Laparoscopic Colectomy
Conditions
Keywords
ventilation; intracranial pressure; laparoscopy
Brief summary
Patients who undergo laparoscopic surgery often experience increased intracranial pressure (ICP). In laparoscopic colectomy surgery, the duration always exceeds 2h with more liability to changes in arterial blood gases, hemodynamics, also the patient is in Trendelenburg position about 30° head down, Trendelenburg position is believed to create changes in hemodynamics, respiratory mechanics, metabolic response, and ICP as it affects vital organs especially if steep positioning. Various modes of mechanical ventilation have been experimented to achieve good intraoperative oxygenation which may cause changes in arterial blood gas values and hemodynamic parameters that might lead to changes in the ICP. In this study we will measure ONSD, basal, intraoperative, and in the PACU to evaluate the effect of different ventilation modes (both VCV mode and PCV-VG mode) on intracranial pressure.
Detailed description
The aim of the current study is to compare the effect of volume control ventilation (VCV) versus pressure control ventilation-volume guaranteed (PCV-VG) as modes of mechanical ventilation on ICP by US guided ONSD measurement during laparoscopic colectomy,
Interventions
DEVICEVolume control ventilation group
Volume control ventilation mode
DEVICEPressure control ventilation-volume guaranteed group
Pressure control ventilation-volume guaranteed mode
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
21 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Body mass index less than 30 * American Society of Anesthesiologist physical class I -III.
Exclusion criteria
* Patient refusal * operative time \< 2 hour (h) * Patients with preexisting eye disease. * History of eye surgery * Optic nerve disease. * Causes of elevated ICP.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in ONSD O(optic) N(nerve) S(sheath) D(diameter) | Changes from baseline, till 30 minutes after recovery from anaesthesia | ONSD is the acronym of O(optic) N(nerve) S(sheath) D(diameter), that ONSD is a non invasive method for measurement of intracranial pressure The optimal cutoff value has not been established, they vary between 4.85 and 5.9 mm and \>5.9 mm is a sure sign of increased intracranial tension |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | Changes from baseline, till 30 minutes after recovery from anaesthesia | is allowed to swing within 20% of the basal value |
| Mean arterial blood pressure | Changes from baseline, till 30 minutes after recovery from anaesthesia | is allowed to swing within 20% of the basal value |
| Peak airway pressure | intra-operative changes from time of induction of anesthesia and intubation (post induction), till the end of surgery (before extubation). | Peak airway pressure values should not exceed 30 cm H2O. Values greater than 40 cm H2O may be harmful to the normal lung. Peak pressure applies when there is airflow in the circuit, i.e.the maximum pressure during inspiration . What determines the peak pressure is the airway resistance in the lungs. So if there is a problem with the airways the peak pressure will rise. |
| Plateau airway pressure | intra-operative changes from time of induction of anesthesia and intubation (post induction), till the end of surgery (before extubation). | Plateau pressure is the pressure applied to small airways and alveoli during positive-pressure mechanical ventilation.when there is no air flow in the circuit. That is when inspiration is complete. This pressure is determined by the lung compliance. So it follows that if there is a problem with the compliance the plateau pressure will rise. Plateau pressure is measured during an inspiratory pause on the mechanical ventilator. Pplat is never bigger than PIP and is typically \<10 cm H2O lower than PIP when airway resistance is not elevated. |
| Dynamic Lung compliance | intra-operative changes from time of induction of anesthesia and intubation (post induction), till the end of surgery (before extubation). | dynamic lung compliance Cdyn = VT / (PIP - PEEP)…..change in volume/change in pressure, where airflow resistance becomes a factor. which ranges physiologically in adults between 50 - 80 ml/cm H2O while for intubated, mechanically ventilated adults is about 30 to 40 ml/cm H2O |
| mean airway pressure | intra-operative changes from time of induction of anesthesia and intubation (post induction), till the end of surgery (before extubation). | mean airway pressure typically refers to the mean pressure applied during positive-pressure mechanical ventilation. Mean airway pressure correlates with alveolar ventilation, arterial oxygenation, hemodynamic performance, and barotrauma |
| pH | Changes from baseline, till 30 min after recovery from anesthesia. | PH ranges normally between 7.35 - 7.45 when \>7.45 it is alkalosis when \<7.35 it is acidosis |
| PaCO2 (carbon dioxide tension) | Changes from baseline, till 30 min after recovery from anesthesia. | PaCo2 which ranges normally between 35 -45 mmHg it increase above 45 with causes of hypercapnia as hypoventilation and insufflation with Co2 and decrease below 35 with hypotension, hypo-perfusion and excessive hyperventilation Normal PaCO2-EtCO2 difference is 2-5 mmHg |
| Headache | for 24 hour after surgery | the severity of headache will be recorded using visual analogue score (where 0 = no pain and 10 = worst pain imaginable), mild headache pain will be defined by scores 1-4, moderate; by scores 5-7, and severe; by scores 8-10. |
| Postoperative nausea and vomiting | for 24 hour after surgery | Nausea will be explained to all patients, where ( 0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, 3 = severe symptoms ) and also the incidence of vomiting will be recorded by asking a questionnaire to all patients; is vomiting present or absent. |
| PaO2 (partial pressure of arterial oxygen) | Changes from baseline, till 30 min after recovery from anesthesia | PaO2 should= FiO2 x 500 (e.g. 0.21 x 500 = 105 mmHg) |
| Static Lung compliance | intra-operative changes from (post induction) just after induction of anesthesia and intubation, till the end of surgery (before extubation). | static compliance and dynamic compliance static lung compliance....Cstat = VT/ ( Pplat - PEEP) ….change in volume/change in pressure when there is no air flow..... The physiological Cstat for adult is 70 - 100 while for intubated, mechanically ventilated adults is about 50 to 60 ml/cm H2O |
Countries
Egypt
Contacts
Primary ContactHanaa M El Bendary
Backup ContactDoaa G Diab
Outcome results
None listed