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At least 343 records · Page 19Linked to original sources
PubMed1994

[Effect of CO2 insufflation into the peritoneal cavity on selected indices of respiratory system function during laparoscopic cholecystectomy].

An attempt was undertaken at evaluation of the influence of CO2 insufflation in patients subjected to laparoscopic cholecystectomy on pulmonary dynamic compliance, pulmonary resistance, pressures in the airways, CO2 pressure in expired air, and arterialized blood gas analysis. The studies were carried out in a group of 33 patients, including 26 women and 7 men, evaluated according to ASA scale as I/II degrees. The means of the values obtained before CO2 insufflation into the peritoneal cavity were compared with the means from the period of pneumoperitoneum maintenance. Statistically significant decrease of pulmonary compliance, increase of the mean pressure in the airways and increase of CO2 pressure both in expired air and arterialized blood were demonstrated. Pulmonary resistance and oxygen pressure in blood remained without statistically significant changes. The attention was paid to the rationale of including capnometry to the standard monitoring equipment during laparoscopic operations.

Adult↗
PubMed1994

[Comparison of intraoperative complications between laparoscopic cholecystectomy by intraperitoneal insufflation and abdominal wall lifting].

We compared intraoperative circulatory and respiratory complications and changes in body temperature during laparoscopic cholecystectomy by intraperitoneal insufflation of carbon dioxide gas (24 cases) with those by abdominal wall lifting (16 cases). The abdominal wall lifting method tended to produce fewer complications than the intraperitoneal insufflation method, but not significantly. In conclusion, the former was thought to be safer than the latter.

Abdominal Muscles↗
PubMed1993

An abdominal wall-lift method of laparoscopic cholecystectomy without peritoneal insufflation.

Laparoscopic cholecystectomy is unusually performed with peritoneal insufflation of carbon dioxide gas, which limits the free use of conventional surgical techniques and is accompanied by operative risks resulting from trocar insertion, hypercapnia, and increased intraabdominal pressure. We have improved the laparoscopic cholecystectomy procedure by using an abdominal wall-lift technique that does not utilize peritoneal insufflation. The operative field is almost the same as in the pneumoperitoneum method with the exception of morbidly obese patients. Because airtightness between manipulating instruments and the abdominal wall is not required, we are able to use conventional surgical instruments and techniques in addition to those specifically designed for laparoscopic surgery. The abdominal wall-lift method enables us to perform laparoscopic surgery with greater ease than the pneumoperitoneum method. It can also be extended to other kinds of abdominal surgery in addition to cholecystectomy.

Abdominal Muscles↗
PubMed1985

An improved esophageal insufflation test.

Previous investigations identified that insufflation of the esophagus may elicit reflex pharyngoesophageal closure, impeding airflow and subsequent voice production. A simplified method for esophageal insufflation consistently evaluates the capacity for alaryngeal speech acquisition. Although primarily a method for predicting tracheoesophageal speech, it may also be an important prognostic indicator for traditional esophageal speech development.

Catheterization↗
PubMedDate not supplied

Cul-de-sac insufflation: an easy alternative route for safely inducing pneumoperitoneum.

Since 1977, routine cul-de-sac insufflation to achieve a pneumoperitoneum for laparoscopy was performed on 350 women under local anesthesia. A van Schie/van Lith intrauterine tenaculum, used together with a self-retaining Trelat speculum, guaranteed maximum stretching of the posterior vaginal fault and fixation of the anteflexed uterus necessary for an accurate 1-cm deep penetration of a pneumoperitoneum needle into the cul-de-sac. The correct position of the tip of the needle was determined precisely by means of two manometers. The failure rate in the first study of 195 procedures was 3.6% and that in the following 155 cases was 1.9%. There were no serious operative complications. The authors recommended the cul-de-sac insufflation approach for inducing pneumoperitoneum as the technique of choice.

Douglas' Pouch↗
PubMed1980

Cul-de-sac insufflation to induce pneumoperitoneum: an analysis of rare problems.

