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At least 145 records · Page 8Linked to original sources

PubMed2002

Impact of laparoscopic CO2-insufflation on tumor-associated molecules in cultured colorectal cancer cells.

BACKGROUND: Laparoscopic CO2-insufflation is believed to stimulate proliferation and metastatic potential of gastrointestinal carcinomas. E-cadherin, I-CAM1, I-CAM2, and CD44 are involved into the metastatic process of different cancer cell lines. The current study investigates the influence of CO2-insufflation on the expression of E-cadherin, I-CAM1, I-CAM2, and CD44 in vitro. METHODS: CX-2 and CC531 colon carcinoma cells (human/rat) were exposed to pneumoperitoneal CO2-insufflation. E-cadherin, I-CAM1, I-CAM2, and CD44 were measured 0, 12, 24, 48, and 72 h after CO2-insufflation using flowcytometry. Control groups were exposed to room air. Data were analyzed by the Wilcoxon-Mann-Whitney U-test. RESULTS: Both cell lines showed significant alteration in E-cadherin, I-CAM1, and CD44 expression after CO2 exposure (p <0.05). No significant differences were found regarding I-CAM2 expression. CONCLUSION: The present study demonstrates CO2-insufflation to influence the expression of E-cadherin, I-CAM1 and CD44. Whether these changes increases the metastatic potential of colorectal cancer cells in vivo needs further investigation.

Adenocarcinoma↗

PubMed2001

Helium and other alternative insufflation gases for laparoscopy.

BACKGROUND: Carbon dioxide (CO(2)) is currently the insufflation gas of choice for laparoscopy. It fulfills most of the requirements for an ideal insufflation gas, being colorless, noninflammable, and rapidly excreted from the circulation. However, its use is associated with adverse cardiorespiratory effects, especially in patients with preexisting cardiorespiratory compromise. METHODS: The descriptive review of relevant literature, moreover, has been proposed that it increases the incidence of port site (wound) metastases from abdominal cancers when used during oncological surgery. In addition, it may cause postoperative pain due to peritoneal irritation, and its use is associated with physiological and immunological impairment. Hence, there is scope for the investigation of alternative insufflation gases. Other possibilities include gasless laparoscopy, helium, nitrous oxide, (N(2)O), and argon. Helium insufflation has been used extensively in animal models but only to a limited extent in humans. In experimental studies, it has been shown to produce fewer changes in cardiorespiratory and intraperitoneal immunological status than CO(2) insufflation, and its use is associated with less spread of tumors to port sites in a variety of small animal tumor models. However, helium also has the potential for some adverse effects. Helium pneumothorax probably resolves more slowly than CO(2) pneumothorax, and helium gas embolism is tolerated poorly in animal models. The clinical significance of these potential problems has yet to be determined. CONCLUSIONS: Although the use of alternative gases appears to be promising, further evaluation is needed within both clinical and laboratory settings before their routine clinical use can be supported.

Abdominal Neoplasms↗

PubMed1993

Effects of insufflation on hemodynamics during thoracoscopy.

Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.

Animals↗

PubMed1989

Continuous oxygen insufflation in addition to IPPV causes air trapping in a mechanical lung model.

It has previously been reported that continuous insufflation of either supracarinal or subcarinal oxygen in addition to intermittent positive-pressure ventilation (IPPV) in patients under general anesthesia, and in critically ill patients in the intensive care unit, causes increased proximal airway pressure, decreased systemic blood pressure, and decreased cardiac output. The investigators hypothesized that these deleterious hemodynamic effects were due to intrapulmonary air trapping, resulting in an increased distal intrapulmonary pressure and volume. The purpose of this study was to test this hypothesis in an appropriate mechanical lung model. The study determined end-inspiratory and end-expiratory lung pressures and volumes during eight experimental sequences: (1) IPPV alone; (2) insufflation of oxygen alone at 2.5, 5.0, and 10.0 L/min (O2-2.5, 5.0, 10.0); (3, 4, and 5) IPPV plus insufflation of oxygen (IPPV + O2-0.0, 2.5, 5.0, 10.0) through a supracarinal catheter (sequence 3), subcarinal catheters (sequence 4), and through a CO2 sampling port of an endotrachael tube (sequence 5); (6 and 7) IPPV + O2-5.0 with increased expiratory time caused by an increased inspiratory flow rate (sequence 6) and a decreased respiratory rate (sequence 7); (8) IPPV + O2-5.0 with increased airway diameter. Experimental sequences 1 and 2 resulted in no increases or minimal ones in lung pressure and volume, respectively. With each insufflation catheter system (sequences 3, 4, and 5), each incremental increase in insufflation flow rate resulted in significant increases in lung pressure and volume. Increasing expiratory times (sequences 6 and 7 compared with 3, 4, and 5) decreased lung pressure and volume. Increasing the airway diameter (sequence 8) had only slight effect on lung pressure and volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗

