Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

An 81-year-old woman with unintentional salicylate intoxication presented with features of sepsis, abdominal pain, and tenderness. Laparotomy was performed to rule out acute cholecystitis. Anesthesia was complicated by severe hypercarbia despite hyperventilation, and progressive cardiovascular and neurologic deterioration postoperatively. The adverse neurologic, respiratory, and hepatic effects of abdominal surgery and general anesthesia probably potentiated salicylate toxicity and increased patient morbidity. Anesthesiologists should be aware of the protean manifestations of salicylate poisoning and consider it as a cause of "medical abdomen."
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PMID:Anesthesia in a patient with undiagnosed salicylate poisoning presenting as intraabdominal sepsis. 1043 24

A 61-year-old male patient underwent laparoscopic cholecystectomy on diagnosis of acute cholecystitis. Thirteen hours later, bile leakage was noted and a second laparoscopic surgery was performed to rectify this. Severe hypercapnia and acute respiratory acidosis occurred during the act of CO2 pneumoperitoneum. The accumulated CO2 could not be eliminated effectively in spite of deliberate adjustment of the respiratory parameters. We suspected that abnormally high CO2 absorption, which outweighed the capability of physiologic elimination in the presence of acute peritonitis, was the cause of the severe CO2 retention in the second laparoscopic surgery. The patient remained intubated with mechanical ventilatory support after surgery. Excessive internal CO2 was washed out gradually and the patient was extubated successfully the next morning. Profound inflammatory responses in peritonitis may increase permeability and absorption of CO2. Hypercapnia can occur as the store of CO2 in the tissues is saturated and there is continuous inflow of external CO2. It usually takes several hours to achieve a steady state of CO2 elimination after desufflation of CO2 pneumoperitoneum and mechanical ventilatory support may sometimes be needed. In conclusion, caution should be taken against hypercapnia and respiratory acidosis in patients with peritonitis undergoing laparoscopic surgery because of the likelihood of these events occurring during the procedure.
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PMID:Severe carbon dioxide retention during second laparoscopic surgery for urgent repair of an operative defect from the preceding laparoscopic surgery. 1880 23