China
Africa
Explore chapters and articles related to this topic
Additional Pre-operative Considerations and Techniques
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Danette Wright, Charlotte Ralston, Dominic Slade
PPP was first described in 1947 by Goni Moreno and is sometimes referred to as the Goni Moreno procedure.54 It was used for several decades as an adjunct to help achieve primary fascial closure at surgery for ‘giant’ hernias, well before prosthetic mesh and biological grafts were easily available.34,54,55 PPP is a preparatory procedure for hernias associated with a significant loss of domain (Figure 6.12a and b). It helps to achieve primary fascial closure by gradually expanding the volume of the abdominal cavity, lengthening the abdominal wall muscles, and generating a gradual chronic abdominal compartment syndrome that the patient can accommodate in a manner akin to women accommodating the gradual increase in abdominal pressure due to pregnancy. Additionally, by slowly increasing intra-abdominal pressure, respiratory adaptation occurs because diaphragmatic excursion is reduced forcing the patient to overcome the reduced inspiratory capacity. Finally, the synergistic effects of the air pushing between adhesions and gravity acting on hernia contents suspended by their adhesions leads to lysis which aids subsequent surgery.
Respiratory system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The patient is moved into a lateral decubitus position to facilitate lateral and anterior access (Fig. 4.23c). The anterior approach may be made using the right lobe of the liver and the spleen as acoustic windows for the respective right and left basal areas and diaphragmatic domes. This may be useful to see diaphragmatic excursion. The probe is placed on the anterior abdominal wall just below the costal cartilages and rib cage on either side of the trunk. Multiple views are obtained using a combination of transverse, parasagittal and oblique sections, with the transducer angled cranially. The patient should take deep breaths, during which the extent of movement can be assessed visually on the ultrasound monitor; M mode is useful to demonstrate and record any movement of a collapsed lung.
Complications of Laparoscopy in General Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
James G. Bittner, J. Esteban Varela
Pneumoperitoneum alters ventilation parameters and gas exchange. One of the most common alterations is an increase in airway pressures. This increase results from a decrease in diaphragmatic excursion and lung and chest wall compliance [1]. Clinically, peak- and end-inspiratory pressures increase by as much as 30%–40% above baseline with insufflation pressures of 10–15 mmHg [1–3]. Measured respiratory compliance decreases by approximately 35% as a result of pneumoperitoneum. Airway pressures rapidly return to normal levels after the release of the pneumoperitoneum. Therefore, the surgeon should immediately discontinue the inflow of insufflation and evacuate the existing pneumoperitoneum whenever any untoward ventilatory or hemodynamic changes occur.
Effects of high-dose L-carnitine supplementation on diaphragmatic function in patients with respiratory failure: A randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2023
Waleed Abdalla, Mona A. Ammar, Asmaa Ali, Dina Ragab, Mohamed Taeimah
In the low-dose group, L-carnitine was administered intravenously at a dose of 6 g/day to maintain normal levels (a normal level of serum L-carnitine is in the range of 34–78 nmol/mL)[8]. In the high-dose group, a continuous intravenous infusion of 18 gm/day of L-carnitine was administered to raise plasma levels to double their normal levels in the high-dose group[7]. Serum levels of L-carnitine were measured on days 0 (before L-carnitine was administered), 3, and 7. A sample of 1 mL of blood was collected in a sodium heparin tube, which was then subjected to centrifugation for 10 minutes. L-carnitine levels in the plasma were determined by enzyme-linked immunosorbent assay (ELIZA). Ultrasound assessments of diaphragmatic function were performed on days 0, 3, and 7 using a Hitachi Aloka Prosound Ultrasound System (Hitachi, Ltd., Higashi-Ueno, Taito-Ku, Tokyo, Japan). The ultrasound footage was preserved for analysis and comparison purposes. The assessments measured diaphragmatic excursion (DE) and diaphragm thickness (DT). Two-dimensional or M mode ultrasonography with a 2.5–6 MHz low-frequency curved probe was used to measure the excursion of each hemidiaphragm (Figures 1A, B). DT was measured using B-mode ultrasonography and a 6–13 MHz high-frequency linear probe. For the latter, measurements were taken at the end of inspiration and expiration, and the diaphragmatic thickening fraction (DTf) was determined (Figures 1C, D). The primary outcome of the study was diaphragmatic function on day 7, as determined by the ultrasonography assessment.
The fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate and increased respiratory muscle function in patients with upper abdominal surgery: a randomized controlled trial
Published in Annals of Medicine, 2022
Yu-Ting Huang, Yih-Jyh Lin, Ching-Hsia Hung, Hui-Ching Cheng, Hsin-Lun Yang, Yi-Liang Kuo, Pei-Ming Chu, Yi-Fang Tsai, Kun-Ling Tsai
Next, we investigated whether IMT affects diaphragm function in patients who underwent upper abdominal surgery. Due to the surgery wound, the diaphragm ultrasonography could be performed only at Timepoint 1 and Timepoint 4. Table 5 shows that the baseline values of the diaphragmatic excursion were not significantly different between the CTL group and the IMT group. The CTL group showed a significant decline in the baseline values one week after discharge (Timepoint 1 vs. Timepoint 4: 52.0 vs. 25.3, p = .002). The IMT group preserved the capability of diaphragmatic excursion after IMT intervention (p = .06). At Timepoint 4, the diaphragmatic excursion was significantly higher in the IMT group than in the CTL group (CTL vs. IMT: 25.3 vs. 37.5, p = .012). The M-mode images of the diaphragmatic excursion are shown in Figure 3. Regarding the diaphragm thickening fraction, there was no significant difference between the CTL group and the IMT group, either within or between the groups. The M-mode images of the diaphragm thickening fraction are shown in Figure 4.
Diaphragmatic ultrasound in weaning ventilated patients: a reliable predictor?
Published in Expert Review of Respiratory Medicine, 2022
Khalil El Gharib, Marc Assaad, Michel Chalhoub
Ultrasound is gaining popularity in critical care because of its ease, safety, the dynamic results obtained instantaneously, and its reproducibility, at least intra-individually [1]. And when applied to diaphragmatic function and dynamics, two sonographic predictors can be been deduced, aiding in the characterization of dysfunction [8]: the diaphragmatic excursion (DE), which measures the distance that the diaphragm can move during the respiratory cycle, and the diaphragm thickening fraction (DTF), which reflects variation in the thickness of the diaphragm during respiratory effort and is calculated as (thickness at end-inspiration – thickness at the end-expiration)/thickness at the end of expiration [1,4]. Diaphragmatic ultrasound can retrieve these two entities using the M-mode, when the probe is placed in the right midline of the axillary and the left axillary posterior line, on a supine patient [9], proportional assist ventilation allowing diaphragmatic effort to be estimated best [10].