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      Análise macroscópica infra-vermelha da difusão do óxido nitroso via inalatória para a cavidade abdominal, em ratos submetidos a pneumoperitônio Translated title: Macroscopic infrared analysis of inhaled nitrous oxide diffusion to abdominal cavity in rats submitted to pneumoperitoneum Translated title: Análisis macroscópica infrarroja de la difusión del óxido nitroso vía inhalatoria para la cavidad abdominal, en ratones sometidos a pneumoperitoneo

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          Abstract

          JUSTIFICATIVA E OBJETIVOS: O óxido nitroso (N2O), por ser uma estrutura tri-atômica assimétrica, assume características de alta emissão e absorção de energia no espectro infra-vermelho, com um pico característico de absorção em 4,5 µm, o que o torna visível ao infra-vermelho curto, quando contrastado com uma fonte emissora de calor (anteparo quente). Diversos autores têm descrito a difusão do N2O para cavidades fechadas por métodos como cromatografia gasosa e analisador de gases, que não permitem um estudo macroscópico detalhado do gás. O presente estudo teve como objetivo a filmagem macroscópica no espectro infra-vermelho da difusão de N2O, utilizado em anestesia inalatória, para a cavidade peritoneal de ratos submetidos a pneumoperitônio de 20 mmHg com ar ambiente. MÉTODO: Dividiu-se os animais em três grupos, de acordo com o anestésico utilizado: I - controle venoso: tiopental intra-peritoneal; II - controle inalatório: isoflurano a 1,2% em O2 100%; III - óxido nitroso: N2O 66% em oxigênio e isoflurano a 0,6%. Os termogramas provenientes da descompressão abdominal foram obtidos, por meio de um radiômetro AGEMA 550 filmados a 7 quadros por segundo. RESULTADOS: O N2O demonstrou-se visível ao infra-vermelho. No momento da descompressão abdominal, não houve nos grupos I e II termogramas com rastros de gases visíveis ao infra-vermelho. Houve, porém, rastros de gases visíveis ao infra-vermelho no grupo III. CONCLUSÕES: Conclui-se que o óxido nitroso inalatório a 66% difundiu-se para a cavidade peritoneal de ratos submetidos a pneumoperitônio de 20 mmHg com ar ambiente, sem aumento de pressão intra-abdominal.

          Translated abstract

          BACKGROUND AND OBJECTIVES: Nitrous oxide (N2O), for its tri-atomic asymmetric structure, has high energy emission and absorption characteristics within the infrared spectrum, with maximum absorption at 4.5 µm, what makes it visible at short infrared, when contrasted with a heat emission source (hot support). Many authors have described N2O diffusion to closed cavities by chromatography methods and gas analyzers, which do not allow a detailed macroscopic study of the gas. This study aimed at macroscopically filming in the infrared spectrum inhaled N2O diffusion to the peritoneal cavity of rats submitted to 20 mmHg room air pneumoperitoneum. METHODS: Animals where divided in three groups according to the anesthetic drug: I - Intravenous control: intraperitoneal thiopental; II - inhaled control: 1.2% isoflurane in 100% O2; III - nitrous oxide: 66% N2O in oxygen and 0.6% isoflurane. Thermal images of abdominal decompression where captured by an AGEMA 550 radiometer filmed at 7 frames per second. RESULTS: N2O was visible to infrared. At abdominal decompression, groups I and II have not shown visible gas traces at infrared thermographs, while group III had visible infrared traces. CONCLUSIONS: Our conclusion was that 66% inhaled nitrous oxide has diffused to peritoneal cavity of rats submitted to 20 mmHg room air pneumoperitoneum, with no intra-abdominal pressure increase.

