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At least 19 recordsLinked to original sources
PubMed2026

Comparison of VCV and PCV-VG modes on diaphragmatic function in diabetic patients undergoing laparoscopic colorectal surgery: a prospective randomized controlled study.

BACKGROUND: Diabetic patients are prone to induce diaphragmatic weakness, which can lead to postoperative pulmonary complications (PPCs). The optimal mechanical ventilation mode may potentially improve postoperative diaphragmatic function. This study evaluates the effects of two ventilation modes under driving pressure-guided ventilation strategy on diaphragmatic function, as assessed by diaphragm thickening fraction (DTF) and diaphragm excursion (DE), in diabetic patients following laparoscopic colorectal surgery. METHODS: Eighty patients diagnosed with Type II diabetes scheduled for elective laparoscopic colorectal surgery, were randomly allocated to either the pressure-controlled volume-guaranteed ventilation (PCV-VG) group (Group P) or the volume-controlled ventilation (VCV) group (Group V) during surgery. The primary outcome was diaphragmatic function assessed during both tidal breathing and maximal inspiratory effort after surgery. Secondary outcomes included intraoperative mechanical power, PPCs, and other complications. RESULTS: A total of eighty patients were included in the final analysis. The averaged area under the curve (AUC) for mechanical power during ventilation was significantly lower in Group P than in Group V (p = 0.002). PCV-VG significantly improved both DE and DTF within the first two days post-surgery (AUCDEtidal: p = 0.088, AUCDTFtidal: p = 0.004, AUCDEmax: p = 0.029, AUCDTFmax: p = 0.017). Postoperative diaphragmatic weakness was less frequent in Group P than in Group V (p = 0.019). However, there was no difference in the incidence of PPCs between the two groups (p = 0.155). CONCLUSION: PCV-VG mode can reduce intraoperative mechanical power, better preserve postoperative diaphragmatic function. However, these improvements did not translate into clinical benefits, as evidenced by the lack of reduction in the incidence of PPCs.

Humans↗
PubMed1979

Prophylactic peroperative intravenous metronidazole in elective colorectal surgery.

In a prospective double-blind randomised trial 83 patients undergoing elective colorectal surgery were given either preoperative intravenous metronidazole or intravenous normal saline. No other antimicrobials were given. Bowel preparation was the same for both groups. Deep post-operative wound sepsis occurred in 6 of 44 (13-6%) patients on metronidazole but in 20 of 39 (51-2%) control untreated patients. Anaerobes were responsible for all cases of deep sepsis in the metronidazole group (in 5 of the 6 cases aerobes were also isolated), and for 16 of the 20 cases of deep sepsis in the control group (all with aerobes). Superficial infection in the metronidazole group was caused by aerobes. Anastomotic leakage occurred in 5 of the 6 patients who developed deep sepsis on metronidazole and in 10 of 20 patients on placebo. Peroperative intravenous metronidazole dramatically reduced postoperative sepsis but failed to prevent infection in the presence of anastomotic breakdown.

Bacterial Infections↗
PubMed1977

Prophylactic systemic antibiotics in colorectal surgery.

The prophylactic value of gentamicin combined with either lincomycin or metronidazole in 52 patients undergoing colorectal surgery was investigated. The results confirmed the value of this practice. In a control group, the sepsis-rate was 48% with 1 death attributable to sepsis, compared with a sepsis-rate of 4% in the treated group. The combination of gentamicin and lincomycin was effective against sepsis but pseudomembranous colitis developed in 2 of the 14 patients treated with this combination of drugs. Lincomycin was discontinued, and when metronidazole was substituted the results were equally good and there were no toxic side-effects.

Abscess↗
PubMed1978

The effect on total antimicrobial consumption and hospitalization time after prophylactic treatment with doxycycline in colorectal surgery.

The effect of routine antimicrobial prophylaxis on hospitalization and the total consumption of antimicrobials in colorectal surgery was evaluated in a prospective and controlled study, where the incidence of abdominal wound sepsis was significantly reduced from 41.6% in the control (n = 60) to 8.6% in the doxycycline group (n = 58). Concomitantly, the average number of postoperative hospital days decreased significantly from 23.4+/-17.9 to 16.4+/-8.2 (p less than 0.01). This difference was more prominent in cases with postoperative abdominal sepsis, where the average number was 35.8 days in the control and 22.8 days in the doxycycline group. In the latter group only 19% of the patients required antimicrobial therapy during the postoperative course, compared with 65% of the patients in the control group. The period of exposure to antimicrobials amounted to 48.3% (451 days) of the postoperative hospital stay in the doxycycline vs. 53.3% (747 days) in the control group. Thus, prophylaxis significantly reduced the rate of wound sepsis, the time of and the need for hospitalization, the total consumption of and the time of exposure to antimicrobials.

