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See detailRecruitment of lung volume during surgery neither affects the postoperative spirometry nor the risk of hypoxaemia after laparoscopic gastric bypass in morbidly obese patients: a randomized controlled study.
DEFRESNE, Aline ULg; HANS, Grégory ULg; GOFFIN, Pierre ULg et al

in British journal of anaesthesia (2014), 113(3), 501-7

BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation ... [more ▼]

BACKGROUND: Intraoperative recruitment manoeuvres (RMs) combined with PEEP reverse the decrease in functional residual capacity (FRC) associated with anaesthesia and improve intraoperative oxygenation. Whether these benefits persist after operation remains unknown. We tested the hypothesis that intraoperative RMs associated with PEEP improve postoperative spirometry including FRC and reduce the incidence of postoperative hypoxaemia in morbidly obese (MO) patients undergoing laparoscopic gastric bypass. METHODS: After IRB approval and informed consent, 50 MO patients undergoing laparoscopic gastric bypass under volume-controlled ventilation (tidal volume 6 ml kg(-1) of IBW) were randomly ventilated with either 10 cm H(2)O PEEP or with 10 cm H(2)O PEEP and one RM carried out after induction of pneumoperitoneum, and another after exsufflation. Anaesthesia and analgesia were standardized. Spirometry was assessed before operation and 24 h after surgery. Postoperative oxygenation and the apnoea-hypopnoea index (AHI) were recorded during the first postoperative night. RESULTS: Age, BMI, and STOP BANG score were similar in both groups. FRC decrease after surgery was minimal [0.15 (0.14) litre in control and 0.38 (0.19) litre in the RM group] and similar between the groups (P=0.35). FVC, FEV1, mean [Formula: see text], percentage of time spent with [Formula: see text] below 90%, and AHI did not differ significantly between the groups. CONCLUSIONS: This study demonstrates that when added to a protective mechanical ventilation combining low tidal volume and high PEEP, two RMs do not improve postoperative lung function including FRC, arterial oxygenation, and the incidence of obstructive apnoea in MO patients after laparoscopic upper abdominal surgery. CLINICAL TRIAL REGISTRATION: EudraCT 2011-000999-33. [less ▲]

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See detailComparison of the Surgical Pleth Index (TM) with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia
Bonhomme, Vincent ULg; Uutela, K.; Hans, Grégory ULg et al

in British Journal of Anaesthesia (2011), 106(1), 101-11

BACKGROUND: The Surgical Pleth Index (SPI) is proposed as a means to assess the balance between noxious stimulation and the anti-nociceptive effects of anaesthesia. In this study, we compared SPI, mean ... [more ▼]

BACKGROUND: The Surgical Pleth Index (SPI) is proposed as a means to assess the balance between noxious stimulation and the anti-nociceptive effects of anaesthesia. In this study, we compared SPI, mean arterial pressure (MAP), and heart rate (HR) as a means of assessing this balance. METHODS: We studied a standard stimulus [head-holder insertion (HHI)] and varying remifentanil concentrations (CeREMI) in a group of patients undergoing neurosurgery. Patients receiving target-controlled infusions were randomly assigned to one of the three CeREMI (2, 4, or 6 ng m(1)), whereas propofol target was fixed at 3 microg ml(1). Steady state for both targets was achieved before HHI. Intravascular volume status (IVS) was evaluated using respiratory variations in arterial pressure. Prediction probability (Pk) and ordinal regression were used to assess SPI, MAP, and HR performance at indicating CeREMI, and the influence of IVS and chronic treatment for high arterial pressure, as possible confounding factors. RESULTS: The maximum SPI, MAP, or HR observed after HHI correctly indicated CeREMI in one of the two patients [accurate prediction rate (APR)=0.5]. When IVS and chronic treatment for high arterial pressure were taken into account, the APR was 0.6 for each individual variable and 0.8 when all of them predicted the same CeREMI. That increase in APR paralleled an increase in Pk from 0.63 to 0.89. CONCLUSIONS: SPI, HR, and MAP are of comparable value at gauging noxious stimulation-CeREMI balance. Their interpretation is improved by taking account of IVS, treatment for chronic high arterial pressure, and concordance between their predictions. [less ▲]

