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N Pianim

Publications and source records attributed to N Pianim.

5 recordsLinked to original sources
PubMed1995

Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen.

OBJECTIVE: Demonstrate the effect that increased intra-abdominal pressure (IAP) has on visceral oxygen delivery and bowel tissue oxygenation (TPO2). METHODS: Six Duroch swine underwent abdominal insufflation with helium to pressures of 15 and 25 mm Hg for 1 hour. Animals were instrumented with a pulmonary artery flotation catheter to measure cardiac output and calculate systemic oxygen delivery. Fluorescence quenching optodes were implanted in the terminal ileum and the subcutaneous tissue of an axillary fold to measure bowel and systemic (control) tissue oxygen levels, respectively. RESULTS: Bowel tissue oxygen fell from 43 +/- 12 mm Hg at baseline to 31 +/- 12 mm Hg, with 15 mm Hg of abdominal pressure at 60 minutes. With 25 mm Hg IAP, bowel TPO2 fell from 24 +/- 12 to 12 +/- 8 mm Hg (p < 0.02). No change in axillary TPO2 was observed during either period of increased IAP. Cardiac output (CO), systemic oxygen delivery, and mixed-venous oxygen saturation (Svo2) also declined, although blood pressure and oxygen consumption remained constant. CONCLUSIONS: Increased IAP produces significant decreases in bowel submucosal TPO2 without similar changes in extra-abdominal (subcutaneous) TPO2. This decline is dependent on the extent and duration of the elevation in IAP. Readily accessible parameters, such as CO and Svo2, also decline with increased IAP and may be useful variables to monitor as relative indicators of bowel hypoperfusion and TPO2.

Abdomen↗
PubMed1993

Medical and economic consequences of gang-related shootings.

Treatment costs for victims of gang violence have fueled the withdrawal of hospitals from trauma networks. Not included in such tallies are the medical resources that these seriously ill and medically indigent patients divert from other areas. We examined the surgical care requirements, costs incurred, and outcomes at a Level I trauma center. Local law enforcement records were matched with hospital admissions over a 1-year period to identify with hospital admissions over a 1-year period to identify casualties of gang violence. Of 191 gunshot wound admissions, 107 (56%) were gang related. The majority were males (92%); ages ranged from 14 to 50 and trauma scores from 1-16. Eighty-six were admitted during periods of minimum staffing (7:00 PM to 7:00 AM), pre-emptying the use of limited resources for other medical/surgical emergencies. Fifty-eight (54%) needed emergency surgery: laparotomy (38), thoracotomy (5), and neck/extremity (15). Forty required multiple surgical procedures, and eight patients required nine subsequent surgeries. There were two deaths. Average hospital stay ranged from 1 to 180 days; inpatient days totalled 1003, 270 of which were spent in the ICU. Total charges neared +2.0 million. Ninety-four patients (88%) were medically indigent. On discharge, 75 patients were disabled, six permanently. We conclude: 1) Gang activity caused the majority of gunshot wounds at our trauma center; 2) multiple injuries predominated, requiring extensive ICU use; 3) the combination of indigent patients and high hospital costs underestimate the financial burden as valuable resources are diverted from other areas; 4) subsequent community costs include rehabilitation and chronic care.

Adolescent↗
PubMed1992

Effectors of hypercarbia during experimental pneumoperitoneum.

Hypercarbia occurs during laparoscopy with carbon dioxide (CO2) insufflation. This may be due to increased ventilatory dead space after expansion of the peritoneal cavity with impairment of diaphragmatic excursion, or to increased absorption of CO2 from the peritoneum. To separate these effects, the authors examined the consequences of different insufflating gases and of diminished tissue perfusion on hypercarbia and dead space during pneumoperitoneum. Helium was chosen as an alternate insufflating gas because it is both inert and minimally absorbed. Eight swine (18 to 20 kg) were anesthetized, paralyzed, and mechanically ventilated at constant minute volume. Pneumoperitoneum with helium was maintained at 15 mm Hg for 45 minutes. After desufflation and stabilization for 1 hour, pneumoperitoneum was repeated with CO2. The sequence was again repeated after hemorrhagic shock to constant mean arterial pressure of 50 mm Hg. Data was analyzed by analysis of variance; significance levels are P < 0.01 unless otherwise listed. Arterial PCO2 increased significantly with CO2 insufflation within 15 minutes in normotensive animals and within 30 minutes during hypotension. Arterial pH decrease with CO2 pneumoperitoneum was significant in both groups at 30 minutes. Mixed venous PCO2 also increased with CO2 pneumoperitoneum within 30 minutes. Hypotension did not alter these changes. No significant changes were seen with helium pneumoperitoneum. Neither helium nor CO2 pneumoperitoneum significantly altered dead space. The authors make the following conclusions: 1) Absorption of CO2 from the abdomen during CO2 pneumoperitoneum produces respiratory acidosis, which is not seen with helium insufflation; 2) Pneumoperitoneum does not significantly increase dead space with either gas; 3) Transperitoneal absorption of CO2 is only partly related to perfusion because significant hypercarbia occurs during hemorrhagic shock.

Absorption↗
PubMedDate not supplied

Laparoscopic surgery with carbon dioxide insufflation causes respiratory acidosis.

This study analyzes the changes in cardiopulmonary parameters of patients undergoing laparoscopic cholecystectomy. Six healthy females with normal preoperative cardiopulmonary status were selected for laparoscopic surgery using the same criteria as for traditional cholecystectomy. Respiratory and cardiovascular parameters were collected and compared prior to peritoneal insufflation and just before desufflation. Patients experienced significant elevations of arterial and end-tidal CO2, accompanied by decreased pH. Bicarbonate concentration, blood pressure and pulse rate remained constant. Based on these results, and on our laboratory investigations, we have introduced helium as an alternate agent for insufflation, and present the data from the first two patients so managed. No change was observed in EtCO2, PaCO2 or pH in either of these two patients during the course of surgery. We conclude that hypercarbia occurs in those undergoing laparoscopic cholecystectomy with CO2 insufflation. This acidosis requires compensation by increased minute ventilation to prevent decline in pH. In our initial experience, helium did not produce these changes, and therefore merits further investigation as an alternate agent for abdominal insufflation.

Acidosis, Respiratory↗