Colon↗
PubMed1977

Effect of prophylactic systemic administration of cephalothin in colorectal surgery.

The effect of standardized prophylactic treatment with systemically administered cephalothin (Keflin) was studied in a series of 120 consecutive patients in whom elective colorectal surgery was planned. The patients were divided by random selection into one treatment group and one control group. The same mechanical cleansing with cathartics and tap water enemas was performed in both groups. The patients in the treatment group received intravenously 2 g cephalothin 2 hours prior to the operation, 2 g during the operation and then 2 g every 6th hour during 4 days. 14 cases were excluded for various reasons. In 19 cases only minor operations were performed, such as laparotomy with or without simultaneous colostomy. The overall frequency of infections was 17.5% in the treatment group and 53.1% in the control group. In the 87 cases undergoing major operations, infections were registered in 17.4% of the treated patients and 58.5% of the control patients. The difference is highly significant (p less than 0.001) in both cases. Escherichia coli was present in about 70% of the infections, often together with other aerobic or anaerobic organisms.

Adult↗
PubMed1976

Antibiotic prophylaxis in colorectal surgery. doxycycline compared to a combination of benzylpenicillin and streptomycin. A preliminary report.

The aim of the study was to evaluate the effect of two different regimens of antibiotic prophylaxis in colorectal surgery. The study comprises 57 consecutive cases. The mechanical preoperative preparation was essentially the same in all cases and the operative technique was standardized as far as possible. Antibiotic prophylaxis was started immediately before surgery and continued for three days postoperatively. Thirty-six patients received doxycycline 200 mg i.v. per day and 21 patients were given benzylpenicillin 10 million I.U. 4 times a day and streptomycin 500 mg twice a day. No major infectious complications (e.g. septicaemia, abscessess) were seen in either group. There were three wound infections in the doxycycline group and four in the penicillin-streptomycin group.

Adolescent↗
PubMed2026

Effects of permissive hypercapnia on intraoperative cerebral oxygenation and early postoperative cognitive function in older patients with fragile brain function during the non-acute phase undergoing laparoscopic colorectal surgery: A randomized controlled trial.

BACKGROUND AND PURPOSE: Older adults with non-acute fragile brain function (NFBF) may be particularly susceptible to perioperative disturbances in cerebral oxygenation and postoperative neurocognitive decline. Permissive hypercapnia (PHC) may enhance cerebral oxygenation, but its effects in this population remain unclear. We examined whether PHC-based ventilation improves intraoperative regional cerebral oxygen saturation (rSO2) and early postoperative cognitive outcomes in older patients with NFBF undergoing elective laparoscopic colorectal surgery. METHODS: In this single-center, single-blind randomized trial, 76 patients were assigned in a 1:1 ratio to PHC-based or conventional ventilation. The primary outcome was the absolute change in rSO2 from baseline (T0) to the end of surgery (T4). Analyses followed the intention-to-treat principle, with prespecified per-protocol sensitivity analysis. Secondary outcomes included intraoperative rSO2 trajectories, cerebral oxygen extraction-related indices, early postoperative cognitive screening, serum neuron-specific enolase and interleukin-6, and safety outcomes. RESULTS: PHC significantly increased rSO2 relative to conventional ventilation (left: adjusted mean difference [aMD] 10.64, 95% CI 8.96-12.33; right: aMD 10.16, 95% CI 8.22-12.11; both P&#xa0;<&#xa0;0.001), with consistent sensitivity results. Repeated-measures analyses showed persistently higher intraoperative rSO2 in the PHC group. Cerebral oxygen extraction-related indices were generally lower with PHC. However, early postoperative cognitive outcomes and serum biomarkers did not differ between groups. Emergence time was modestly longer with PHC, whereas adverse events were comparable. CONCLUSIONS: PHC-based ventilation favorably modified intraoperative cerebral oxygenation and oxygen-extraction profiles but did not translate into detectable early postoperative cognitive or biomarker benefits in older adults with NFBF.

Humans↗
PubMed1979

Comparison between systemic and oral antimicrobial prophylaxis in colorectal surgery.