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See detailIntravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation.
Hans, Grégory ULg; Lauwick, Séverine ULg; Kaba, Abdourahmane ULg et al

in British Journal of Anaesthesia (2010), 105(4), 471-9

BACKGROUND: I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia. METHODS: A randomized ... [more ▼]

BACKGROUND: I.V. lidocaine reduces volatile anaesthetics requirements during surgery. We hypothesized that lidocaine would also reduce propofol requirements during i.v. anaesthesia. METHODS: A randomized controlled study of 40 patients tested the effect of i.v. lidocaine (1.5 mg kg(-1) then 2 mg kg(-1) h(-1)) on propofol requirements. Anaesthesia was maintained with remifentanil and propofol target-controlled infusions (TCI) to keep the bispectral index (BIS) around 50. Effect-site concentrations of propofol and remifentanil and BIS values were recorded before and after skin incision. Data were analysed using anova and mixed effects analysis with NONMEM. Two dose-response studies were then performed with and without surgical stimulation. Propofol TCI titrated to obtain a BIS around 50 was kept constant. Then patients were randomized into four groups: A, saline; B, 0.75 mg kg(-1) bolus then infusion 1 mg kg(-1) h(-1); C, 1.5 mg kg(-1) bolus and infusion 2 mg kg(-1) h(-1); and D, 3 mg kg(-1) bolus and infusion 4 mg kg(-1) h(-1). Lidocaine administration coincided with skin incision. BIS values and haemodynamic variables were recorded. Data were analysed using linear regression and two-way anova. RESULTS: Lidocaine decreased propofol requirements (P<0.05) only during surgery. In the absence of surgical stimulation, lidocaine did not affect BIS nor haemodynamic variables, whereas it reduced BIS increase (P=0.036) and haemodynamic response (P=0.006) secondary to surgery. CONCLUSIONS: The sparing effect of lidocaine on anaesthetic requirements seems to be mediated by an anti-nociceptive action. [less ▲]

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See detailEffect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy
Senard, Marc ULg; Deflandre, Eric; Ledoux, Didier ULg et al

in British Journal of Anaesthesia (2010), 105(2), 196-200

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See detailNorepinephrine and ephedrine do not counteract the increase in cutaneous microcirculation induced by spinal anaesthesia.
Lecoq, Jean-Pierre ULg; Brichant, Jean-François ULg; Lamy, Maurice ULg et al

in British Journal of Anaesthesia (2010), 105(2), 214-9

BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive ... [more ▼]

BACKGROUND: /st> Neuraxial anaesthesia improves tissue perfusion and tissue oxygen tension. Vasodilation induced by this technique may result in hypotension requiring the administration of vasoactive drugs. The use of peripheral vasoconstrictors might counteract the improved tissue perfusion and its potentially beneficial effects. We therefore investigated the effect of i.v. norepinephrine and ephedrine on skin perfusion using laser-Doppler flowmetry (LDF) in patients during spinal anaesthesia. METHODS: /st> Skin blood flow expressed in perfusion units (PU) provided by LDF was measured simultaneously at the foot and the manubrium levels in 44 patients during spinal anaesthesia with a sensory level below T5. Norepinephrine infusion was then titrated to normalize mean arterial pressure (MAP) in 23 patients (Group NOR). Ephedrine (max. 10 mg) was administered in 21 patients (Group EPH). Changes in relative PU were compared between the two sites of measurements in each group during drug administration. The same doses of norepinephrine were assessed in 11 normal volunteers to assure comparable vasoreactivity at the foot and manubrium levels. RESULTS: /st> Spinal anaesthesia resulted in a 10% decrease in MAP (P<0.001), an increase in relative PU values at the foot level (P<0.001), and a decrease at the sternum level (P<0.05). Norepinephrine and ephedrine produced a significant increase in relative PU values at the foot level when compared with the sternum level (NOR: P=0.02; EPH: P=0.0035). In volunteers, norepinephrine decreased cutaneous perfusion similarly at the manubrium and foot levels. CONCLUSIONS: /st> Improved skin perfusion induced by spinal anaesthesia was not counteracted by the use of norepinephrine or ephedrine. [less ▲]