PubMedDate not supplied

Evaluation of a technique of nitrogen insufflation to decrease plastic endotracheal tube cuff flammability during carbon dioxide laser surgery.

STUDY OBJECTIVE: To determine whether nitrogen insufflation reduces the laser-induced combustibility of polyvinyl chloride (PVC) endotracheal tube cuffs. SETTING: Research laboratory of a metropolitan, university-affiliated medical center. DESIGN AND INTERVENTIONS: A plastic catheter was fastened along the shafts of 10 PVC endotracheal tubes with self-adhesive copper foil tape down to a level just above the cuff. The modified endotracheal tubes were inserted into graduated cylinders and flushed with oxygen. The cuffs were then inflated with air, and a carbon dioxide (CO2) laser was aimed at them. Five of the modified endotracheal tubes had 10 L/min of nitrogen insufflated via the plastic tube. MEASUREMENTS AND MAIN RESULTS: The laser ignited only 1 of the cuffs insufflated with nitrogen; however, all 5 of the modified endotracheal tubes that were not insufflated burned (p < 0.05). CONCLUSION: Nitrogen insufflation decreases CO2 laser-induced PVC endotracheal tube cuff combustibility. However, clinical applications of this technique should be undertaken with caution, as the administration of a hypoxic mixture may be possible.

Carbon Dioxide↗

PubMedDate not supplied

Effect of body habitus and parity on insufflated CO2 volume at various intraabdominal pressures during laparoscopic access in women.

STUDY OBJECTIVE: To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO2 pneumoperitoneum during laparoscopic access in women. DESIGN: Prospective observational cohort study (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital. PATIENTS: From January through June 2004, 100 healthy women underwent operative laparoscopic surgery consecutively by the senior author (GAV). Indications were: chronic pelvic pain (CPP, n = 66), pelvic mass (n = 7), CPP and pelvic mass (n = 4), infertility (n = 23). Median (range) height, weight, BMI, parity and age were 1.65 m (1.45-1.85 m), 70 kg (43-118 kg), 25.5 kg/m2 (17-39 kg/m2), 1.1 (0-5), and 34 years (19-58 years), respectively. INTERVENTIONS: While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO2 volume was serially recorded at intraperitoneal insufflation pressures (IPIPs) of 10, 15, 20, 25, and 30 mm Hg. The primary 10-mm trocar was introduced at IPIP of 30 mm Hg. Upon entering the peritoneal cavity, the abdominal contents were visualized with the laparoscope to ensure there was no injury, and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg before switching the patient to the Trendelenburg position. MEASUREMENTS AND MAIN RESULTS: The mean (SD) insufflated CO2 volumes at 10, 15, 20, 25, and 30 mm Hg were 1.7 (0.74) L, 3.1 (0.9) L, 3.96 (1.05) L, 4.42 (1.1) L and 4.72 (1.14) L, respectively. Using multivariate analysis, we demonstrated that at 20 to 30 mm Hg the insufflated CO2 volume correlated positively with the height, weight and BMI of women. Parity correlated positively at all pressures. There was no correlation with age at any pressure. CONCLUSIONS: Higher CO2 volume is required to establish appropriate pneumoperitoneum in tall, overweight, and parous women at 20 to 30 mm Hg. Setting the IPIP at 20 to 30 mm Hg before primary trocar insertion eliminates the need to monitor CO2 insufflated volume regardless of women's age, parity, and body habitus.

Abdominal Cavity↗

PubMed1995

Direct needle insufflation for pneumoretroperitoneum: anatomic confirmation and clinical experience.

OBJECTIVES: The feasibility and safety of direct needle insufflation to create pneumoretroperitoneum was assessed by an imaging study and clinical experience. METHODS: A total of 10 patients without previous retroperitoneal surgery or diseases received computed tomography scans of the retroperitoneum 2 cm above the iliac crest. Distances between quadratus lumborum and colon (Q-C distance) were measured in the supine and lateral positions. Changes of Q-C distance were calculated when the patient was changed from the supine to the lateral position. Operative charts on 38 retroperitoneoscopic procedures were collected prospectively to assess complications related to direct needle insufflation, which was performed by inserting a 14 G Veress needle blindly along the posterior axillary line 2 cm above the iliac crest. RESULTS: Q-C distance increased from 8.7 to 27.3 mm (left side) and 4.6 to 18.1 mm (right side) when the patient was changed from the supine to the lateral position, both P values < 0.05. An average distance of 23 mm between colon and quadratus lumborum was found when patients were lying laterally. The misplacement of a Veress needle was encountered in 1 patient, in which a prefascia insufflation resulted in conversion of the endoscopic procedure. Needle puncture caused no visceral or great vessel injury. CONCLUSIONS: Significant anterior movement of the colon was found when patients were changed from the supine to the lateral position. It provided a window for inserting the Veress needle blindly into the retroperitoneum. The high success rate (97%) and low complication rate of direct needle insufflation were found in actual clinical applications. We considered needle insufflation a safe and effective method of establishing a pneumoretroperitoneum for any retroperitoneoscopic procedure.

Adult↗

PubMed2002

Toomey syringe aspiration may be inaccurate in detecting esophageal intubation after gastric insufflation.

We sought to determine whether gastric distention from air insufflation affects the accuracy of the Toomey syringe in detecting esophageal intubation. We conducted a randomized, single-blinded, crossover trial using human cadavers in which cuffed endotracheal (ET) tubes were placed into the esophagus and trachea. Operators used the Toomey syringe to determine the location of the ET tube before and after gastric insufflation via Ambu-bag ventilation. Greater amounts of air were aspirated (35.4 cc vs. 13.7 cc, respectively, p < 0.001) and less resistance was noted on a five-point scale (3.2 vs. 4.8, respectively, p < 0.001) from esophageally placed ET tubes after gastric insufflation. Sensitivity in detecting esophageally placed ET tubes decreased from 100% in noninsufflated cadavers to only 58% after gastric insufflation (p < 0.001). In the thawed fresh frozen cadaveric model, the Toomey syringe was unreliable in detecting an esophageal intubation after gastric distention insufflation.

Adult↗

PubMed2001

Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation.

