Comparison Postoperative Shoulder Pain, Nausea, and Vomiting Between Low and Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Background: Low-pressure pneumoperitoneum during laparoscopic surgeries decreases some side effects related to inflate gas into abdominal cavity. The current study aimed at comparing the effects of standard- and low-pressure pneumoperitoneum on shoulder pain, nausea, and  vomiting after laparoscopic cholecystectomy. Methods: In a randomized clinical trial, 202 ASA classes I and II patients, candidates for elective laparoscopic cholecystectomy, were randomly divided into the groups of standard- (12 to 14mmHg)and low- (6 to 7mmHg)pressure pneumoperitoneum. Postoperative shoulder pain, nausea, and vomiting were assessed between the 2 groups. Results: Post-operative shoulder pain was statistically lower in low-pressure group in comparison with standard-pressure group (P = 0.001). Nausea and vomiting were not statistically different between the 2 groups (P = 0.54). Conclusions: Low-pressure pneumoperitoneum during laparoscopic cholecystectomy was an efficient method to decrease postoperative shoulder pai

Effects of Low Pressure of Laparoscopic Cholecystectomy on Arterial Pressure of Carbon Dioxide and Mean Blood Pressure

Background: The effect of low pressure pneumoperitoneum in laparoscopic cholecystectomy on partial pressure of carbon dioxide in the arterial blood (PaCO2) is an important subject which has not been completely defined.Methods: In a double-blind clinical trial, we randomly studied 202 ASA (The ASA physical status classification system) class 1, 2 patients aged between 20 and 85 years who were candidates for elective laparoscopic cholecystectomy. They were randomly divided into two groups of low pressure pneumoperitoneum (6-8 mm Hg) and standard pressure pneumoperitoneum (12-14 mm Hg). By the same general anesthesia protocol in the two groups, PaCO2 was assessed before CO2 insufflation and desufflation. Mean Arterial blood Pressure (MAP) was measured in the two groups.Results: PaCO2 was not significantly different between the 2 groups before CO2 insufflation. But, PaCO2 was statistically lower in low pressure pneumoperitoneum group before CO2 desufflation (P= 0.001). Mean Arterial Pressure (MAP) in standard pressure pneumoperitoneum group was lower than the low pressure pneumoperitoneum group at 5 and 10 minutes after CO2 insufflation and before the time of CO2 desufflation (P=0.001, P=0.006 and P=0.001, respectively). While, MAP was not statistically different between the two groups before CO2 insufflation (P=0.55).Conclusion: Low pressure pneumoperitoneum during laparoscopic cholecystectomy can be an effective protocol to prevent the rise of PaCO2 by preserving the hemodynamic status in such cases.

A Case Report of death from retroperitoneal hematoma following femoral vein Catheterization

کاتتریزاسیون ورید فمورال برای انجام دیالیز یکی از شایع ترین دسترسی های وریدی است. عوارض مختلفی از جمله خونریزی و آسیب های شریانی و فیستول شریانی وریدی برای این روش گزارش شده است. یکی از عوارض نادر ولی کشنده این روش هماتوم رتروپریتونئال ناشی از آسیب دیواره ورید است. مهمترین نکته در پیشگیری از ایجاد این عوارض تکنیک مناسب قرار دادن کاتتر است. در این مطالعه ما به معرفی یک مورد مرگ ناشی از عارضه بسیار نادر و بالقوه کشنده این تکنیک یعنی هماتوم رتروپریتونال می پردازیم.  Femoral vein catheterization is one of the most common venous accesses for dialysis. Various complications such as bleeding and arterial damage and arterio venous fistula have been reported for this procedure. One of the rare but fatal complications of this procedure is retroperitoneal hematoma due to damage to the vein wall. The most important point  in preventing these complications is the proper technique in  placement of the catheter. In this study, we introduce a case of death from a very rare and potentially fatal complication of this technique, retroperitoneal hematoma

کرونا ویروس و درد شکم،گزارش 3 مورد لاپاراتومی منفی

The global spread of coronavirus 2019 (SARS-CoV-2) and various reports indicate a change in the symptoms caused by the virus and gastrointestinal symptoms becoming an important part of the diagnostic symptoms of the virus. The most common gastrointestinal symptoms include anorexia, nausea, vomiting, and abdominal pain. The probable cause of abdominal symptoms in these patients is the presence of the virus in the digestive system and stimulation of the immune system, followed by the release of inflammatory mediators leading to manifestation of symptoms in this part of the body, causing symptoms of peritoneal irritation. Due to the high physiological stress of surgery, deciding on surgery in patients infected with the virus, who have abdominal pain and a positive abdominal examination is a new challenge for physicians and medical staff. In this study, we introduce three patients with COVID-19 who underwent surgery due to abdominal pain and a positive abdominal examination for peritonitis but had normal findings in surgery, and surgery increased mortality.    گسترش جهانی کرونا ویروس و گزارش های متعدد نشان دهنده تغییر در علائم این ویروس و اضافه شدن علائم گوارشی به بخش مهمی از علائم تشخیصی این ویروس شده است.شایع ترین علائم گوارشی شامل بی اشتهایی و تهوع و استفراغ و درد شکم میباشد. با توجه به استرس فیزیولوژیک بسیار زیاد جراحی، تصمیم گیری در مورد انجام عمل جراحی در بیماران مبتلا به این ویروس با درد شکم و معاینه شکمی مثبت چالش جدیدی برای پزشکان و کادر درمانی است.در این مطالعه ما به معرفی 3 بیمار مبتلا به کرونا ویروس که با علائم درد شکم و معاینه شکمی مثبت از نظر پریتونیت تحت عمل جراحی قرار گرفتند و یافته های نرمال در عمل جراحی داشتند و عمل جراحی باعث افزایش مرگ و میر شد،میپردازی