          Translated abstract

          JUSTIFICATIVA Y OBJETIVOS: El óxido nitroso (N2O), por ser una estructura tri-atómica asimétrica, toma características de alta emisión y absorción de energía en el espectro infrarrojo, con un pico característico de absorción en 4,5 µm, lo que lo hace visible al infrarrojo corto, cuando contrastado con una fuente emisora de calor (resguardo caliente). Diversos autores han descrito la difusión del N2O para cavidades cerradas por métodos como cromatografia gaseosa y analizador de gases, que no permiten un estudio macroscópico detallado del gas. El presente estudio tubo como objetivo la filmación macroscópica en el espectro infrarrojo de la difusión de N2O, utilizado en anestesia inhalatoria, para la cavidad peritoneal de ratones sometidos a pneumoperitoneo de 20 mmHg con aire ambiente. MÉTODO: Los animales fueron divididos en tres grupos, de acuerdo con el anestésico utilizado: I- Control venoso: tiopental intra-peritoneal; II- Control inhalatorio: isoflurano a 1,2% en O2 100%; III- Óxido Nitroso: N2O 66% en oxígeno e isoflurano a 0,6%. Los termogramas provenientes de la descompresión abdominal fueron obtenidos, por medio de un radiómetro AGEMA 550 filmados a 7 cuadros por segundo. RESULTADOS: El N2O se demostró visible al infrarrojo. En el momento de la descompresión abdominal, no hubo en los grupos I y II termogramas con rastros de gases visibles al infrarrojo. Hubo, todavía, rastros de gases visibles al infrarrojo en el grupo III. CONCLUSIONES: Se concluye que el óxido nitroso inhalatorio a 66% se difundió para la cavidad peritoneal de ratones sometidos a pneumoperitoneo de 20 mmHg con aire ambiente, sin aumento de la presión intra-abdominal.

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          Anesthetic implications of laparoscopic surgery.

          Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
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            Effect of Nitrous Oxide and of Narcotic Premedication on the Alveolar Concentration of Halothane Required for Anesthesia

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              Peroperative nitrous oxide delays bowel function after colonic surgery.

              Forty patients scheduled for elective colonic surgery were allocated at random to receive either nitrous oxide or air during surgery. Preoperative management, surgery, parenteral therapy and postoperative analgesics were similar in both groups. Anaesthetic management included isoflurane, vecuronium by infusion and fentanyl 3 micrograms kg-1 h-1. The air group required a mean inspired isoflurane concentration of 0.8% (SD 0.3), whereas the nitrous oxide group required 0.4% (SD 0.2). No differences were found in duration of operation, blood loss, need for postoperative analgesia or postoperative nausea. Patients in the air group had less gas in the small bowel (P less than 0.005) and in the large bowel (P less than 0.001), and operating conditions were better than in the nitrous oxide group (P less than 0.01). After operation, the air group had significantly earlier bowel function than the nitrous oxide group, with earlier passing of flatus (3.4 (1.2) vs 4.7 (1.4) days) (P less than 0.05) and faeces (4.7 (1.5) vs 6.3 (2.2) days) (P less than 0.05) and required a shorter postoperative hospital stay (10.0 (1.3) vs 11.7 (2.5) days) (P less than 0.05).
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rba
                Revista Brasileira de Anestesiologia
                Rev. Bras. Anestesiol.
                Sociedade Brasileira de Anestesiologia (Campinas )
                1806-907X
                April 2004
                : 54
                : 2
                : 218-228
                Affiliations
                [1 ] Universidade Federal do Paraná Brazil
                [2 ] Sociedade Internacional de Termografia (UKTA/ITA)
                [3 ] Thermotronics ST Ltda
                [4 ] Universidade Federal do Paraná Brazil
                [5 ] Pontifícia Universidade Católica do Paraná Brazil
                [6 ] Pontifícia Universidade Católica do Paraná Brazil
                Article
                S0034-70942004000200009
                10.1590/S0034-70942004000200009
                5247f402-4520-45a4-8af5-9adebf9dce1c

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0034-7094&lng=en
                Categories
                ANESTHESIOLOGY

                Anesthesiology & Pain management
                ANESTHETICS,ANIMAL,MEASUREMENT TECHNIQUES,ANESTÉSICOS,TÉCNICAS DE MEDIÇÃO

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