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See detailNeurokinin-1 receptor antagonists in the prevention of postoperative nausea and vomiting
Diemunsch, P.; Joshi, G. P.; Brichant, Jean-François ULg

in British Journal of Anaesthesia (2009), 103(1), 7-13

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See detailDoes implicit memory during anaesthesia persist in children?
Lopez, Ursula; Habre, w; Laurencon, M. et al

in British Journal of Anaesthesia (2009), 102(3), 37984

Background. Recent studies suggest that implicit memory (especially perceptual implicit memory) persists during adequate general anaesthesia in adults. Studies in children, however, have failed to ... [more ▼]

Background. Recent studies suggest that implicit memory (especially perceptual implicit memory) persists during adequate general anaesthesia in adults. Studies in children, however, have failed to demonstrate implicit memory during general anaesthesia, possibly because of differences in methodological design. We therefore designed a prospective study with the aim of evaluating implicit memory in children undergoing general anaesthesia, using a perceptual memory test based on the mere exposure effect, previously tested in a control group. Methods. Twelve infrequent neutral words were played 12 times in a random sequence via headphones to 36 children aged 8–12 yr during elective or emergency surgery. The children were not premedicated, and general anaesthesia was maintained with isoflurane. The word presentation started immediately after the surgical incision. Within 36 h after the stimulus presentation, the memory was assessed by using a forced-choice preference judgement task. Time constraint and word deterioration with a low-pass filter were used to prevent the subjects from utilizing intentional retrieval. The implicit memory score was obtained by calculating the proportion of target words preferred, which was compared with the chance level (0.5). Results. The percentage of correct responses given by the children was comparable with the chance level. The memory score was mean (SD) 0.48 (0.16) (95% CI 0.43–0.53). Conclusions. The use of a perceptual implicit memory test based on the mere exposure procedure in children failed to reveal any evidence of implicit memory under general anaesthesia. [less ▲]

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See detailEffect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery.
Hans, Pol ULg; Marechal, Hugues ULg; Bonhomme, Vincent ULg

in British Journal of Anaesthesia (2008), 101(5), 731-7

BACKGROUND: Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence ... [more ▼]

BACKGROUND: Coughing during emergence from general anaesthesia may be detrimental, particularly after cervical spine surgery. We compared the effect of propofol or sevoflurane anaesthesia on the incidence and severity of coughing during recovery in patients undergoing cervical spine surgery via an anterior approach. As a secondary aim, we also evaluated the influences of smoking and estimated residual anaesthetic agent concentrations on coughing. METHODS: Thirty-four patients were enrolled in a randomized prospective, double-blind study to receive either propofol (PPF) or sevoflurane (SEVO) for maintenance of anaesthesia. The decision to perform tracheal extubation was based on specified criteria, including resumption of spontaneous respiration and consciousness. During emergence from anaesthesia and extubation, coughing was observed and graded at predefined times. RESULTS: The incidence of severe coughing was higher in the SEVO group than in the PPF group (59% and 6%, respectively), and also in smokers than in non-smokers (50% and 17%, respectively). The peak incidence of coughing was at tracheal extubation. The probability of coughing was influenced by the estimated residual concentration of anaesthetic agents at extubation, except for smokers in the SEVO group who were at the highest risk of coughing. CONCLUSIONS: The incidence of coughing after cervical spine surgery when tracheal extubation is performed according to clinical criteria is lower after propofol anaesthesia compared with sevoflurane anaesthesia. Smokers are at increased risk of coughing, independently of the type of anaesthesia maintenance. Higher residual concentrations of anaesthetic agents decrease the probability of coughing, except for smokers anaesthetized with sevoflurane. [less ▲]

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See detailDelta down compared with delta pulse as an indicator of volaemia during intracranial surgery
Deflandre, Eric; Bonhomme, Vincent ULg; Hans, Pol ULg

in British Journal of Anaesthesia (2008), 100(2), 245-250

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See detailEffect of an intubation dose of rocuronium on Spectral Entropy and Bispectral Index (TM) responses to laryngoscopy during propofol anaesthesia
Hans, Pol ULg; Giwer, Jérôme ULg; Brichant, Jean-François ULg et al

in British Journal of Anaesthesia (2006), 97(6), 842-847

Background. The spectral entropy of the electroencephalogram has been proposed to monitor the depth of anaesthesia. State Entropy (SE) reflects the level of hypnosis. Response Entropy (RE), computed from ... [more ▼]

Background. The spectral entropy of the electroencephalogram has been proposed to monitor the depth of anaesthesia. State Entropy (SE) reflects the level of hypnosis. Response Entropy (RE), computed from electroencephalogram and facial muscle activity, reflects the response to nociceptive stimulation. We evaluated the effect of rocuronium on Bispectral Index (TM) (BIS) and entropy responses to laryngoscopy. Methods. A total of 25 patients were anaesthetized with propofol using a target-controlled infusion. At steady state, they randomly received 0.6 mg kg(-1) rocuronium (R) or saline (S). After 3 min, a 20 s laryngoscopy was applied. BIS, RE and SE were recorded continuously and averaged over 1 min during baseline, at steady state, 2 min after R or S administration (R/S+2) and 0, 1, 2 and 3 min after laryngoscopy (L0, L1, L2, L3). Results. At R/S+2, the RE-SE gradient was higher in Group S than in Group R. Laryngoscopy provoked an increase in BIS, RE and SE. Comparing R/S+2 and L0 values in Groups R and S, BIS increased from 43 (6) to 49 (8) and 42 (9) to 51 (15), SE increased from 43 (7) to 50 (8) and 41 (10) to 55 (12), and RE increased from 46 (8) to 54 (9) and 47 (12) to 66 (15), respectively. BIS and SE did not differ between groups. At L0, RE and RE-SE were higher in Group S [66 (15) and 11 (4), respectively] than in Group R [54 (9) and 4 (2), respectively]. Conclusions. Rocuronium alters the RE-SE gradient and the RE and RE-SE responses to laryngoscopy. Muscle relaxation may confound interpretation of entropy monitoring. [less ▲]

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See detailBlood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery
Hans, Pol ULg; Vanthuyne, A.; Dewandre, Pierre-Yves et al

in British Journal of Anaesthesia (2006), 97(2), 164-170

BACKGROUND: Dexamethasone prevents postoperative nausea and vomiting but may increase blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic and type 2 diabetic ... [more ▼]