Since 1977, cul-de-sac insufflation has been used to achieve pneumoperitoneum for laparoscopic sterilization of 570 women. The authors have previously published findings on 350 of these women (Int J Gynaecol Obstet 17(4):375, 1980), reporting technical failure rates of 3.6% and 1.9% for a series of 195 and 155 women, respectively. The failure rate for the latest series of 220 women declined to 1.4%. Reasons for this lower rate and recurring causes of the failures are given, and recommendations for the use of cul-de-sac insufflation for inducing pneumoperitoneum are suggested.

Douglas' Pouch↗
PubMed1993

Retrograde air insufflation in MRI: a technical note.

Retrograde air insufflation was employed to distend the colon and the ileum in 18 patients and five volunteers for magnetic resonance examination. Good and moderate marking of the ileum was obtained in 18 cases. The colon was nearly completely distended in every case. Intraluminal tumor, mural thickening, and extraluminal lesion were outlined by intraluminal air and surrounding air-distended bowel. This study shows that retrograde air insufflation is a useful method to mark the colon and most parts of the ileum.

Adult↗
PubMed1989

[Liver function of patients with arterial hypoxemia in chronic obstructive respiratory tract disease and the effect of nasal oxygen insufflation].

Patients suffering from chronic obstructive airway disease often have arterial hypoxemia, which is more or less severe. If hypoxemia deteriorates the function of the liver is still unknown. The aim of this study was to determine, if a mostly oxygen dependent process of liver metabolism (galactose elimination capacity) is disturbed and if it can be increased by oxygen insufflation. Under the same conditions an oxygen independent process (indocyaninegreen clearance) should not be influenced. Our results show, that galactose elimination capacity under room air was pathologic and can be increased significantly by oxygen breathing. No change of indocyaninegreen clearance was seen under the same conditions. After termination of oxygen therapy the galactose elimination capacity was as bad as before oxygen breathing. Dysfunctions of the liver, which are caused by hypoxemia, can be positively influenced by oxygen, but only for the duration of oxygen insufflation.

Aged↗
PubMed1985

Manometrically guided colon insufflation during double-contrast barium enemas.

The double-contrast enema's potential for high accuracy depends in part on consistently good inflation of the colon. However, optimal inflation is often not obtained because of deflation during filming, underinflation because of fear of perforating the colon, or patient discomfort. To help meet the dual requirements of ensuring consistently good bowel inflation while avoiding over-inflation, we have designed a modified insufflator which incorporates a manometer and allows accurate readings of intraluminal large-bowel pressures during or following insufflation. In more than 3000 examinations using this method we have experienced no complications.

Barium Sulfate↗
PubMed2000

The influence of different insufflation pressures during carbon dioxide pneumoperitoneum on the development of pulmonary metastasis in a mouse model.

BACKGROUND: The effects of different insufflation pressures on the development of pulmonary metastasis was investigated in a mouse laparoscopy model. METHODS: BALB/C mice intravenously inoculated with colon 26 cells were randomized to one of five treatment groups (10 mice per group): pneumoperitoneum at different pressures of 5, 10 or 15 mmHg; full laparotomy for 60 min; or anesthesia control. Cancer nodules on the lung surface 19 days postoperatively were compared between groups. RESULTS: (a) As compared with the control group, pneumoperitoneum at 10 and 15 mmHg and laparotomy enhanced the growth of pulmonary metastases (p < 0.01). (b) The growth of metastases also was greater in laparotomy group mice than in mice undergoing pneumoperitoneum at 5 and 10 mmHg (p < 0.05). CONCLUSIONS: These results suggest that the effects of different insufflation pressures on the growth of pulmonary metastases are not identical, and that pneumoperitoneum with high pressure may promote pulmonary metastases similar to those with laparotomy.

Analysis of Variance↗
PubMed1998

Effect of temperature of insufflated CO2 during and after prolonged laparoscopic surgery.