OBJECTIVE: Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects of coronary snaring with looped sutures and gas insufflation on the coronary endothelium. The protective efficacies on the coronary endothelium of coronary snaring with elastic sutures or humidified gas insufflation with/without heparin and dipyridamole-added were also tested. METHODS: Thirty-six mongrel dogs were used. After systemic heparinization (150 U/kg), a 5 mm longitudinal coronary incision was made with looped non-elastic monofilament sutures or elastic sutures applied proximally and distally. The incised coronary artery was exposed to non-humidified carbon dioxide, humidified carbon dioxide with lactated Ringer solution, or humidified carbon dioxide with heparin and dipyridamole-added lactated Ringer solution for 10 or 20 min in each group. After gas insufflation, the incised coronary artery was repaired, then, the coronary was reperfused. Perfusion-fixation was done for observation of the coronary endothelium by scanning electron microscopy. The adverse effect on the endothelium was graded as follows: grade 1, appeared normal; grade 2, few blood cells deposited; grade 3, many blood cells deposited; grade 4, few endothelial cells delaminated with blood cells deposited; grade 5, many endothelial cells delaminated with blood cells deposited. RESULTS: Non-elastic looping caused much more endothelial tears than elastic looping (P<0.00001). Non-humidified gas blowing for 20 min caused more endothelial cell damage than humidified gas blowing (P=0.00005). Non-humidified gas blowing for 10 min caused less damage than for 20 min (P=0.00326), but still caused more damage than humidified gas blowing (P=0.00253). Heparin and dipyridamole-added humidification reduced coronary endothelial area mottled by the deposited cells when compared with simple humidification (P=0.00120). CONCLUSIONS: Coronary snaring resulted in coronary endothelial injury, which was ameliorated by using elastic sutures instead of non-elastic sutures. Non-humidified gas insufflation made blood cells deposited and endothelial cells delaminated with time. Humidified gas insufflation attenuated these adverse effects. Heparin and dipyridamole-added humidification had potential advantage in terms of reducing deposited blood cells on the endothelium over simple humidification.

Animals↗

PubMed2000

Haemodynamic changes during thoracoscopic surgery the effects of one-lung ventilation compared with carbon dioxide insufflation.

We investigated the haemodynamic and respiratory effects of one-lung ventilation and carbon dioxide insufflation in 13 adult patients undergoing video-assisted thoracoscopy. Cardiorespiratory variables were determined during carbon dioxide insufflation at intrahemithoracic pressures of 5, 10 and 15 mmHg, and after 5 and 15 min of one-lung ventilation. Carbon dioxide insufflation was associated with a clear deterioration in circulatory function. The cardiac index decreased subsequent to increasing intrathoracic pressures. The mean cardiac index (SD) at pressures of 10 and 15 mmHg was 1.86 (0.39) and 1.52 (0.46), respectively, and may be compared with the reduced venous return consistent with tension pneumothorax. One-lung ventilation did not affect haemodynamic variables but reduced arterial oxygenation indices (PaO2/FIO2) from 424.29 (160.79) after induction of anaesthesia, to 207.72 (125.50) after 5 min and 172.04 (72.03) after 15 min of one-lung ventilation, respectively. The oxygenation index was not influenced by intrahemithoracic carbon dioxide insufflation. One-lung ventilation via a double-lumen endobronchial tube is safe and convenient for video-assisted thoracoscopic surgery. It has no further consequences on haemodynamic variables, whereas the compression of the lung by carbon dioxide insufflation may cause circulatory dysfunction.

Adult↗

PubMed2001

Analgesic effectiveness of subcutaneous carbon-dioxide insufflations as an adjunct treatment in patients with non-specific neck or low back pain.

OBJECTIVES: To evaluate the analgesic effectiveness of subcutaneous carbon-dioxide insufflations in addition to standard physical treatment in patients with non-specific neck or low back pain. DESIGN: A pragmatic, randomized controlled trial. SETTING: Rehabilitation hospital inpatients. INTERVENTIONS: Patients received either subcutaneous carbon-dioxide insufflations (10 treatments) and standard physical treatment or standard physical treatment only. OUTCOME MEASURES: Affective pain perception (42-point scale), sensory pain perception (30-point scale), pain intensity (100 mm visual analogue scale). RESULTS: Between-groups differences were -2.2 [95% CI -5.2; +0.9] (affective pain perception), -1.2 [-3, 0; + 0.7] (sensory pain perception), and -6.5 [-14; +1.0] (pain intensity) respectively in favour of subcutaneous carbon-dioxide insufflations. CONCLUSIONS: Subcutaneous carbon-dioxide insufflations do not seem to be a worthwhile adjunct in the given setting of inpatient rehabilitation. Trials in a monotherapeutic setting, which aim more at the efficacy of subcutaneous carbon-dioxide insufflations, might help to solve this issue.

Aged↗

PubMed2004

Effects of intraperitoneal and extraperitoneal carbon dioxide insufflation on blood gases during the perioperative period.