BACKGROUND: Dexamethasone prevents postoperative nausea and vomiting but may increase blood glucose. We compared blood glucose concentrations after dexamethasone in non-diabetic and type 2 diabetic patients undergoing surgery and looked for any association with preoperative glycosylated haemoglobin [HbA (1c)] and BMI. METHODS: Sixty three patients were enrolled: 32 were non-diabetic (Group ND) and 31 type 2 diabetic (Group D) without insulin treatment. Anaesthesia was induced using i.v. anaesthetic agents and maintained with sevoflurane. All patients received 10 mg dexamethasone at induction. Blood glucose concentrations were measured at induction and then every 60 min for 240 min. Data were analysed using anova. Effects of HbA (1c) and BMI were investigated using linear correlation and logistic regression. RESULTS: Blood glucose concentrations increased significantly over time and peaked at 120 min after 10 mg dexamethasone in both groups. The magnitude of increase was comparable between the groups [mean (SD) 29 (19) and 35 (19)% of baseline in Group D and Group ND, respectively]. Maximum concentrations were higher in Group D [8.97 (1.51) mmol litre(-1), range 6.67-12.94 mmol litre(-1)] than in Group ND [7.86 (1.00) mmol litre(-1), range 5.78-10.00 mmol litre(-1)]. There was a significant correlation between the maximum concentrations and BMI (R(2)=0.21) or HbA (1c) (R(2)=0.26). Logistic regression analysis revealed that the higher the BMI, the lower the HbA (1c) threshold associated with an increased probability (>0.5) of observing blood glucose levels higher than 8.33 mmol litre(-1) during 240 min after dexamethasone administration. Similarly, the higher the HbA (1c), the lower the BMI threshold associated with the same probability. CONCLUSIONS: After 10 mg dexamethasone, blood glucose levels increase in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Poorly controlled diabetes and severe obesity can influence the development of hyperglycaemia. [less ▲]

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See detailCombined use of Bispectral Index (TM) and A-Line (TM) Autoregressive Index (TM) to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis
Bonhomme, Vincent ULg; Llabres, V.; Dewandre, Pierre-Yves et al

in British Journal of Anaesthesia (2006), 96(3), 353-360

BACKGROUND: This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index ... [more ▼]

BACKGROUND: This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index (BIS) guided anaesthesia combined with epidural analgesia. METHODS: An epidural catheter was inserted in 23 patients allocated randomly to receive ropivacaine plus clonidine (Group R) or normal saline (Group S) epidurally. General anaesthesia was induced with propofol, cis-atracurium and a remifentanil infusion that was stopped 3 min after tracheal intubation, and maintained using sevoflurane to keep BIS at 50 (range 40-60). Mean arterial pressure, heart rate, end-tidal sevoflurane, BIS and AAI were analysed from 2 min before to 17 min after surgical incision. RESULTS: While BIS was maintained at 50, AAI significantly increased from a 2 min averaged value of 12 (4) to 21 (7) in Group S within the first 5 min after surgical incision, but did not change in Group R. Maximum AAI values reached during the study period were significantly higher in Group S than in Group R [38 (12) and 27 (10), respectively]. Binary logistic regression analysis allowed the calculation of AAI threshold values above which the probability of predominant nociception over anti-nociception was higher than 95%. At 1 MAC sevoflurane concentration, a 2 min averaged AAI of 35 or an AAI peak value of 62 were associated with such a probability. CONCLUSIONS: During a BIS-guided constant level of hypnosis, AAI response to the onset of surgical stimulation significantly differs according to the analgesic regimen. Further studies are needed to refine the estimation of sensitivity and specificity of this variable in assessing the balance between nociception and anti-nociception during general anaesthesia. [less ▲]

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See detailComparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia
Hans, Pol ULg; Dewandre, Pierre-Yves; Brichant, Jean-François ULg et al

in British Journal of Anaesthesia (2005), 94(3), 336-340

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may ... [more ▼]

