The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study

Background: It is recommended to heat and humidity CO2 in laparoscopic surgery to prevent postoperative pain and hypothermia but information about its effects on hemodynamic and respiratory parameters is limited. We aimed to investigate the effects of standard and heated-humidified CO2 on hemodynamic and respiratory parameters, body temperature and pain in healthy patients. Methods: One hundred patients who underwent total laparoscopic hysterectomy for benign pathology were divided into two groups: Group CD (cold-dry) patients were administered standard CO2, while Group HH (heated-humidified) patients were administered 95% humidified insufflation at 37 degrees C. Hemodynamic and respiratory parameters, body temperature, pain score and blood count parameters were recorded. Results: A total of 96 patients were included in the study, taken from the 100 patients. Group HH (n:47) had only higher systolic blood pressure at 75, mean blood pressure at 50 and 55 and a lower heart rate between 15 and 45 min (p:0.049, 0.037, 0.013 respectively). Pain score, morphine consumption, end-tidal CO2 and arterial blood gas values were not different between the groups, with only body temperature from 40 min and minimum value being significantly higher (at a difference of 0.86-1.04 degrees C) in Group HH. Postoperative leukocyte, neutrophil and NLR (neutrophil-leukocyte ratio) were found to be higher in this group (p 0.05). Conclusion: It has been found that both standard and heated-humidified CO2 do not constitute a problem in terms of hemodynamic and respiratory parameters in healthy patients. The heated-humidified CO2 group had only a higher core body temperature and inflammatory response. (C) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

WOS: 000458367000008PubMed ID: 30761854Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SIT), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects. Conclusion: SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia

The Effects of Different Pressure Pneumoperitoneum Models Created By Standard or Heated-Humidified CO2 Insufflation on Ovary and Peritoneum: an Experimental Study in Rats

There is still controversy over whether structural and morphological changes can be observed in tissues depending on the carbon dioxide (CO2) nature or the applied intra-abdominal pressures (IAP). This study aimed to investigate the effects of different pressure or CO2 nature used for pneumoperitoneum in gynecological laparoscopic surgery on inflammation, DNA damage, oxidative stress, and histopathological changes in ovarian and peritoneal tissue. For this purpose, forty female rats were randomly divided into 6 groups and different pneumoperitoneum models were created in these groups. Rats in group other than control and sham groups received standard (CD) or heated-humidified CO2 (HH) insulations at low (4 mmHg) or high pressure (8 mmHg). The ovary and peritoneum sections were evaluated microscopically for apoptotic index (API) and API scoring was calculated. Tissue and plasma interleukin-6 (IL-6), tumor necrotizing factor-alpha (TNF-alpha), anti-Mullerian hormone (AMH) and 8-hydroxydeoxyguanosine (8-OHdG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). The most severe changes occurred in the 8CD group microscopically, while the least severe changes occurred in the 4HH group. All histopathological parameters except for ovarian apoptotic index and peritoneal PCNA at low pressure were higher in the CD group. TNF-alpha and 8-OHdG levels were higher in the CD group at both low and high pressures. Standard CO2 caused more prominent histopathological changes at high pressures and systemic inflammation in both pressure groups. The least change between the experimental study groups in terms of histopathological and biochemical was observed in the low-pressure heated-humidified group.This study was supported by the Ege University Scientific Research Projects Coordination Unit (grant number: TGA-2019-20808 (to Ilkben Gunusen)).Ege University Scientific Research Projects Coordination Unit [TGA-2019-20808

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients