Abstract: Anastomotic leaks, stenosis, and bleeding from the gastrojejunal anastomosis (GJA) after gastric bypass may carry high morbidity and mortality. To date, the standard operation with the circular stapler (CS) used the 25 mm with a staple height of 4.8 mm. We present herein our experience with the 3.5-mm staple height.
Abstract: Laparoscopic antireflux surgery is an accepted treatment for persistent gastroesophageal reflux but about 4% of patients will eventually require revision surgery.
Abstract: To date, the dosing of sugammadex is based on real body weight without taking fat content into account. We compared the reversal of profound rocuronium-induced neuromuscular blockade in morbidly obese patients using doses of sugammadex based on four different weight corrections. One hundred morbidly obese patients, scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomly assigned four groups: ideal body weight; ideal body weight + 20%; ideal body weight + 40%; and real body weight. Patients received sugammadex 2 mg.kg(-1), when adductor pollicis monitoring showed two responses. The primary endpoint was full decurarisation. Secondary endpoints were the ability to get into bed independently on arrival to the post-anaesthetic care unit and clinical signs of residual paralysis. There was no residual paralysis in any patient. Morbidly obese patients can safely be decurarised from rocuronium-induced neuromuscular blockade T1-T2 with sugammadex dosed at 2 mg.kg(-1) ideal body weight + 40% (p < 0.0001).
Abstract: Bariatric results expressed in the relative measure excess weight loss (%EWL) vary significantly by initial body mass index (BMI): the heavier the patient, the lower the %EWL. We examine if this variation is caused by using a wrong outcome measure and argue that no relative weight loss measure can express bariatric or metabolic goals unequivocally.
Abstract: Currently, there is no consensus opinion regarding the optimal procedure of choice in super-super-morbid obesity (Body mass index, BMI > 60 kg/m²). Roux-en-Y gastric bypass (RYGB) is associated with failure to achieve or maintain 50% excess weight loss (EWL) or BMI < 35 in approximately 15% of patients. Also, percent EWL is significantly less after 1-year in the super-super-obese group as compared with the less obese group and many patients are still technically considered to be obese (lowest post-surgical BMI > 35) following RYGB surgery in this group. The addition of adjustable gastric band (AGB) to RYGB has been reported as a revisional procedure but this combined bariatric procedure has not been explored as a primary operation.
Abstract: BACKGROUND: The effects of the patient's body position on the intraabdominal workspace in laparoscopic surgery were analyzed. METHODS: The inflated volume of carbon dioxide was measured after insufflation to a preset pressure of 15 mmHg for 20 patients with a body mass index (BMI) greater than 35 kg/m(2). The patients were anesthetized with full muscle relaxation. The five positions were (1) table horizontal with the legs flat (supine position), (2) table in 20 degrees reverse Trendelenburg with the legs flat, (3) table in 20 degrees reverse Trendelenburg with the legs flexed 45 degrees upward at the hips (beach chair position), (4) table horizontal with the legs flexed 45 degrees upward at the hips, and (5) table in 20 degrees Trendelenburg with the legs flat. The positions were performed in a random order, and the first position was repeated after the last measurement. Repeated measure analysis of variance was used to compare inflated volumes among the five positions. RESULTS: A significant difference in inflated volume was found between the five body positions (P = 0.042). Compared with the mean inflated volume for the supine position (3.22 +/- 0.78 l), the mean inflated volume increased by 900 ml for the Trendelenburg position or when the legs were flexed at the hips, and decreased by 230 ml for the reverse Trendelenburg position. CONCLUSIONS: The Trendelenburg position for lower abdominal surgery and reverse Trendelenburg with flexing of the legs at the hips for upper abdominal surgery effectively improved the workspace in obese patients, even with full muscle relaxation.
Abstract: Isolated laparoscopic sleeve gastrectomy is increasingly being used for the treatment of morbid obesity. However, doubts still persist regarding long-term weight loss, and the 5-year results are awaited. Whether the aetiology of failed excess weight loss is the result of an inadequate sleeve or attributable to dilatation of the sleeve is not clear. In an effort to prevent gastric dilatation and increase gastric restriction to promote further weight loss in the long term, we performed a combined procedure of laparoscopic adjustable gastric banding with sleeve gastrectomy. The patient was a 39-year-old woman with a life-long history of obesity and a body mass index of 79.8 kg/m(2). The surgical technique of the laparoscopic adjustable gastric banded sleeve gastrectomy is described. There were no immediate complications, and the patient was discharged home on the third postoperative day. She is doing extremely well on clinic follow-up at 6 weeks. To the best of our knowledge, laparoscopic adjustable gastric banded sleeve gastrectomy, as a primary operation, has not been described in the literature. It is hoped that this combined procedure will be most useful in the super-super obese (body mass index > 60) patients. More patients with a long-term follow-up are necessary to provide definitive conclusions regarding long-term benefits and complications of this combined bariatric procedure.
Abstract: BACKGROUND: Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality. METHODS: We retrospectively analyzed 2,645 patients who underwent FS-LRYGB from May 2004 to August 2008. Operative time, hospital stay and readmission, re-operation, and 30-day morbidity/mortality rates were then calculated. The 30-day follow-up data were complete for 2,606 patients (98.5%). RESULTS: There were 539 male and 2,067 female patients. Mean age was 39.2 years (range 14-73), mean BMI 41.44 kg/m(2) (range, 23-75.5). The mean hospital stay was 3.35 days (range 2-71). Mean total operative time was 63 min (range 35-150). One patient died of pneumonia within 30 days of surgery (0.04%). One hundred and fifty one (5.8%) patients had postoperative complications as follows: gastrointestinal hemorrhage (n = 89, 3.42%), intestinal obstruction (n = 9, 0.35%), anastomotic leak (n = 5, 0.19%) and others (n = 47, 1.80%). In 66 patients, the bleeding resolved without any surgical re-intervention. One hemorrhage resulted in hypovolemic shock with subsequent renal and hepatic failure. CONCLUSION: The systematic approach and the full standardization of the FS-LRYGB procedure contribute highly to the very low mortality and the low morbidity rates in our institution. Gastrointestinal bleeding appears to be the commonest complication, but is self-limiting in the majority of cases. Our approach also significantly reduces operative time and turns the technically demanding laparoscopic Roux-en-Y gastric bypass procedure into an easy reproducible operation, effective for training.
Abstract: Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.
Abstract: During insufflation of the abdomen to create a pneumoperitoneum for laparoscopy, both intra abdominal pressure and insufflated volume can be measured and are used to calculate the abdominal pressure-volume relationship. First, an accurate, linear relationship was identified using a mathematical model with an elastance, E, or its reciprocal the compliance C and with a pressure at zero volume, PV0. This function was stable and could be used to describe the abdominal characteristics of patients. With these characteristics the effects of drugs, position, ventilation can be evaluated. Leakage or absorption of CO2 did not affect the measurements in a second study. In a third study the minimal amount of data needed to determine the parameters of the mathematical model was identified. Three pressure-volume measurements were sufficient to describe all cases.
Abstract: A case of an epitheloid angiosarcoma of the splenic capsula is reported. This tumour developed in close relation to a gauze sponge, which was accidentally left behind 38 years earlier during a left-sided nephrectomy. The tumour probably arose from pluripotential mesothelial stem cells within the splenic capsula, with subsequent mesothelial to endothelial metaplasia and neoplastic transformation. Clinical, radiological, peroperative and pathological features of this angiosarcoma add to the validity of the concept of inert foreign body tumorigenesis.
Abstract: A 72-year-old-female presented intermittent retrosternal pain, heartburn and dysphagia. Computerized CT-Scan showed a large mass with a cross-sectional diameter of 5 cm at the lateral side of part II of the duodenum. The preoperative histology was unclear. The tumour was successfully removed by laparoscopic approach.
Abstract: Benign mature teratomas account for approximately 10-15% of all ovarian neoplasms. Many patients with these dermoid cysts are asymptomatic. The most frequent complication is torsion of the teratoma (in 3,5% of the cases). In a 26-year female patient admitted for severe, acute abdominal pain, a computerized abdominal tomography in accordance with the clinical characteristics of the abdominal examination, was highly suggestive for a torsion of a teratoma. The diagnose was confirmed by a celioscopic operative approach and the teratoma with the left tubo-ovarian complex was successfully removed laparoscopically.
Abstract: BACKGROUND: Thoracoscopic-assisted pulmonary resection for lung cancer is controversial. The appropriateness of this approach has to be compared with the golden standard of an open resection. METHODS: This study consists of 66 patients with a clinical stage 1 disease. A thoracoscopic exploration was executed in 41 patients. Only in 16 cases was a thoracoscopic resection finally possible. The clinical and pathological TNM classification, the histological types and the surgical procedure are reported. The reasons for conversion are documented. RESULTS: To investigate the appropriateness of the thoracoscopic approach we evaluated only the pathologically proven stage 1 disease in both groups. Postoperative complications, hospital stay and survival are compared. CONCLUSION: Until now we can conclude that there is no adverse effect on survival because of the thoracoscopic approach.
Abstract: The efficacy of computed tomography (CT) and mediastinoscopy as staging modalities to assess mediastinal lymph node status was evaluated in 569 patients with a presumed resectable non-small cell lung cancer (NSCLC). Computed tomography scan was performed in every patient and followed by mediastinoscopy in 331 and by thoracotomy in 477 patients. Mediastinal lymph nodes on CT larger than 1.5 cm were considered pathological. Overall, CT had a sensitivity of 69%, a specificity of 71% and an accuracy of 71% in identifying mediastinal lymph node metastases. For mediastinoscopy these figures were 72%, 100% and 89%, respectively. Computed tomography accuracy was distinctly lower in squamous cell carcinomas and in central tumors, as CT sensitivity was significantly lower in left-sided tumors. The positive predictive value (PPV) of CT in T1 lesions (29%) and PPV and negative predictive value (NPV) of CT in T2 squamous cell carcinomas (30% and 83%, respectively) were low, so questioning its use in those instances. We perform a mediastinoscopy in every situation except for squamous cell carcinomas or small (less than 3 cm) peripheral tumors in the absence of enlarged mediastinal lymph nodes. This selective attitude is rewarding since a) the number of pN2 in the straight thoracotomy group was only 16% versus 41% in the mediastinoscopy group, b) the exploratory thoracotomy rate in the straight thoracotomy group was low (4.6%).
Abstract: In coronary artery bypass grafting, we prefer the right gastroepiploic artery as an adjunct to the internal mammary arteries, due to its comparable size to the mammary artery, flow, length, freedom of atherosclerosis, pharmacologic responses, and patency rate. No major gastric complications after the use of the gastroepiploic artery have been reported yet. We report gastric perforation due to excessive coagulation of side branches of the gastroepiploic artery supplying the greater curvature of the stomach.
Abstract: Barrett's carcinoma occurred in 66 of 331 patients with adenocarcinomas of the esophagus or gastroesophageal junction. Only 32 (46%) of these patients had a history of gastroesophageal reflux. A history of alcohol and tobacco abuse was absent in 50% and 47.5%, respectively. The mean length of Barrett's metaplasia was 7.37 cm. Operability was 98.5% and resectability 95.5%. No postoperative or hospital deaths occurred. Pathologic staging was as follows: stage 0 and I, 38.3%; stage II, 20.6%; stage III, 22.2%; and stage IV, 19%. Overall survivals were 80.5% at 1 year, 62.7% at 2 years, and 58.2% at 5 years. Five-year survival for patients with stage I disease was 100%; for stage II, 87.5%; for stage III, 22.2%; and for stage IV, 0%. Thirty-four (51.5%) patients were under surveillance for a related or unrelated condition before diagnosis of their carcinoma; only nine (26.5%) had diseased lymph nodes. In 32 the diagnosis was made at their first medical contact, and 78% of them had diseased lymph nodes. Five-year survival without nodal metastasis was 85.3% and significantly better than for patients with metastasis, 38.3% (p = 0.0033). Of the 66 patients, 19 (28.7%) had a biopsy-proved history of Barrett's metaplasia before malignancy developed. Mean time interval between diagnosis of metaplasia and degeneration was 3.8 years (89.5% > 1 year). Over the surveillance period, the length of metaplastic Barrett's esophagus remained unchanged in all patients. Barrett's ulceration was present from the beginning in 14 patients, and three patients never had an ulcer. Intestinal metaplasia was seen in 18 patients. Resected specimens revealed severe dysplasia in 16 patients. Of the 19 patients, 73.7% had stage I disease. Our data suggest that close endoscopic monitoring and systematic biopsies of the smallest irregularities in the metaplastic mucosa may result in early detection of carcinoma. In this respect, patients with an ulcer within a zone of intestinal metaplasia seem to be at risk. Early detection increases substantially the chances for cure by diminishing the risks of lymph node involvement. Resection remains the treatment of choice in Barrett's adenocarcinoma including high-grade dysplasia, because mortality can be kept low with excellent to very good functional results in the majority of the patients provided the intervention is performed by experienced teams.
Abstract: Primary nonparasitic splenic cysts are very rare. Clinical manifestations vary but are often not very typical. Ultrasound and computed tomography are of use for establishing diagnosis. A microscopic examination of the surgical specimen is the only way to make the diagnosis of an epidermoid cyst. The histological characteristic of an epidermoid cyst is the presence of an epidermoid epithelial cyst lining of the inner surface. Treatment requires surgery and is necessary to prevent serious complications. Spleen saving surgical procedures are advocated. We present two cases of young patients with a large epidermoid cyst of the spleen who were operated on. On one patient, we had to perform a splenectomy because of the size and central localization of the cyst with compression of the splenic pedicle. On the other patient we managed to perform a partial splenectomy.
Abstract: An improvement in surgical working space is achieved by positioning the patient so that the lowest abdominal pressure is achieved at a given volume. A low abdominal pressure is also important to facilitate pulmonary ventilation. However, it is not known whether a position with low abdominal pressure also lowers airway pressure and improves lung compliance.
The goal of this study was to measure the difference in airway pressure associated with different positions using an analysis of variance on repeated measurements. In 10 patients scheduled for bariatric surgery the abdomen was inflated to 3 L using the abdominal pressure volume relationship (APVR) as previously described and with approval of the hospital ethical committee. Abdominal pressure, peak airway pressure and lung compliance were measured with the thorax horizontal with the legs flat and flexed, the thorax in the reverse trendelenburg position with the legs flat and flexed, and thorax in the trendelenburg position with the legs flat while the volume was kept constant. All patients were volume ventilated at 14 respirations per minute with a positive end expiratory pressure (PEEP) of 5 cmH2O. The tidal volume was adapted to achieve an end-tidal PCO2 of 40 mmHg and kept constant during the measurements.
Conclusion: The reverse trendelenburg position with the legs flexed provided the greatest lung compliance, which differed significantly from the compliance in other positions. The horizontal position with the legs flexed provided the second highest lung compliance. The trendelenburg position was associated with a significant reduction in lung compliance.
1. J.P.Mulier, B Dillemans, A Vanlander, K Verbeke Volume instead of pressure controlled abdominal insufflation in morbid obese patients. Obes Surg 2007 Suppl IFSO
Abstract: Having a sufficient abdominal inflation volume at the lowest possible abdominal pressure is important in obese patients to improve the surgical working space. We calculated the ideal abdominal pressure to achieve a working space of 3 L. It is not clear whether changes in the patient’s position change the volume of the working space. The goal of this study was to measure the change in abdominal elastance (E) or pressure at zero volume (PV0), indicators of abdominal volume, associated with a change in the patient’s position.
The abdominal pressure volume relation was measured as previously described. (1) This measurement was taken in 10 patients with approval of the hospital ethical committee with the thorax horizontal and the legs horizontal or flexed, the thorax in the reverse trendelenburg position and the legs horizontal or flexed, or the thorax in the trendelenburg position. E and PV0 were calculated for each position and an analysis of variance was performed on repeated measurements..
Flexing the legs significantly lowered E from 3.6 to 2.6 mmHg/L without affecting the PV0. Reverse trendelenburg increased PV0 by 0.7 mmHg and trendelenburg insignificantly decreased PV0 by 0.3 mmHg without affecting E.
The ideal position, the trunk horizontal and the legs flexed, increased the abdominal volume by 1000 ml at 15 mmHg in comparison with the horizontal position without leg flexion; reverse trendelenburg without leg flexion, the worst position, decreased the volume by 200 ml.
Conclusion: When reverse trendelenburg is needed to give the surgeon access to the upper abdomen it should be minimal and the legs should be flexed as much as possible to maximize the surgical working space.
1. J P Mulier B Dillemans T Declercq The linearity of the abdominal pressure volume relation. Acta Clinica Belgica, 2007:62 (suppl 1)
Abstract: A dedicated anesthetist and good peri-operative care are important but not enough.
Surgeons should be aware of various parameters of anesthesia that can make a difference during surgery.
1. Proper positioning lowers the risk of difficult intubation to the risk associated with normal intubation. Use of an inflatable pillow to facilitate positioning during intubation is simple and effective.
2. Use muscle relaxation but be aware that the monitoring at the thumb does not correlate well with abdominal relaxation. Know that muscle relaxants have no effect on the abdomen in some patients and that the abdomen of a woman who has not been pregnant is small.
3. Position the patient with maximal flexion of the legs. This facilitates lung ventilation and abdominal inflation. Horizontal positioning of the table further improves abdominal inflation while the reverse trendelenburg position is preferable for lung ventilation.
4. Measure the abdominal pressure volume relation in the reverse trendelenburg position with the legs flexed. Inflate the abdomen to reach a volume of 3 L. Keep this pressure constant.
5. Ventilate with positive end-expiratory pressure (PEEP) using the pressure controlled mode if airway pressure is too high. Use a recruitment maneuver only briefly if saturation is below 90 and immediately maintain with PEEP.
6. Allow the end-tidal PCO2 to rise above 40 mmHg. This prevents volutrauma, facilitates ventilation, improves microcirculation and wound healing and keeps blood pressure elevated.
7. Keep blood pressure elevated at the end of the procedure when all staple lines are evaluated to minimize the risk of post operative bleeding. Know how to position a gastric tube properly (the more rigid and thicker the easier to position) and perform a leak test with volume load.
8. Give inhalation anesthetics at a high concentration (2 Mac) to improve muscle relaxation at the end of the operation when full relaxation is not possible before awakening.
9. Start pressure support ventilation at the end of the procedure with an initially high support. Lower the support level when the abdomen is deflated, when muscle relaxation is reversed and when the patient awakens. The pressure support mode accelerates weaning from the ventilator.
10. A short surgical time is important. Early extubation and sitting up improves outcome. If a patient cannot breathe enough, do not delay (re) intubation and ventilation. Use non invasive support ventilation if possible.
Abstract: Many anesthetists are reluctant to anesthetize morbidly obese patients because the risk of difficult intubation is higher than in non-obese patients. Morbid obesity also increases the risk of a patient having retained gastric contents that can be aspirated. Proper positioning is suggested to decrease the difficulty of intubation, but positioning heavy patients with pillows or sandbags is challenging and time consuming and therefore not easy to execute.
We developed an easy to position, inflatable bag, the “safety birdâ€, that elevates and rotates the thoracic spinal column. The patient can lay on it uninflated before induction. During induction the bag is inflated with a manual bulb until laryngoscopy reveals the best tracheal view. CT images of 3 patients who were difficult to intubate (group A) were compared with those of 5 patients who were easy to intubate (group B) with approval of the hospital ethical committee. The angle between the trachea and the hypopharynx was greater than 30° in group A and less than 30° in group B. Simple elevation of the head, known as the sniffing position, reduced the angle sufficiently in group B In group A, the sniffing position was not effective and elevation of the upper thorax with the “safety bird†was needed to reduce the angle below 30°. A study with more patients is needed to validate CT imaging as a preoperative screening test for diagnosing difficult intubation.
Conclusion: The measurement of the tracheal-hypopharyngeal angle and its reduction by the sniffing positioning and inflation of the “safety bird†can help facilitate intubation. Proper positioning may reduce the risk of intubating morbidly obese patients to the level associated with non-obese patients.
Abstract: The measurement of the abdominal pressure volume relation (APVR) gives information on compliance and its reciprocal, elastance (E). The APVR is linear under clinical situations, allowing for easy calculation of compliance. The relationship is easily quantified with only a few points of measurement; which show the effects of medications and be used to compare patients.
Two parameters, E and the pressure at zero volume (PV0) describe the linear relationship. PV0, the pressure at zero inflated volume, varies between 0 and 10 mmHg. Muscle relaxants and the trendelenburg position decrease the PV0. A high BMI increases the PV0. Positive end-expiratory pressure (PEEP) and high tidal volume change the PV0 if measured during inspiration. E varies widely between patients, from 1 to 5 mmHg/L. Children and small persons have a high elastance due to their size. Woman who have been pregnant two or more times have a lower E due to elongation of fascia, while older persons have a higher E due to decreased elastine levels. Flexion of the legs changes the E while table position affects PV0.
It is difficult to calculate the E and PV0 before surgery. The bladder pressure is different from the abdominal pressure and use of a gastric balloon is too complicated. During the initial abdominal inflation the measurement of E and PV0 can be used to calculate the ideal inflation pressure for each patient. Under muscle relaxation and with the ideal positioning, a working volume at the lowest inflation pressure can be achieved. This facilitates pulmonary ventilation and CO2 removal. Persons with a very low E can be identified. They have a high risk of overdose with muscle relaxants. New techniques are being developed to improve the surgical working space during laparoscopy in these patients.
Abstract: During mechanical ventilation a high end-tidal PCO2 increases cardiac output and improves microcirculation in obese patients.(1) The goal of this study was to accept a higher end-tidal PCO2 and to measure the effect on ventilation and vasopressor use Twenty obese patients with a BMI above 40 who underwent bariatric surgery received pressure controlled ventilation (PCV) at a rate of 14 respirations/min and a positive end-expiratory pressure (PEEP) of 5 cmH2O with approval of the hospital ethical committee. The adapted pressure was set to achieve an end-tidal PCO2 below 40 mmHg in one group and below 60 mmHg in the other group. To evaluate the comparability of the groups, each patient received volume controlled ventilation (VCV) before PCV, at a tidal volume of 500 ml, a rate of 14 respirations/min, and a PEEP of 5 cmH2O while the plateau airway pressure was measured. During PCV the following parameters were measured: the adapted minute volume, the airway pressure, the end-tidal PCO2 and the amount of ephedrine injected to keep the systolic arterial pressure above 140 mmHg during inspection of the staple line. These parameters were compared between the groups using a non paired t test. Oxygen saturation measured by pulse oximetry, switching to spontaneous breathing and awakening time were also compared. There were no significant differences in BMI, age and airway pressure during VCV between the groups. Minute volume ventilation, airway pressures and ephedrine use were significantly higher in the group with low end-tidal PCO2. Ventilation at a high end-tidal PCO2 is possible. Cardiac output was not measured but was probably higher as less ephedrine was needed to elevate the blood pressure. In the group with the high end-tidal PCO2, oxygen saturation was not lower, and spontaneous breathing and awakening occurred more rapidly. We conclude that there is an advantage in slight hypoventilation in obese patients during a pneumoperitoneum with CO2.
1. Hager H. Hypercapnia improves tissue oxygenation in morbidly obese surgical patients.
Anesth Analg. 2006 Sep;103(3):677-81.
Abstract: Being alert and fully awake and having muscle force is important for obese patients after laparoscopic bariatric surgery. However, the time to close after laparoscopy is short compared to laparatomy. If pressure support ventilation can be started before the end of the laparoscopy, end tidal PCO2 can rise without having a patient breathing against the ventilator. The purpose of this study was to verify whether pressure support ventilation (PSV) is possible after a leak test and before full decurarisation. A secondary purpose was to compare PSV and pressure controlled ventilation (PCV) in terms of the total dose of muscle relaxants and the time between the end of surgery and extubation.
Thirty patients with a BMI above 40 who underwent gastric bypass surgery were randomly assigned to receive PCV until spontaneous breathing resumed or PSV after the leak test with approval of the hospital ethical committee. Cisatracurium and sufentanil were given as clinically required; desflurane was given above 1 Mac and the concentration was reduced before the end of surgery. All patients were given neostigmine 0,5 mg after abdominal deflation. Patients with a non elastic abdomen needing more than 15 mmHg to achieve a 3 L inflated volume were excluded.
All 15 patients assigned to receive PSV underwent the transition to this ventilator setting quickly and easily. The average T4 stimulation at the moment of the leak test was 1.4 in the PSV group versus 0.6 in the PCV group. There was significantly more cisatracurium (32 mg ± 4) used in the PCV group than the PSV group (23 mg ± 2). There was no difference in the dose of sufentanil. End tidal PCO2 was significantly higher in the PSV group than the PCV group ( 54 mmHg ± 10 vs 44 mmHg ± 6 ) and the assisted breathing did not disturb the surgical field. The mean time between end of surgery and extubation was significantly shorter in the PSV group than the PCV group (3 ± 2 minutes vs. 5 ± 6 minutes). Conclusion. PSV at the end of laparoscopic surgery is possible, accelerates the awakening and facilitates the extubation.