BACKGROUND: Pneumoperitoneum with room temperature carbon dioxide (CO2) has been shown to decrease core temperature and urine output. METHODS: The effect of 37 degrees C (warm) and room temperature (cool) CO2 pneumoperitoneum on core temperature, urine output, and central hemodynamics was compared in 26 randomized patients undergoing prolonged laparoscopic surgery (>90 min). RESULTS: The core temperature (p < 0.05) and cardiac index (p < 0.05) were significantly higher after warm than after cool pneumoperitoneum. Urine output was significantly higher during warm (2.3 +/- 1.6 ml/kg/h) than during cool (0.9 +/- 0.7 ml/kg/h) insufflation (p < 0. 05). Two of 13 patients with warm and 11 of 13 patients with cool pneumoperitoneum needed mannitol to maintain adequate diuresis (p < 0.05). CONCLUSIONS: Warm insufflation probably causes a local vasodilation in the kidneys and may be beneficial to patients with borderline renal function.

Body Temperature↗
PubMed1998

Utility of insufflation filters in laparoscopic surgery.

OBJECTIVES: To determine whether filters, regularly used as part of the insufflator tubing during laparoscopic surgery, trap microbial and particulate matter from CO2 tanks, thus preventing passage from one patient to another. METHODS: A total of 67 used filters were collected from 17 CO2 tanks and six insufflation machines at three local hospitals, and sterile unused filters were used as controls. The used filters were distributed equally and sequentially into three groups: Group I-viewed under a dissecting microscope for particulate matter; group II-examined by mass spectrometry for contamination with oils and other impurities; group III-incubated on sheep blood agar plates and evaluated for growth of microorganisms. RESULTS: Negative. Used filters were indistinguishable by all parameters from controls. CONCLUSIONS: This limited study suggests filters now used in laparoscopic surgery fail to trap microbes or particulate matter. The question remains whether tank waste is absent or these filters fail to trap waste matter.

Bacteria↗
PubMed1999

Laparoscopic extraperitoneal inguinal hernia repair with spinal anesthesia and nitrous oxide insufflation.

BACKGROUND: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with nitrous oxide insufflation was investigated. METHODS: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures (24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications were collected prospectively. RESULTS: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time was 39 +/- 7 min for unilateral hernia and 65 +/- 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients (63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence. CONCLUSIONS: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.

Aged↗
PubMed1985

Gastric insufflation during IAC-CPR and standard CPR in a canine model.

This study was undertaken to determine the effect of interposed abdominal compressions (IAC) during cardiopulmonary resuscitation (CPR) on gastric insufflation when the airway is not secured with an endotracheal tube. A canine model was used in which a common ventilation pressure was applied to separate cuffed esophageal and tracheal tubes. Gas entering the stomach was collected by a pre-placed gastrostomy tube leading to a bell spirometer. Gas entering the lungs was measured with a Wright Respirometer in series with the endotracheal tube. During standard CPR, measurable gastric gas volume was collected in 28 of 30 trials (mean 215 +/- 93 ml/ventilation). During IAC-CPR, in which abdominal pressure was maintained during ventilation after every 5th chest compression, measurable gastric gas was collected in 15 of 30 trials (mean 40 +/- 11 ml/ventilation). Interposed abdominal compressions as an adjunct to standard CPR may not only be of hemodynamic benefit, but may also reduce the incidence of gastric insufflation and attendant complications.

Abdomen↗
PubMed1991

IPPV plus low-flow intermittent oxygen insufflation (end-exhalation to beginning inhalation) does not improve CO2 elimination.