The aim of this study was to evaluate the effects of intraperitoneal and extraperitoneal CO2 insufflation on blood gases during and after laparoscopic surgery. Forty patients were included in this study. Twenty patients underwent elective laparoscopic cholecystectomy with intraperitoneal insufflation (intraperitoneal group) and 20 patients underwent laparoscopic inguinal hernia repair with extraperitoneal insufflation (extraperitoneal group). Arterial blood gases were analyzed at four points: 10 minutes after induction, 10 minutes after insufflation, 10 minutes after desufflation, and 30 minutes after the operation in the recovery room. PaCO2 values in the intraperitoneal group at the four points were 36.8 +/- 4, 39.6 +/- 5.9, 40.7 +/- 4.4, and 42.3 +/- 4.8 mm Hg; in the extraperitoneal group, 35.8 +/- 3.9, 37.4 +/- 4, 42.8 +/- 6.6, and 46.2 +/- 5.9 mm Hg. In the extraperitoneal group, there was a significant increase in postoperative PaCO2 compared to the desufflation PaCO2. In our study, extraperitoneal CO2 insufflation caused increases in PaCO2 values that started perioperatively and continued in the postoperative period.

Adult↗

PubMed1991

The persufflator: an insufflation device for laparoscopy and especially for CO2-laser-endoscopic surgery.

A new insufflation device for laparoscopic surgery has been developed which permits the persufflation of the abdominal cavity with humidified CO2 at 37 degrees C, with flow rates of 4 l/min/mm of mercury (3 l/min/cm of water) insufflation pressure, i.e. 60 l/min for an insufflation pressure of 15 mm of mercury (20 cm of water). The device consists essentially of an operative laparoscope with a large side opening of 7 mm internal diameter, and a pressure valve limiting the insufflation pressure. The device is safe, since the intraabdominal pressure can never exceed the insufflation pressure. The device has been extensively tested in greater than 500 CO2-laser-endoscopic procedures and has proven to be safe and useful. Smoke can be constantly removed and the pneumoperitoneum is unaffected even by the removal or leakage of large volumes of CO2 from the pneumoperitoneum.

Endoscopes↗

PubMed1996

Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible.

Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.

Abdomen↗

PubMed1997

Respiratory mechanics, gastric insufflation pressure, and air leakage of the laryngeal mask airway.

A potential risk of the laryngeal mask airway (LMA) is incomplete mask seal, which causes air leakage or insufflation of air into the stomach. The objective of the present study was to assess respiratory mechanics, quantify air leakage, and measure gastric air insufflation in patients ventilated via the LMA. Thirty patients were studied after induction of anesthesia but prior to any surgical manipulations. After the insertion of the LMA, patients were ventilated with increasing tidal volumes until one of the three following end points were reached: 1) gastric air insufflation, 2) airway pressure > 40 cm H2O, or 3) limitation of further increase in tidal volume by air leakage. The following variables were determined:inspired volume (VI), expired volume (VE), maximum inspiratory pressure (Pmax), airway pressure at gastric inflation (Pinfl), respiratory time constant (RC), compliance (C), resistance (R), and leakage fraction (FL). Respiratory mechanics were in the physiological range. Gastric insufflation occurred in 27% of the patients at inspiratory pressures between 19 and 33 cm H2O. Air leakage of more than 10% was evident at inspiratory pressures between 25 and 34 cm H2O. The end point of 40 cm H2O airway pressure was reached in only three patients. We conclude that the LMA is not better in preventing airway pressure transmission to the esophagus than a conventional face mask. However, a high FL is associated with reduced gastric air insufflation.

Adolescent↗

PubMed1993

The effect of cricoid pressure on preventing gastric insufflation in infants and children.

