The effect of lower intra-abdominal pressure on intracranial pressure measured by optic nerve sheath diameter during laparoscopic surgery

The aim of this study was to show different optic nerve sheath diameters (ONSD) using ultrasonography under different intra-abdominal pressures (IAPs) and to investigate the association between intracranial pressure (ICP) elevation and perioperative hemodynamic parameters. One hundred patients aged 18-80 years with ASA scores I&II were included. All patients received the same anesthesia protocol and were divided into two groups depending on their IAP, Group A (10 mmHg) and Group B (15 mmHg). ONSD, peak (Ppeak) and plateau (Pplateau) airway pressures, end-tidal volume carbon dioxide (ETCO2), heart rate (HR), and mean arterial blood pressure (MAP) were measured before pneumoperitoneum (T0), at the 10th minute of pneumoperitoneum (T1), and at the end of pneumoperitoneum (T2). No differences were determined between the groups in terms of age, gender, anthropometric measurements, ASA scores, underlying disorders, or duration of pneumoperitoneum, surgery, and anesthesia. Group B patients had higher ONSD values at T2 than Group A (5.0±0.2 vs 5.2±0.2) (p [Med-Science 2020; 9(3.000): 774-8

Does heparin dosage calculated with ideal body weight reduce blood product use in open heart surgery?

The heparin regimen providing anticoagulation during cardiopulmonary bypass (CPB) is usually adapted to total body weight (TBW). However, this may cause redundant anticoagulation and increase perioperative bleeding, transfusion requirements and reoperation. We compared a heparin regimen based on ideal body weight (IBW) with the traditional regimen. After ethical approval, 100 adults undergoing elective cardiac surgery with CPB were recruited for the prospective, observational study in a tertiary hospital. Prior to CBP an unfractioned heparin dose was adjusted to 300 IU/kg based on TBW (Group TBW, n=50), or IBW (Group IBW, n=50). IBW was calculated using the Lorentz formula. The minimal Activated Coagulation Time (ACT) target value is 400 sec for CPB. Demographic data, cross-clamp and CPB durations, and Hb, Htc, platelet, PT, Aptt and fibrinogen values were similar between the groups (p>0.05). Heparin and total protamine doses were significantly higher in Group IBW (p [Med-Science 2019; 8(1.000): 123-8

It Suddenly Occurred: Extensive Subcutaneous Emphysema after Bipolar Transurethral Resection of Prostate

Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP). It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome