RESUMO
Reporte de de un caso de edema pulmonar en el postoperatorio inmediato de uan cirugia laparascópica ginecológica. La etiología del edema pulmonar en este caso no pudo ser determinada con precisión, pero se plantea con precisión, pero se plantearon dos posibles causas que lo explicaran. La primera sería un aumento súbito del retorno venoso luego de la remoción del CO2 de la cavidad peritoneal, lo que a su vez producira una sobre carga de liquidos. La segunda sería un aumento en la permeabilidad capilar pulmonar que podria resultar...
Assuntos
Humanos , Anestesia por Inalação , Anestesia Obstétrica , Pressão Sanguínea , Insuflação , Laparoscopia , Pneumoperitônio/patologia , Edema PulmonarRESUMO
BACKGROUND: Although cardiac tamponade due to pericardial effusion is not frequently seen it may, in many cases require surgical drainage. The aim of this study is to show our experience with a laparoscopic approach to perform the pericardio-peritoneal window in the management of recurrent pericardial effusion. METHODS: We included 16 patients with recurrent pericardial effusion and echocardiographic global tamponade. A pneumoperitoneum was made and 3 trocars were placed; an avascular area of the diaphragm was chosen and a pericardial window was made (4 cm diameter). RESULTS: Pericardial-peritoneal window was carried out successfully (mean operative time 40 min). All patients presented relief of symptoms. The mean follow-up was 729 days. No patient experienced recurrence on repeated ecocardiographic examinations. There were no fatal events related to the procedure. CONCLUSIONS: Laparoscopic pericardial window is a simple, safe, and effective alternative for the treatment of recurrent pericardial effusion with global cardiac tamponade.
Assuntos
Tamponamento Cardíaco/cirurgia , Laparoscopia/métodos , Derrame Pericárdico/cirurgia , Pericárdio/cirurgia , Peritônio/cirurgia , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/complicações , Tamponamento Cardíaco/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pericárdico/mortalidade , Pericárdio/patologia , Peritônio/patologia , Pneumoperitônio/patologia , Recidiva , Estudos Retrospectivos , Instrumentos CirúrgicosRESUMO
BACKGROUND: Pneumoperitoneum may be responsible for ultra-structural alterations in the mesothelium during laparoscopy. To characterize the effect of pneumoperitoneum on the mesothelial cells with CO(2) and compressed air; and to compare to laparotomy and control group (anesthesia only). MATERIALS AND METHODS: Forty C-57 mice were divided in four groups of 10 animals each: CO(2), air, laparotomy, and control group. The animals were submitted to pneumoperitoneum at 8 mmHg during 30 min (CO(2) or compressed air). Five animals of each group were sacrificed 2 and 24 h after the procedure. Fragments of parietal peritoneum were collected and processed for scanning electron microscopy. RESULTS: Control group revealed uninterrupted mesothelial cells, without any evidence of cellular limits; close contact between the cells; absence of intercellular clefts and presence of microvilli. In the laparotomy group, similar results to the control group, with decreased microvilli were noted. Air pneumoperitoneum was associated with alterations in the morphology of the mesothelial cells, clear cellular limits, and cells with spherical and fusiforme formats. CO(2) pneumoperitoneum showed mesothelial cells with clear cellular limits, predominantly spherical cellular format, and intercellular clefts that allowed the visualization of the exposed basal membrane. These alterations were more intense after 24 h. There was a statistical significance between CO(2) group (2 and 24 h) compared to the control group and laparotomy for cellular limits, intercellular clefts and microvilli, P < 0.0001. CONCLUSIONS: Pneumoperitoneum causes damage in the mesothelial ultra-structure, which differs from the laparotomy group. CO(2) pneumoperitoneum is more harmful to the mesothelium than the air.
Assuntos
Laparoscopia/efeitos adversos , Peritônio/patologia , Pneumoperitônio/etiologia , Pneumoperitônio/patologia , Ar , Animais , Dióxido de Carbono , Modelos Animais de Doenças , Epitélio/patologia , Epitélio/ultraestrutura , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Eletrônica de Varredura , Peritônio/ultraestrutura , Pressão , Estresse MecânicoRESUMO
Estudio retrospectivo de un período de 10 años (desde enero de 1992 hasta diciembre de 2001), para evaluar si hay diferencias en complicaciones según la técnica utilizada en la producción del neumoperitoneo en cirugía laparoscópica, determinando los índices de morbilidad y mortalidad asociados a las dos técnicas de abordaje utilizadas en este tipo de cirugía. Se revisaron las historias médicas de 537 casos de intervención con cirugía laparoscópica, en el Hospital Miguel Pérez Carreño; 400 casos de abordaje con aguja de Veress y 137 casos de abordaje por trocar de Hasson. Se observó una tasa de lesión visceral de 1 por ciento y lesión vascular de 0,5 por ciento en el abordaje cerrado; no hubo complicaciones para el abordaje abierto. La mortalidad del abordaje cerrado fue de 0,25 por ciento. No hay diferencias estadísticamente significativas entre ambos métodos. La mayoría de las complicaciones (83,3 por ciento) ocurrieron en el año 1992. Los dos métodos de abordaje laparoscópico poseen similar margen de seguridad.
Assuntos
Humanos , Masculino , Adulto , Feminino , Idoso , Laparoscopia/métodos , Pneumoperitônio/cirurgia , Pneumoperitônio/patologia , Peritônio/lesões , Métodos , Prontuários Médicos , Instrumentos Cirúrgicos , /métodosRESUMO
Objective - To verify the efficacy and safety of compressed air to produce pneumoperitoneum for laparoscopic surgery in pigs for a training program of residence. Methods - Dalland pigs weighing 15-17kg underwent general anethesia and mechanical ventilation. They were divided in 3 groups: A - (38) the pneumoperitnoneum was established with an automatic COZ insufflator, B - (7) as in A except the C02 gas was changed by compressed air, and C - (11) abdomen insufflation was obtained with compressed air directly from hospital pipe network system. Intra-abdominal pressure in all groups was kept between 12 and 15 mmHg. The laparoscopic procedures performed were distributed proportionally among groups: 20 bilateral nephrectomy, 20 dismembered pyeloplasty and 16 partial nephrectomy. Arterial blood sampling for gasometry was obtained before and 2h after establishment of pneumoperitoneum in 5 pigs of group C. Results - The cost of 25 4,5kg COZ container used in group A was R$ 3,150.00 (U$ 1,050.00). The mean length time of surgeries in groups A, B and C were respectively: 181±30rnin, 196±39min e 210±47min (p>0.05). Respiratory alkalosis occurred in 3 out of 5 pigs of group C. No animal exhibited signs of gas embolism or died during surgery. Conclusion - The use of compressed air for laparoscopy in pigs was safe, reduced costs and did not require the use of an automatic gas insufflator.
Assuntos
Animais , Dióxido de Carbono/administração & dosagem , Insuflação/instrumentação , Laparoscopia , Modelos Animais , Pneumoperitônio/patologia , Internato e Residência , Nefrectomia , SuínosRESUMO
A associacao de pneumotorax e pneumoperitonio e rara devido a diferenca de pressao entre o torax e o abdomen que e maior que 40cm H2O, tanto na inspiracao como na expiracao. Neste trabalho, apresentaremos dois casos desta associacao ocorridos na UTI do Hospital d Pronto Socorro de Porto Alegre (HPS), revisando sua fisiopatogenia, diagnostico e terapeutica