Navegando por Palavras-chave "Pneumoperitoneum"
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- ItemAcesso aberto (Open Access)Avaliação do posicionamento da agulha de veress durante o estabelecimento do pneumoperitônio pela técnica fechada, em porcos(Colégio Brasileiro de Cirurgiões, 2004-10-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Paiva, Vanessa Carla [UNIFESP]; Delorenzo, Aline; Moreira, Márcia Bento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sociedade Brasileira de Cirurgia Laparoscópica; Hospital do Servidor Público do Estado de São PauloBACKGROUND: To establish reliable evidence regarding the adequate positioning of the tip of a Veress needle in the interior of the peritoneal sac during the establishment of the pneumoperitoneum by the closed technique. METHODS: In 11 pigs, the needle was introduced in the peritoneal sac through the left hipocondrium. Tests of positioning of the tip of the instrument were carried out. Gas (CO2) was injected, and pressures, flows and volumes were registered periodically. The correct intraperitoneal position of the needle was confirmed and, subsequently, removed, being reintroduced in the right hipocondrium and placed under direct vision in the pre-peritoneal space. The same parameters were surveyed. RESULTS: The test of the draining was always positive in the peritoneum. Resistance to the infusion of serum in the peritoneal sac was not observed, but resistance was detected on 45.5% of cases in the pre-peritoneal space. Some serum was recouped in 63.5% of cases in the peritoneal sac and in 54.5% in the pre-peritoneal space. The dripping flowed freely in 66.6% of cases in the peritoneal sac and in 45.5% in the pre-peritoneal space. In the peritoneal sac, = 5mmHg initial pressure increased gradually during 120 seconds until reaching 15 mmHg. In the pre-peritoneal space, the initial pressure was of 15mmHg and oscillated between 12 and 15mmHg. The volume of gas injected was of 1500 ml in the peritoneal sac and of 100 ml in the pre-peritoneal space. CONCLUSION: Initial pressure of ±5mmHg is indicative of the tip of the needle being placed in the peritoneal sac, inside of which there should fit ten times more gas than in the pre-peritoneal space. When the tip of the Veress needle is placed in the interior of the peritoneal sac, the increase of intraperitoneal pressures and volumes can be predicted by statistics.
- ItemSomente MetadadadosBody temperature evaluation during induced pneumoperitoneum with CO2: an experimental study in pigs(Springer, 2012-06-01) Rezende, Marcelo; Prado, Orlando; Bandeira, Cesar; Petri, Andre; Montero, Edna [UNIFESP]; Universidade Estadual de Maringá (UEM); Universidade Federal de São Paulo (UNIFESP)In prolonged laparoscopic procedures, hypothermia is frequently observed. the possible influence of the vasodilating action of CO2, due to its increased levels in the blood during the laparoscopic procedures, has yet to be studied. the objective of this study was, therefore, to evaluate body temperature patterns in pigs subjected to pneumoperitoneum with CO2.Thirty male pigs were allocated into three groups of ten animals each: group I, anesthetic procedure and abdominal puncture only; group II, the same as for group I and insufflation with CO2; and group III, the same as for group I and insufflation with medical grade compressed air. After anesthetic induction and surgical preparation, rectal and esophageal temperatures were measured every 10 min. Blood was collected during the experiment for the gasometric measurement of pCO(2). Animals were insufflated with no gas loss and were kept anesthetized for 180 min. for statistical analysis, Friedman and Kruskal-Wallis tests were used at a level of significance of 95% (P < 0.05).Animals in groups I and II (P = 0.000) had a statistically significant drop in both esophageal and rectal temperatures during the experiment, but not animals in group III. However, when the groups were compared among themselves, no statistically significant differences were found at any of the times measured. A statistically significant drop in pCO(2) levels was observed for groups I and III, but not for animals in groups II.The use of CO2 did not significantly affect body temperature variation in pigs subjected to pneumoperitoneum. However, CO2 produced a temperature drop pattern different than that of compressed air, indicating that CO2 may lead to thermoregulatory changes and influence the peripheral temperature drop.