BACKGROUND: The use of cricoid pressure for the possible prevention of regurgitation of gastric contents during induction of anesthesia in both adults and children has been recommended. However, equally important is the technique in possibly preventing insufflation of gas into the stomach. This study was designed to determine the efficacy of cricoid pressure application in preventing gastric gas insufflation in pediatric patients and to determine the airway pressure at which gas entered the stomach (pop-off point). METHODS: Fifty-nine patients, 2 weeks to 8 yr of age, physical status 1-4, scheduled for elective surgery, received an inhalational induction of anesthesia with halothane, N2O, and O2. A single observer used a stethoscope to auscultate over the upper abdomen for any air entry. In study I (without paralysis), the proximal airway pressure was slowly increased by gradually closing the pop-off valve on the anesthesia machine until gas was heard entering the stomach (pop-off point) or until the peak inspiratory pressure (PIP) reached 40 cm H2O. Thereafter, the pressurization procedure was repeated three times, altering the application and removal of cricoid pressure. The same patients were then paralyzed (study II), and the stomach evacuated before commencing an identical pressurization sequence with and without cricoid pressure. RESULTS: Appropriately applied cricoid pressure was 100% effective in preventing gas insufflation into the stomach of all children up to 40 cm H2O PIP with and without paralysis. In addition, paralysis significantly decreased the median pop-off point in any given patient. CONCLUSIONS: Appropriate application of cricoid pressure prevents gastric gas insufflation during airway management via mask up to 40 cm H2O PIP in infants and children. An additional benefit of cricoid pressure occurs in paralyzed patients in whom gastric insufflation occurs at lower inflation pressures.

Anesthesia, General↗

PubMed2005

Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections.

OBJECTIVES: The efficacy of mechanical insufflation-exsufflation, in addition to standard chest physical treatments, was investigated as a first-line intervention for patients with neuromuscular diseases with respiratory tract infections and airway mucous encumbrance. DESIGN: The short-term outcomes of 11 consecutive neuromuscular disease patients with respiratory tract infections and tracheobronchial mucous encumbrance who were administered mechanical insufflation-exsufflation and conventional chest physical treatments in an intensive care unit were compared with the outcomes of 16 historical matched controls who had received chest physical treatments alone. Treatment failure was defined as the need for cricothyroid "minitracheostomy" or endotracheal intubation, despite treatment. The number of subjects administered bronchoscopy-assisted aspiration during the hospital stay was also compared. RESULTS: Treatment failure was significantly lower (P < 0.05) in the mechanical insufflation-exsufflation group than in the conventional chest physical treatments group (2/11 vs. 10/16 cases). The use of bronchoscopy-assisted aspiration was similar in the two groups (5/11 vs. 6/16 cases). Mechanical insufflation-exsufflation did not produce serious side effects and was well tolerated by all subjects. CONCLUSIONS: Provision of mechanical insufflation-exsufflation in combination with standard chest physical treatments may improve the management of airway mucous encumbrance in neuromyopathic patients; its use should be included in the noninvasive approach to treatment of respiratory tract infections with impaired mucous clearance.

Adolescent↗

PubMedDate not supplied

Nonendoscopic antegrade percutaneous gastrostomy: the effect of preplacement gastric insufflation on tube position and intra-abdominal anatomy.

Nonendoscopic tube gastrostomy was performed on 47 anesthetized dogs using the technique of Fulton and Dennis with or without gastric insufflation prior to tube placement. Immediately after tube placement, dogs were euthanized and postmortem examinations performed. When gastric insufflation was not performed (group I), gastrostomy tubes penetrated the visceral surface of the stomach in 25% of dogs. The deep leaf of the omentum was interposed between stomach and body wall in the majority of these dogs, exposing other intra-abdominal organs to potential injury. Additionally, displacement and tethering of the spleen cranial to the gastrostomy site were observed in 33% of dogs in group I. Similar results were obtained when preplacement gastric insufflation was performed after the orogastric tube was inserted sufficiently far to displace the stomach laterally against the body wall (group II). In contrast, consistent positioning of gastrostomy tubes through the parietal surface of the stomach was achieved when the stomach was insufflated prior to lateralizing the left abdominal wall with the gastric end of the orogastric tube (group III). It was concluded that the blind percutaneous gastrostomy technique is made safer by insufflating the stomach immediately prior to pushing the gastric wall laterally into contact with the parietal peritoneum.

Abdomen↗