| 1. |
- Eiriksson, K., et al.
(författare)
-
High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism
- 2011
-
Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 98:6, s. 845-852
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Various recommendations exist regarding intra-abdominal pressure (IAP) during laparoscopic liver resection. A high IAP may reduce bleeding but at the same time increase the risk of gas embolism. This study investigated the effects of two different IAPs during laparoscopic left liver lobe resection in piglets. Methods: Sixteen piglets underwent laparoscopic left liver lobe resection using carbon dioxide pneumoperitoneum of either 8 or 16 mmHg (8 per group). A combination of CUSA System 200 (TM) and LigaSure (TM) instruments was used for parenchymal division. During resection, a standard injury to the left liver vein was also created to increase the risk of bleeding and/or gas embolism during the operation. Heart rate, cardiac output, and arterial, pulmonary arterial, pulmonary capillary wedge and central venous pressures were measured. Arterial blood gases were monitored continuously. Transoesophageal echocardiography was video recorded to detect and quantify gas embolism within the right cardiac ventricle. The duration of operation and bleeding were noted. Results: High IAP resulted in reduced bleeding (P = 0.016), but gas embolism occurred more frequently (P = 0.001) than with low IAP. Gas embolism disturbed gas exchange, with an increase in arterial pressure of carbon dioxide, and a decrease in arterial partial pressure of oxygen and pH. These effects were sustained for at least 30 min after surgery. Conclusion: High IAP reduces the amount of bleeding but increases the risk of gas embolism. Monitoring for gas embolism is therefore indicated if a high IAP is used during laparoscopic liver resection.
|
|
| 2. |
- Eiriksson, Kristinn, 1967-
(författare)
-
Technical Aspects of Laparoscopic Liver Resection. An Experimental Study
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Various techniques are used to transect the liver. With increase in laparoscopic liver resections (LLR), it is of even more interest to develop surgical techniques to minimize bleeding and the risk for gas embolism during transection. Instrument like argon enhanced coagulator provides good hemostasis but increases the danger of gas embolism. The CO2 pneumoperitoneum that is routinely used in most types of laparoscopic surgery can be modified by the use of different gas pressure. It can be assumed that different pressure influences bleeding but also the risk for gas embolism.In presented porcine studies, three instrumental combinations have been studied. In study I sixteen piglets were randomized to LLR with either the cavitron ultrasonic aspirator (CUSA™) in combination with vessels sealing system (Ligasure™) or with CUSA™ and ultrascision scissors (Autosonix™), with the endpoints of intra-operative bleeding and gas embolism. In study IV sixteen piglets were randomized to LLR either with staple device (Endo-GIA™) or the Ligasure™ - CUSA™ combination with same primary endpoints and additionally secondary endpoints of effect on gas-exchange, systemic- and pulmonary hemodynamic.Focusing on intra-abdominal pressure (IAP) in study II, sixteen piglets were randomized to LLR with an IAP of either 8 or 16 mmHg. Primary endpoints were bleeding and gas embolism and secondary endpoints, effect on gas-exchange, systemic- and pulmonary hemodynamic.In study III effect of argon gas was tested during LLR. Sixteen piglets were randomized to either argon pneumoperitoneum or CO2 pneumoperitoneum. Primary endpoints were effect on gas-exchange, systemic- and pulmonary hemodynamic.In presented studies, we tested efficacy and safety of different techniques for LLR. CUSA™ can be used in combination with either Ligasure™ or Autosonix™. However, Ligasure™ reduces the amount of bleeding. The recent introduction of staplers seems promising with a further reduction in bleeding, gas embolism, and operating time. The IAP influences both the amount of bleeding as well as gas embolism. It seems reasonable to use a higher IAP to decrease bleeding with caution and with close monitoring for gas embolism. Argon gas embolism gives more extensive effect on gas-exchange and hemodynamic and should probably be avoided in this type of surgery.
|
|
| 3. |
- Fors, Diddi, et al.
(författare)
-
Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection
- 2012
-
Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 109:2, s. 272-278
-
Tidskriftsartikel (refereegranskat)abstract
- Carbon dioxide (CO2) embolism is a potential complication in laparoscopic liver surgery. Gas embolism (GE) is thought to occur when central venous pressure (CVP) is lower than the intra-abdominal pressure (IAP). This study aimed to investigate whether an increased CVP due to induction of PEEP could influence the frequency and severity of GE during laparoscopic liver resection. Twenty anaesthetized piglets underwent laparoscopic left liver lobe resection and were randomly assigned to either 5 or 15 cm H2O PEEP (n10 per group). During resection, a standardized injury to the left hepatic vein [venous cut (VC)] was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored, and online arterial blood gas monitoring and transoesophageal echocardiography (TOE) were used. The occurrence and severity of embolism was graded as 0 (none), 1 (minor), or 2 (major), depending on the TOE results. No differences were found between the two groups regarding the frequency or severity of GE, during either the VC (P0.65) or the rest of the surgery (P0.24). GE occurred irrespective of the CVPIAP gradient. Mechanisms other than the CVPIAP gradient seemed during laparoscopic liver surgery to contribute to the formation of CO2 embolism. This is of clinical importance to the anaesthetists.
|
|
| 4. |
- Fors, Diddi
(författare)
-
Gas Embolism in Laparoscopic Liver Surgery
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Laparoscopic liver surgery is complicated due to the structure of this organ with open sinusoids. A serious disadvantage is the risk of gas embolism (GE) due to CO2 pneumoperitoneum. CO2 can enter the vascular system through a wounded vein. A common opinion is that gas fluxes along a pressure gradient, e.g. CVP-intra abdominal pressure (IAP). The occurrence of GE could also be eased by entrainment, a ‘Venturi-like’ effect, due to cyclic differences in thoracic pressure and blood flow caused by mechanical ventilation at normal frequency.The aims of these studies were to survey, in a porcine model, the influence on respiratory and haemodynamic variables by GE, to determine at what frequency, severity and duration GE occurs during laparoscopic liver resection (LLR) and whether there are methods to influence the occurrence or severity of GE.Pulmonary and circulatory variables were monitored and measured as well as continuous blood gas monitoring. Transoesophageal echocardiogram was used to identify GE and, according to the amount of bubbles in the right outflow tract of the heart, GE was graded as 0, 1 and 2. Pneumoperitoneum was created by using CO2and IAP was set to 16 mm Hg.A single bolus dose of CO2 influenced respiratory and haemodynamic variables for at least 4 h. During LLR GE occurred in 65-70% of the animals, of which the more serious caused negative influence on cardiopulmonary variables.Elevated PEEP (15 cm H2O) increased CVP but GE occurred irrespective if CVP was lower than or exceeded IAP. In two last studies, a hepatic vein was cut and left open for 3 m before it was clipped. Interestingly, no signs of GE were seen despite an open vein and IAP > CVP in 8 of 20 animals. In the last study high frequency jet ventilation was used in order to minimise the risk of entrainment. The duration of GE was shortened.The occurrence of GE seemed to be influenced by several different factors. The physiological reaction of a GE is impossible to predict for a specific patient, and depends among other factors on comorbidity, and amount, site and entrance rate of GE.
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
- Weineland, Sandra, et al.
(författare)
-
Acceptance and commitment therapy for bariatric surgery patients, a pilot RCT
- 2012
-
Ingår i: Obesity Research and Clinical Practice. - : Elsevier BV. - 1871-403X .- 1878-0318. ; 6:1, s. e21-e30
-
Tidskriftsartikel (refereegranskat)abstract
- Bariatric surgery (BS) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date. Although BS interventions are effective, 20-30% of BS patients start to regain weight within 24 months. Emotional eating is a behavior pattern which has been found to predict poor outcome. The aim of this study is to evaluate the effects of acceptance and commitment therapy (ACT) for patients who underwent BS, with regard to emotional eating, body dissatisfaction and quality of life. This study is a randomized controlled trial (n = 39) with two conditions (1) ACT including two face-to-face sessions and support via an Internet application and (2) treatment as usual (TAU) comprising the standard follow-up used by the BS team. Results show that participants in the ACT condition significantly improve on eating disordered behaviors, body dissatisfaction, quality of life and acceptance for weight related thoughts and feelings, as compared to those in the TAU group. This study shows that it is possible to improve effects of BS by specifically targeting emotional eating behavior.
|
|