- ItemAcesso aberto (Open Access)Efeitos da elevação da pressão intra-abdominal e de seu tempo de ação na cicatrização de suturas mecânicas no estômago de cães(Universidade Federal de São Paulo (UNIFESP), 2006) Chaves Junior, Nilson [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetivo: Estudar a fase inicial da cicatrização de uma sutura gástrica confeccionada com grampeador linear cortante, submetida ao aumento de pressão intra-abdominal por pneumoperitônio entre 12 e 14 mmHg, durante sessenta e cento e vinte minutos, comparando-as com a mesma sutura mantida sob pressão atmosférica Métodos: Utilizou-se 30 cães distribuídos em 3 grupos de 10 animais: Grupo I, denominado de controle (sutura gástrica linear cortante), Grupo II (sutura gástrica linear cortante) e aumento da pressão intra-abdominal logo após a sutura por 60 minutos e Grupo III (sutura linear cortante) e aumento da pressão intra–abdominal logo após a sutura por 120 minutos. Todos os cães foram mantidos sob anestesia geral por 120 minutos após a sutura comum aos 3 grupos. Decorridos 7 dias de pós– operatório, avaliou-se os parâmetros macroscópicos do estômago e microscópicos de fragmentos gástricos junto a linha de sutura. Resultados: Na observação macroscópica dos grupos (n=30), não se evidenciou deiscências, fístulas ou abscessos, porém houve presença de aderências do omento em torno dessas suturas em 100% dos animais dos grupos II e III (n=20), mostrando significância estatística quando comparados com aqueles do grupo I (p=0,008*). Os estudos histopatológicos mostraram que os animais do grupo controle (n=10) tiveram todas as fases da cicatrização se desenvolvendo normalmente no final do 7° dia, e quando se comparou os resultados com aqueles animais que estiveram submetidos ao aumento da pressão intra–abdominal, grupos II e III (n=20), notou-se alterações com significância estatística nos testes não paramétricos empregados de parâmetros na fase aguda da cicatrização, tais como: migração de fibroblastos (p=0,011*), edema (p<0,001*) e congestão (p=0,011*), que interferiram na reepitelização do tecido (p<0,001*) portanto, no processo final de cicatrização. Conclusões: As suturas se desenvolveram em estágios evolutivos diferentes, em cada grupo de animais, e aquelas submetidas ao aumento de pressão intra-abdominal tiveram retardo no processo normal de cicatrização. Esses fenômenos foram mais evidentes no grupo que permaneceu por mais tempo sob ação do pneumoperitônio.
- ItemAcesso aberto (Open Access)Estudo das alterações funcionais e morfológicas pulmonares em modelo animal de pneumoperitônio(Universidade Federal de São Paulo (UNIFESP), 2017-02-22) Brandão, Julio Cezar Mendes [UNIFESP]; Oliveira, Itamar Souza de [UNIFESP]; http://lattes.cnpq.br/0568989035666759; Universidade Federal de São Paulo (UNIFESP)Study of functional and morphological pulmonary alterations in an animal model of pneumoperiton. Background: Laparoscopic surgeries require pneumoperitoneum achieved by pressure-controlled insufflation of carbon dioxide into peritoneal cavity. This can change the respiratory mechanics and promotes an oxidative stress. We aimed to assess the effect of different intra-abdominal pressures (IAP) from the pneumoperitoneum in a ventilated rat model with normal lungs. Methods: The animals (n=48) were allocated randomly into 6 groups: Sham group, group without pneumoperitoneum; IAP5 mmHg; IAP8 mmHg; IAP10 mmHg; IAP12 mmHg and IAP14 mmHg. All animals were ventilated during 60 minutes with VT 5 mL/kg, PEEP 2 cmH2O, FiO2 35% and RR 60- 70 bpm. At the end of the experiment the animals were euthanatized and the lungs were removed for analysis. We performed lipid peroxidation, myeloperoxidase activity, cytokines measurements, and histopathologic analysis. Results: The Sham group was lower when compared with other groups in all analysis. TNF-alpha: IAP8 (5.73 pg/mL) was lower when compared with IAP12 (6.32 pg/mL) and IAP14 (7.56 pg/mL) (p<0.001). IAP 12 was lower when compared to IAP14 (p<0.001). IL-6: IAP8 (8.23 pg/mL) was lower when compared to IAP10 (8.91 pg/mL) (p<0.05). IAP10 was lower when compared to IAP12 (9.74 pg/mL) (p<0.01) and to IAP14 (14.57 pg/mL) (p<0.001). IAP12 was lower when compared to IAP14 (p<0.001). Lipid peroxidation: IAP8 was lower when compared to IAP10 (p<0.001), IAP10 was lower when compared to IAP12 (p<0.01). IAP12 was lower when compared to IAP14 (p<0.001). MPO activity: IAP8 (8.23 mU/mL) was lower when compared to IAP10 (8.91 mU/mL) (p<0.05). IAP10 was lower when compared to IAP12 (9.74 mU/mL) (p<0.01), and IAP12 was lower when compared to IAP14 (14.57 mU/mL) (p<0.001). Histological: The tissues from IAP8 rats exhibited low architecture alveolar damage, augment of alveolar septae and neutrophil infiltration, whereas IAP10 and IAP12 groups exhibited alteration in architecture alveolar with septal rupture edema and neutrophil infiltration and the IPA14 exhibited severe septal rupture, edema, diffuse bleeding and neutrophil infiltration. Conclusions: These data demonstrated histological growing changes according to the increase of the intraperitoneal pressure. The biochemical and inflammatory analysis demonstrated increase in the groups with higher pressure. Those findings suggest that the lower pressure protects the lungs from injury after pneumoperitoneum.
- ItemSomente MetadadadosInjuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review(Springer, 2009-07-01) Azevedo, Joao Luiz Moreira Coutinho [UNIFESP]; Azevedo, Otavio Cansancao [UNIFESP]; Miyahira, Susana Abe [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Becker, Otavio Monteiro [UNIFESP]; Hypolito, Octavio Henrique Mendes [UNIFESP]; Machado, Afonso Cesar Cabral Guedes [UNIFESP]; Cardia, Wellington [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Godinho, Lola [UNIFESP]; Almeida, Carlos Eduardo Saldanha [UNIFESP]; Moreira, Camila Hobi [UNIFESP]; Freire, Dalmer Faria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background the aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.Methods Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. the following words were combined: Veress'' or insufflation needle'' or pneumoperitoneum needle,'' and complications'' or injuries'' or lesions.'' the bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).Conclusion the insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
- ItemAcesso aberto (Open Access)O papel do pneumoperitônio na avaliação de parâmetros respiratórios e hemodinâmicos de ratos anestesiados, com ou sem intubação intratraqueal(Colégio Brasileiro de Cirurgiões, 2005-10-01) Botter, Flávia Coelho De Souza [UNIFESP]; Taha, Murched Omar [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Fagundes, Anna Tereza Negrini; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo AmaroBACKGROUND: To investigate hemodynamic and respiratory changes in rats submitted to CO2 pneumoperitoneum or not, under anesthesia with and without endotracheal intubation. METHODS: Male albino rats (n = 40), average weight of 300g, three months aged, were randomized: GA - anesthesia with endotracheal intubation for one hour with CO2 pneumoperitoneum (4mmHg); GB - anesthesia without intratracheal intubation for one hour with CO2 pneumoperitoneum (4mmHg); GC - anesthesia without endotracheal intubation for one hour without pneumoperitoneum; GD - anesthesia with endotracheal intubation for one hour without pneumoperitoneum. Median arterial pressure (MAP- mmHg), heart rate (HR-beat/min), respiratory frequency (RF - rm/min), central venous pressure (CVP - cmH2O), peripheral oxygen saturation (STO2), partial CO2 pressure (PaCO2), arterial bicarbonate (HCO3-), oxygen saturation (SO2) and pH were recorded. Measurements were performed at the begining of the procedure (MO) and after, 30 minutes (M1) and 60 minutes (M2). RESULTS: In GA and GC (groups with CO2 pneumoperitoneum) there was an increase of MAP, PaCO2, HCO3-, HR, CVP and decrease of pH, CO2, STO2 in comparison with those without pneumoperitoneum. On the other hand, endotracheal intubation attenuated these changings during the first hour of anesthesia. CONCLUSION: General anesthesia with endotracheal intubation, associated to CO2 pneumoperitoneum (4 mmHg) during one hour, proved advantageous in hemodynamic and respiratory systems, in relation to the animals with pneumoperitoneum without endotraqueal intubation, and to those within four hour of anesthesia, in spite of intubation.
- ItemAcesso aberto (Open Access)Trombose mesentérica como complicação da colecistectomia videolaparoscópica(Colégio Brasileiro de Cirurgiões, 1998-08-01) Figueira, Antonio [UNIFESP]; Apodaca-Torrez, Franz Robert [UNIFESP]; Colleoni Neto, Ramiro [UNIFESP]; Triviño, Tarcisio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16 mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during penumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it.