BACKGROUND: The Bispectral Index (BIS) and spectral entropy of the electroencephalogram can be used to assess the depth of hypnosis. Ketamine is known to increase BIS in anaesthetized patients and may confound that index as a guide to steer administration of hypnotics. We compared the effects of ketamine on BIS, response entropy (RE) and state entropy (SE) during surgery under sevoflurane anaesthesia. METHODS: Twenty-two women undergoing gynaecological surgery were enrolled in this double-blind, randomized study. Anaesthesia was induced i.v. and maintained with sevoflurane. Under stable surgical and anaesthetic conditions, patients were assigned to receive either a bolus of ketamine 0.5 mg kg(-1) or the same volume of saline. Blood pressure, heart rate, BIS, RE and SE were measured every 2.5 min from 10 min before (baseline) until 15 min after ketamine or saline administration. The maximum relative increase in BIS, RE and SE compared with baseline was calculated for each patient. Values are mean (sd). RESULTS: Baseline values were BIS 33 (4), RE 31 (5), SE 30 (5) for the ketamine patients and BIS 35 (3), RE 33 (5) and SE 32 (6) for the patients receiving saline. BIS, RE and SE increased significantly from 5 min (BIS) and 2.5 min (RE and SE) after ketamine administration, peaking at 46 (8) (BIS), 52 (12) (RE) and 50 (12) (SE) respectively. The maximum relative increase in RE [42.2 (10.4%)] and SE [41.6 (10.9)%] was higher than that of BIS [29.4 (10.4%)]. Blood pressure, heart rate and RE-SE gradient did not change in either group. CONCLUSIONS: Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE-SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis. [less ▲]

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See detailOccupational stress and burnout in anaesthesia
Nyssen, Anne-Sophie ULg; Hansez, Isabelle ULg; Baele, Philippe et al

in British Journal of Anaesthesia (2003), 90(3), 333-337

Background. Formal studies on stress in anaesthetists have usually measured stress through mental or physiological indicators. When using this approach, one must be careful not to confuse the effects of ... [more ▼]

Background. Formal studies on stress in anaesthetists have usually measured stress through mental or physiological indicators. When using this approach, one must be careful not to confuse the effects of stress or outcome variables and the sources of stress or antecedent variables. To date, it seems from the literature that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress. Furthermore, work characteristics such as job satisfaction, job control and job support may moderate the effects of stress. Methods. We measured the effects of stress together with the sources of stress and job characteristics, using self-reported questionnaires rather than physiological indicators in order to better diagnose stress in anaesthetists. Results. The mean stress level in anaesthetists was 50.6 which is no higher than we found in other working populations. The three main sources of stress reported were a lack of control over time management, work planning and risks. Anaesthetists reported high empowerment, high work commitment, high job challenge and high satisfaction. However, 40.4% of the group were suffering from high emotional exhaustion (burnout); the highest rate was in young trainees under 30 years of age. Conclusions. Remedial actions are discussed at the end of the paper. [less ▲]

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See detailSupplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy
Joris, Jean ULg; Poth, N. J.; Djamadar, A. M. et al

in British Journal of Anaesthesia (2003), 91(6), 857-61

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See detailPulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients.
Joris, Jean ULg; Hinque, V. L.; Laurent, P. E. 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 ▲]

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See detailPostoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures.
Joris, Jean ULg; Kaba, Abdourahmane ULg; Lamy, Maurice ULg

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 ▲]

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See detailMetabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy.
Joris, Jean ULg; Cigarini, I.; Legrand, Marc ULg et al

in British Journal of Anaesthesia (1992), 69(4), 341-5

We have compared metabolic and respiratory changes after laparoscopic cholecystectomy (n = 15) with those after open cholecystectomy (n = 15). The durations of postoperative i.v. therapy, fasting and ... [more ▼]

We have compared metabolic and respiratory changes after laparoscopic cholecystectomy (n = 15) with those after open cholecystectomy (n = 15). The durations of postoperative i.v. therapy, fasting and hospital stay were significantly shorter in the laparoscopy group. During the first and second days after operation, analgesic consumption but not pain scores (visual analogue scale) were significantly smaller after laparoscopy, while vital capacity, forced expiratory volume in 1 s, and PaO2 were significantly greater. The metabolic and acute phase responses (glucose, leucocytosis, C-reactive protein) were less after laparoscopy compared with laparotomy. Although plasma cortisol and catecholamine concentrations were not significantly different between the two groups, after surgery interleukin-6 concentrations were less in the laparoscopy group. [less ▲]

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