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Evidence-based Practice and Quality Improvement

Patients safety during laparoscopic operations

1AP4-3

Marinchev, V.; Vasilkov, V.; Osinkin, D.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 16-16
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Background and Goal of Study: The main problem of an anaesthesiologist is to defend the patients from surgical agression by safe and adequate anaesthesia. Cardiovascular responces to peritoneal insufflation of CO2 in laparoscopic cholecystectomy (LCHE) is wellknown. How is EEG changed in this time? Goal of study is to make a comparison of hemodynamics and cerebral responses (changes in bispectral index) during LCHE.

Patients and methods: After Ethics Committee approval, 59 patients ASA 1 - 2, scheduled to undergo LCHE. Mean age 43,7 ± 2,5, 70% from them were women. All patients were screened before the operation according the programme of our clinic. Anaesthesia standartised: induction with Propofol (1-2mg/kg), Fentanyl (1,5-2μg/kg), Atracurium (0,3-0,5 mg/kg). Anaesthesia was maintained with Sevoflurane (up to 1 - 1,3 MAC) and Fentanyl (1 μg/kg). Patients were ventilated with low flow oxygen. Monitoring: SBP, DBP, ECG, HR, SpO2, etCO2 and Sevoflurane concentration. BIS monitoring by “ASPECT A-1000”. Hemodynemic (CO, SV, SVR et others) investigated by noninvasive bioimpedance method. Statistical analysis was performed using Students t test and results were expressed as mean ± standart deviation.

Results and Discussion:

1. The most significant changes in hemodynemic occurred after peritoneal insufflation of CO2 and transfered the Patients to anti-Trendelenburg 30°.

2. The base thoracic impedance was reduced and indicated of accumulation fluid in the chest.

3. Correction of arterial hypotension should be done by inotropic drugs, but i.v. fluids should be restricted.

4. We registreted decreasing BIS-index and some hemodynemic parameters (CO, SV, CI) after hypotension.

5. BIS-monitoring helped to reduce consumption of drugs for general anaesthesia and decreased incidence of postoperative nousea and vomiting by 15%.

6. BIS- index is most close connected with expiration concentration of sevoflurane - coefficient of correlation (r) - 0,71.

Conclusion: The study demonstrated that the use of standarted anaesthesia (Propofol + Fentanyl + Sevoflurane) with monitoring hemodynamics and BIS-index in LCHE can be successfully and safety performed.

© 2013 European Society of Anaesthesiology