with no BiPAP; SpO2 was also significantly improved. After removal of BiPAP System 12/4, these benefits were maintained, allowing faster recovery of pulmonary function. No significant effects were observed on PEFR. BiPAP System 8/4 had no significant effect on the postoperative pulmonary restrictive syndrome. CONCLUSION: Prophylactic use of BiPAP System 12/4 during the first 24 h postoperatively significantly reduces pulmonary dysfunction after gastroplasty in obese patients and accelerates reestablishment of preoperative pulmonary function. [less ▲]Detailed reference viewed: 138 (2 ULg)
Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures.
Joris, Jean ; Kaba, Abdourahmane ; Lamy, Maurice
in British Journal of Anaesthesia (1997), 79(4), 422-6
In this prospective study, we have compared women undergoing laparoscopic cholecystectomy, laparoscopic gynaecological surgery and laparoscopic minor gynaecological procedures (diagnostic, tubal, ligation ... [more ▼]
In this prospective study, we have compared women undergoing laparoscopic cholecystectomy, laparoscopic gynaecological surgery and laparoscopic minor gynaecological procedures (diagnostic, tubal, ligation) (n = 10 in each group) to determine if lower abdominal laparoscopy results in less postoperative pulmonary dysfunction than upper abdominal laparoscopy. Pulmonary testing was performed before operation, and 3 and 6 h after operation, on the first and second days after surgery. After operation, a significant reduction in forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate occurred after laparoscopic cholecystectomy at each time. There were no significant changes after minor gynaecologic laparoscopy, whereas laparoscopic gynaecological surgery resulted in minor pulmonary dysfunction on the day of surgery only. We conclude that postoperative pulmonary function was less impaired after gynaecological laparoscopy than after laparoscopic cholecystectomy. This study suggests that the site of surgery is an important determinant of lung dysfunction after laparoscopy. [less ▲]Detailed reference viewed: 25 (0 ULg)
Laparoscopic-Assisted Colectomy in Heart Transplant Recipients
Detry, Olivier ; Defraigne, Jean-Olivier ; et al
in Clinical Transplantation (1996), 10(2), 191-4
Reports of laparoscopy in heart graft recipients are scarce and, to our knowledge, laparoscopic colectomy has not yet been reported in heart transplant patients. The magnitude and the tolerance of the ... [more ▼]
Reports of laparoscopy in heart graft recipients are scarce and, to our knowledge, laparoscopic colectomy has not yet been reported in heart transplant patients. The magnitude and the tolerance of the hemodynamic changes induced by pneumoperitoneum are unknown in heart graft recipients, who have a denervated heart and are "preload-dependent". The authors report the clinical courses of 2 heart graft recipients who developed acute diverticulitis without perforation or peritonitis and who underwent laparoscopic-assisted colectomy without complications. [less ▲]Detailed reference viewed: 50 (6 ULg)
Efficacy of nonsteroidal antiinflammatory drugs in postoperative pain
in Acta Anaesthesiologica Belgica (1996), 47(3), 115-123
Historically, NSAIDs, used for more than 25 years to treat rheumatologic diseases, were then introduced to relieve pain after tooth extraction, and finally about 10 years ago for postoperative analgesia ... [more ▼]
Historically, NSAIDs, used for more than 25 years to treat rheumatologic diseases, were then introduced to relieve pain after tooth extraction, and finally about 10 years ago for postoperative analgesia. NSAIDs have been increasingly used over the past ten years in the treatment of postoperative pain, such that they now play an important role in the management of postoperative analgesia, either alone or combined with opioids. When used alone, they are effective in relieving minor or moderate pain such as that seen after maxillofacial, minor orthopedic, or some ambulatory surgical procedures, and postpartum pain (episiotomy). In these indications, the main benefit as compared with opioids is the lack of respiratory depression, nausea and vomiting. Since these side effects delay discharge from the hospital after ambulatory surgery, the use of NSAIDs may result in faster recovery and earlier discharge. Because of the ceiling effect of NSAIDs, their efficacy as sole agents is usually insufficient to treat pain after major surgery (orthopedic, abdominal, thoracic). NSAIDs should then be combined with opioids. As part of a balanced analgesia regimen, NSAIDs will allow for opioid-sparing, and might subsequently reduce opioid-mediated side effects. A 20 to 50% reduction in opioid consumption, sometimes with improved quality of analgesia, has been reported using different NSAIDs following various types of surgery. Better respiratory function, improved sleep quality, and faster recovery of gastrointestinal function have been reported with NSAIDs. However, the use of NSAIDs has not been shown to be associated with improved outcome or more rapid recovery. [less ▲]Detailed reference viewed: 21 (1 ULg)