It has been previously reported that continuous insufflation of low-flow O2 (0.05 to 0.20 L/kg/min), both supracarinally and subcarinally, in addition to intermittent positive-pressure ventilation (IPPV) (IPPV + O2 at a specific flow rate) caused progressive hemodynamic deterioration in patients. As demonstrated in a subsequent mechanical lung model, the hemodynamic deterioration was most probably due to lung hyperexpansion. The purpose of this study was to test the hypothesis that the O2 retarded the outflow of gas from the lung during exhalation and that if the insufflation were limited to the period of time from the end of tidal exhalation (EE) to the beginning of the next IPPV tidal inspiration (BI), lung hyperexpansion would not occur. The use of intermittent O2 in addition to IPPV was studied in both a mechanical lung model and in patients under general anesthesia; the mechanical lung model permitted direct examination of lung volume, and the patient study allowed determination of gas exchange effects. In the mechanical lung model and in the patients, a wide range of EE-BI O2 flow rates were used; respectively, 1 to 40 L/min and 0.05 to 0.20 L/kg/min. In the mechanical lung model, lung pressure and volume at EE and end-inspiration did not increase as long as the O2 flow was kept at or below 10 L/min. In the patients, airway pressure and hemodynamics did not change appreciably, but there was also no increase in CO2 elimination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Effect of body habitus and parity on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women.

STUDY OBJECTIVES: Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women. DESIGN: Prospective observational cohort study (Canadian Task Force classification II-1). SETTING: University affiliated teaching hospital. PATIENTS: We prospectively collected data on 356 women undergoing laparoscopy for a variety of indications by the senior author (G.A.V.). The median and (range) for height, weight, BMI, parity, and age were 1.64 m (1.45-1.85 m), 65 kg (40-120 kg), 24.3 kg/m2 (16-47 kg/m2), 1 (0-5) and 34 years (18-87 yrs), respectively. INTERVENTION: Under general endotracheal anesthesia including muscle relaxants and with the patient in appropriate stirrups in the horizontal position, a nondisposable Veres needle was inserted at the umbilicus or left upper quadrant (Palmer's point) with CO2 flowing at 1 L/min. The initial Veres intraperitoneal insufflation pressure was recorded once the Veres needle was believed to be in the peritoneal cavity. MEASUREMENTS AND MAIN RESULTS: The mode and the median VIP pressure was 4 mm Hg with a range of 2 to 10 mm Hg. With multivariate analysis, the VIP pressure correlated positively with the weight (r = 0.518, p <.001) and BMI (r = 0.545, p <.001) and negatively with the parity (r = -0.179, p <.001) of women. The correlation of the VIP pressure with height and age was r = 0.029 (p = .591) and r = -0.044 (p = .411), respectively. CONCLUSION: A VIP pressure < or =10 mm Hg indicates intraperitoneal placement of the Veres needle. The VIP pressure correlates positively with the weight and BMI and negatively with the parity of women. There is no correlation of the VIP pressure with women's height and age.

Adolescent↗
PubMed1984

Carbon dioxide insufflation for more comfortable colonoscopy.

Forty patients examined with the use of carbon dioxide insufflation during fiberoptic colonoscopy showed no significant residual gas on plain radiographs taken 30 minutes after the procedure. By contrast, 19 of 20 patients examined with air insufflation showed excessive distension of large and/or small intestine. The rapid absorption of carbon dioxide may be a safety factor in a few patients and adds to the comfort of the procedure in many others by virtually eliminating overdistension afterwards. It also makes it technically possible to perform a barium enema immediately after colonoscopy.

Air↗
PubMedDate not supplied

Quality of air contrast barium enema performed the same day as incomplete colonoscopy with air insufflation.

The quality of 17 air contrast barium enemas performed the same day as incomplete colonoscopies using air insufflation was compared with 21 air contrast barium enemas performed on a different day from incomplete colonoscopies. A gastrointestinal radiologist blinded to the timing of the procedures reviewed the barium studies scoring them as 1 (unsatisfactory) to 4 (excellent) in four areas. The mean overall quality score for the air contrast barium enemas done the same day as incomplete colonoscopy was 3.29 vs. 2.97 for those done on a different day (p = 0.24). There were no significant differences in quality scores between same-day versus different-day air contrast barium enemas for the specific parameters of quality of distention, barium coating, and amount of spasm. We conclude that when colonoscopy using air insufflation is incomplete because of looping or angulation, air contrast barium enema can be done the same day without impairing the quality of the barium study.

Air↗