European Journal of Molecular & Clinical Medicine

Background:  Laparoscopy has been used as a therapeutic as well as a diagnostic tool in pelvic and abdominal surgeries. Present study was aimed at to study correlation of acid base and blood gas changes during laparoscopy and effects of various insufflating agents comparing Carbon Dioxide with Nitrous Oxide at a tertiary care hospital. Material and Methods: Present study was hospital based, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. Results: We compared effects of pneumoperitoneal insufflating agents among 2 groups of 35 patients each as Group N (Nitrous oxide as the insufflating agent) versus Group C (carbon dioxide as the insufflating agent). The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet the increase in the tissue oxygen demand, it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in both the groups, with numerically high values in Group C. The PeCO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂. Though the rises of the PaCO2 and fall in pH were statistically significant, they did not reach hazardous level. Group N (14.28 %) had more incidences of nausea and vomiting as compared to Group C (5.71 %).
Conclusion: Nitrous oxide appears to be the most suitable insufflating agent, used to produce pneumoperitoneum as compared to carbon dioxide, with general anaesthesia for laparoscopic surgeries.

Spontaneous rupture of gangrenous uterus with generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract which makes preoperative diagnosis difficult. A correct and definite diagnosis can be made with laparotomy or laparoscopy.  We report a case of a 55-year-old lady who presented with generalized peritonitis with pneumoperitoneum. This report aims to alert surgeons to the possibility that perforation of uterus due to gangrene with anaerobic infection also shows air under diaphragm apart from hollow viscus perforation

Background: Laparoscopy involves the visualization of abdominal and pelvic organs after creating an artificial pneumoperitoneum. Present study was aimed at to study effects of various insufflating agents during general anaesthesia and correlation of acid base and blood gas changes during laparoscopy to determine ideal insufflating agent amongst CO₂, O₂ and N₂O at a tertiary hospital. Material and Methods:  Present study was single-center, comparative study, conducted in female patients from age group of 20-40 years in ASA Class – I/ II undergoing diagnostic laparoscopy and laparoscopic tubal ligation. 105 patients were divided in three groups of 35 patients each as Group- I (oxygen as the insufflating agent), Group II (Nitrous oxide as the insufflating agent) & Group III (carbon dioxide as the insufflating agent).Results: Mean age, body weight & types of procedures were comparable among all groups & no significant statistical difference was noted. The blood gas analysis showed a rise in PaO₂ and O₂ saturation, due apparent rise mainly to the FiO₂. Though the PaO₂ is adequate to meet in increased the tissue oxygen demand it is inconsistent with the FiO₂ (33%) delivered. The post operative and oxygen saturation came back to their pre-operative values. The PaCO₂ was significantly higher intra-operatively in all the three groups, with a numerically high value in Group III. The PECO₂ followed the trend of PaCO₂ and the fall of pH was consistent with the rise in PaCO₂.  Though the rise of the PaCO₂& fall in pH was statistically significant, they did not reach hazardous level. The Group I had the highest incidence of nausea and vomiting (88.57 %) followed by Group II (14.28 %). Conclusion:         Nitrous oxide appears to be the most suitable amongst the three gases; Oxygen, Nitrous oxide and carbon dioxide, with general anaesthesia.

Background: Multiple agents are used for laparoscopic cholecystectomy since laparoscopic cholecystectomy is routinely performed surgery and desirable to have a stable intraoperative hemodynamic status by avoiding hypotension, hypertension or tachycardia. The search for ideal agent is still ongoing, alpha -2 adrenergic agonist have created interest in manner. So, the present study was conducted to compare the beneficial effect of clonidine and dexmedetomidine during laparoscopic cholecystectomy in maintain perioperative cardiovascular stability.
Methods: The present double blind randomized, prospective clinical study was carried out among patients scheduled for elective laparoscopic cholecystectomy under general anaesthesia for a duration of 2 years. The sample size was calculated as 90 using formula: n=4pq/d² and were divided equally into groups A (control), group B (clonidine) and group C (dexmedetomidine). Preanesthetic assessment of all the selected patients were done with complete history, general examination, airway assessment, systemic examination along with laboratory investigations. During perioperative period, hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded various intervals.
Results: Increase in heart rate was statistically insignificant in all the groups at baseline (B) and just after induction (D0).After infusion of drugs, increase in heart rate was significantly lower in all the intervals in Dexmedetomidine group and Clonidine group comparing with Control group.On comparing dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in DBP were observed at all intervals except at 30 minutes after pneumoperitoneum (APN30) and after reversal(DBP_AR).While comparing Dexmedetomidine group with clonidine group, insignificant fall (p>0.05) in SBP and MAP were observed at all intervals except at 50 minutes after pneumoperitoneum (APN50).While comparing Clonidine with Dexmedetomidine, significantly decrease heart rate was observed in dexmedetomidine group.
Conclusion: Creation of pneumoperitoneum in laparoscopic abdominal surgeries produces significant increase of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). During pneumoperitoneum in laparoscopic abdominal surgeries both intravenous clonidine and intravenous dexmedetomidine results to attenuate in all hemodynamic parameters (HR, SBP, DBP and MAP) During pneumoperitoneum in laparoscopic surgeries heart rate is better controlled by dexmedetomidine.

