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D S de Vega

Publications and source records attributed to D S de Vega.

4 recordsLinked to original sources
PubMed1997

Acid-base balance alterations in laparoscopic cholecystectomy.

BACKGROUND: The purpose of this study is to determine alterations of acid-base balance originated by pneumoperitoneum with CO2. Influence of other factors such as anesthetic technique, duration of procedure, and volume of CO2 insufflated has also been analyzed. METHODS: Some 132 patients were divided in three groups according to anesthetic technique used. Arterial blood gases were determined before pneumoperitoneum, at 20 min after it, and every 30 min, until procedure's end, and in postoperative period up to a total of four samples. RESULTS: Pneumoperitoneum originated a fall of pH (p << 0. 001), ion bicarbonate (p << 0.001), and base excess (p << 0.001) and an elevation of PaCO2 (p << 0.001). No correlation was found between these changes and duration of pneumoperitoneum or amount of CO2 insufflated. Changes were fundamentally of a metabolic type. There were no statistically significant differences among anesthetic techniques. CONCLUSIONS: In conclusion, pneumoperitoneum with CO2 originates alterations of the acid-base balance, mostly of a metabolic type. This could mean that besides CO2 absorption, there is a tissular hypoperfusion due to the increase of abdominal pressure.

Abdomen↗
PubMed1997

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques].

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.

Adult↗
PubMedDate not supplied

DNA content by flow cytometry in gastric carcinoma: pathology, ploidy and prognosis.

BACKGROUND/AIMS: The prognostic relevance of histopathologic findings in gastric carcinoma is well established. Studies on DNA-ploidy are still scanty and contradictory. METHODOLOGY: Histopathologic parameters, DNA ploidy and S-phase were evaluated in 78 cancer patients curatively resected, using formalin-fixed paraffin-embedded tissue. RESULTS: Thirty-nine tumors (50%) were aneuploid. No significant correlation was found between histologic data and ploidy, but tumors with nodal involvement were more frequently aneuploid. In univariate analysis, tumor location (p=0.05), tumor size (p=0.01), differentiation grade (p=0.02), Lauren classification (p=0.01), deeper infiltration of gastric wall (p=0.001), nodal affectation (p=0.0000) and number of lymph nodes (p=0.01), TNM stage (p=0.0000), type of gastrectomy performed (p=0.04), and DNA ploidy (p=0.04) significantly influenced survival. S-phase values had no effect on prognosis. In the multiple regression model, factors independently associated with survival were TNM stage (p=0.0009), nodal affectation (p=0.01) and, marginally, ploidy (p=0.08). CONCLUSIONS: In gastric carcinoma curatively resected, the more relevant prognostic factors were stage and nodal involvement. Fifty percent of the tumors were aneuploid. Aneuploidy was significantly associated with poorer prognosis.

Adult↗