In a prospective randomised trial in which 93 patients undergoing elective colorectal operations were given a short prophylactic course of metronidazole and kanamycin orally or systemically, postoperative sepsis occurred in only 3 (6.5%) of those given antimicrobials systemically, compared with 17 (36%) of those given oral prophylaxis (P less than 0.01). 15 of the 17 infections in patients who received antimicrobials orally were due to kanamycin-resistant bacteria present in the colon at operation. Bacterial overgrowth of Staphylococcus aureus was recorded in 6 of the patients who received oral therapy. Antibiotic-associated pseudomembranous colitis occurred in 7 patients, 6 of whom had received prophylaxis orally. These results indicate that oral administration of prophylactic antimicrobials in colon surgery should be avoided because of the risks of bacterial resistance, superinfection, and antibiotic-associated pseudomembranous colitis. Systemic per-operative antimicrobial prophylaxis is safer and more effective.

Administration, Oral↗
PubMed1976

Enzyme inhibition in colorectal surgery.

Anastomotic dehiscence is particularly common after low anterior resection of the rectum. The enzyme collagenase is largely responsible for this high complication rate. Inhibition of this enzyme in an experimental model produced significantly stronger colonic anastomoses. There may be a place for such an inhibitor in clinical surgery.

Animals↗
PubMed1978

[Preoperative preparation in colorectal surgery: antibiotics (author's transl)].

Out of a total of 2727 operations of the large bowel because of tumors and inflammatory disease, performed over a 14-year period, 897 were one-stage resections of the colon and rectum without relaxing colostomy. Standard preoperative preparation of the bowel consists of a balanced diet, laxatives, and enema supplemented by 9 g Neomycin and 1.8 g Achromycin, within a 2-day period. Disturbances in wound healing occurred in 12.5%, seroma included. Anastomotic insufficiency occurred in 4%, and fatal fecal peritonitis due to tumors in 1.3% and due to diverticulitis in 1.2%. Total mortality was about 5.7%. Postoperative hospitalization after resections because of tumors was 15 days and because of diverticulitis, 19 days.

Cathartics↗
PubMed1978

[Whole-gut irrigation for large bowel preparation in colorectal surgery (author's transl)].

In a controlled trial with 32 patients, whole-gut irrigation (wgi) was compared with elemental diet as a method of large-bowel preparation. Cleansing effect, caloric intake (bad taste of diet), and preparation time were significantly better in the first group (wgi). Since 1976, 203 patients have undergone wgi. Investigations concerning the effect of addition of antibiotics to the irrigant revealed optimum reduction of fecal flora with neomycin--bacitracin--clindamycin.

Clindamycin↗
PubMed1978

Prophylactic administration of low-dose heparin in colorectal surgery.

A retrospective study of 192 patients operated on by three members of the Edward Wilson Colon and Rectum Unit, Sydney Hospital, was carried out. All operations performed involved dissection within the pelvis. Prophylactic administration of low-dose heparin was used for 71 of these patients. The incidences of clinical thromboembolic disease were 7 per cent in both the group receiving heparin and the other group. In slightly more than half of the patients, pulmonary emboli occurred in the absence of peripheral deep venous thrombosis. It is suggested that the source of these emboli was thrombosis arising in the pelvic veins.

Colon↗
PubMed1979

Tinidazole in the prevention of wound infection after elective colorectal surgery.

During the first six months of 1978, 71 patients were the subject of a controlled trial of the use of tinidazole for the prevention of wound infection after elective colonic surgery. The trial design was prospective, randomized and double-blind with tinidazole or placebo given at the last oral intake before operation. The objective endpoint of the trial was the presence or absence of wound infection manifested by pus. All patients underwent a standard preoperative preparation of bowel washouts, and a standardized surgical technique included, in all cases, the use of wound drainage. At the end of the trial there were three wound infections in 40 patients who were given tinidazole, and eleven wound infections in 31 patients who were given placebo. The difference in wound infection rate between these two groups is significant (x2 with Yates correction = 7.3; P less than 0.01).

Clinical Trials as Topic↗
PubMed1979

[A prophylactic regimen for infections in colorectal surgery (author's transl)].

Without special prophylaxis, surgery of the colon and rectum is likely to result in postoperative complications due to infection at a percentage of 30 to 50. Prophylaxis against infections in colonic operations covers preoperative influence on general body defence, a subtle operating technique and special preparation of the intestine, the latter including adequate bulkage - free diet, a special preparation of the intestine and preoperative administration of antibiotics. Preparation by means of phthalylsulfathiazol has shown no effects. A preparation programme is suggested for 3 to 8 days preoperatively.

Adolescent↗