Background: Nowadays laparoscopic surgery is going to be the first choice for surgical management of various indications, especially with the well-trained laparoscopic surgeon. The benefits of minimal access techniques include less pain, early mobilization, shorter hospital stay, and better cosmetic results, which have further increased its applications. The aim of this study to compare the efficacy of intravenously administered clonidine and magnesium sulfate on hemodynamic stress response during laparoscopic surgeries.
Materials& Methods: This is a prospective randomized study done on 50 ASA physical status I and II subjects in the age group of 20-60 years planned for elective laparoscopic surgeries with CO2 pneumoperitoneum were enrolled in department of anesthesia at American International Institute of Medical Sciences, Udaipur, Rajasthan, India during one year period. They were randomly allocated to one of the two study groups, Group C (Clonidine group) and Group M (Magnesium group).Group CPatients were given a solution containing clonidine 1.5 μg/kg (group C) in 50 ml of normal saline over a period of 15 min and Group MPatients were given a solution containing magnesium sulfate 50 mg/kg in 50 ml of normal saline over a period of 15 min. The parameters like Systolic blood pressure, Diastolic blood pressure, mean arterial Blood pressure, heart rate and SPO2 were recorded.
Results: The mean value of age was 39.25 years in group C and 42.78 years in group M, which was statistical not significant (P>0.05). The comparison of mean value of body weight and duration of surgery was statistical not significant (P>0.05). Hemodynamic changes such as Systolic blood pressure, Diastolic blood pressure, mean arterial Blood pressure, heart rate and SPO2 was statistical nonsignificant in different time interval. Statistically significant difference observed in the Modified Ram say sedation scale between the two groups. Clonidine found to have significantly lesser sedation than magnesium at the time of extubation.
Conclusion: We concluded that intravenous administration of clonidine 1.5μg/kg before pneumoperitoneum is as effective as intravenous magnesium sulfate 50mg/kg before pneumoperitoneum in blunting the haemodynamic stress responses during laparoscopic surgeries and clonidine has lesser sedation than magnesium at extubation.

Background: The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstones. The present study was conducted to compare high- and low-pressure carbon dioxide pneumoperitoneum in patients undergoing laparoscopic cholecystectomy (LC).
Materials & Methods: 80 patients undergoing laparoscopic cholecystectomy were divided into 2 groups of 40 each. In group I, the pneumoperitoneum with PaCO2 of 7–10 mmHg and in group II with 12–14 mmHg using standard four-port method was used. Abdominal pain at the site of surgery and shoulder-tip pain were assessed based on the verbal rating scale (VRS). Parameters such as arterial blood pressure, heart rate, and body temperature were recorded during and 1 hour, 6 hours, 12 hours and 24 hours after the surgery.
Results: The mean abdominal pain was 7.8, 6.3, 5.2 and 4.5 and in group II 6.4, 4.1, 5.0 and 2.9 at 1 hour, 6 hours, 12 hours and 24 hours in group I and group II respectively. Nausea/vomiting score was 5.9, 4.5, 3.8 and 2.5 in group I and 4.7, 3.7, 2.6 and 2.1 in group II respectively. Shoulder tip pain in group I was 6.4, 4.6, 3.7 and 2.9 in group I and 6.0, 4.4, 3.2 and 1.9 in group II respectively. The difference was significant (P< 0.05).
Conclusion: Low pressure pneumoperitoneum was found to be betterthan high pressure pneumoperitoneum in patients with laparoscopic cholecystectomy.