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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laparoscopic techniques in general surgery have become a widely accepted method, especially for treatment of symptomatic gallstone disease. Many reports have investigated the indications, contraindications, equipment, techniques and outcome of laparoscopic procedures. However, as yet, relatively few studies have discussed the problems concerning patient's monitoring and care during the postoperative course. In the present paper, the authors review the pertinent literature analyzing the management of the postoperative period after laparoscopic surgery of the upper abdomen. Obviously, most data have regarded cholecystectomy, that is the most frequent procedure. Surgical laparoscopists have utilized knowledge deriving from gynecological experience, but these procedures are generally short and performed on young, otherwise healthy female patients. On the contrary, laparoscopic digestive surgery shows both gastrointestinal and peculiar general problems. These procedures are frequently performed on older patients who may have pre-existing diseases and require longer periods of peritoneal insufflation. During surgery of the upper abdomen, the pneumoperitoneum and the patient's operative position produce haemodynamic and respiratory changes coupled with acid-base disturbances. Intraabdominal hypertension causes a venous stasis along the inferior vena caval territory that can lead to a decrease in cardiac preload and in cardiac output. Usually, a compensatory increase in peripheral vascular resistance ensures normal or mildly high values of arterial tension. Furthermore, a hypercapnia and a mild mixed acidosis can develop as a result of the concomitance of different pathogenetic factors.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative course after laparoscopic surgery of the upper abdomen]. 799 Nov 66

Weight loss reduces many of the health hazards associated with obesity including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, sleep apnea, hypoxemia and hypercarbia, and osteoarthritis. Potential adverse effects of weight loss include a greater risk for gallstone formation and cholecystitis, excessive loss of lean body mass, water and electrolyte problems, mild liver dysfunction, and elevated uric acid levels. Less consequential problems such as diarrhea, constipation, hair loss, and cold intolerance may also occur. The short-term adverse effects are not severe enough to contraindicate weight loss, nor do they outweigh its short-term benefits.
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PMID:Short-term medical benefits and adverse effects of weight loss. 836 5

Although the role of laparoscopic cholecystectomy (LC) as a safe and cost effective procedure has been ascertained, its role in the geriatric population, the majority of whom present with coexistent diseases, has yet to be defined. We retrospectively reviewed outcome parameters of 144 consecutive patients over age 65 undergoing LC, for both acute cholecystitis and symptomatic cholelithiasis. These results were compared with 72 patients having open cholecystectomy (OC) during the same time period and in the year preceding the introduction of LC. Groups were well matched with respect to age, age distribution indication for surgery, and underlying comorbid illnesses. Of those with symptomatic cholelithiasis, LC did not prolong operative time when compared with OC, but resulted in significantly earlier discharge (1.8 +/- 2.9 vs. 6.7 +/- 5.7 days (P < 0.0001)), with comparable hospital costs and with no increase in postoperative complications. With respect to acute cholecystitis, LC significantly prolonged operative time (105.8 +/- 40.8 vs. 78.1 +/- 28.5 minutes (P < 0.05)), but when successful, significantly reduced postoperative stay (4.2 +/- 3.8 vs. 7.5 +/- 2.3 days (P < 0.05)). There was no increase in postoperative complications in those having LC, and hospital costs were comparable with OC. Seven patients were converted from LC to OC; 4 of these (16%) were for acute cholecystitis versus a 2.5 per cent incidence of conversion for symptomatic cholelithiasis, and these resulted in prolonged hospital stays and costs. There was no incidence of hypotension/hypercarbia, despite a 64 per cent incidence of cardiopulmonary cardiopulmonary diseases in those having LC. There was a 14 per cent incidence of cardiopulmonary complications in those having LC in contrast to a 43 per cent incidence in OC. LC in the geriatric population is a safe procedure for symptomatic cholelithiasis. The procedure should be undertaken with caution in those with acute cholecystitis with a low threshold for either early conversion or primary OC. Finally, our results suggest that extensive hemodynamic monitoring is not indicated.
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PMID:Laparoscopic cholecystectomy in the geriatric population. 861 69