Gaiwal Sucheta, Palep J H, Mirkute Rohini, Prasad Nimitha, Kush Mehta
Department of Anaesthesiology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
J Minim Access Surg. 2025 Apr 1;21(2):147-152. doi: 10.4103/jmas.jmas_69_24. Epub 2024 Jul 30.
Enhanced Recovery After Surgery (ERAS) programs represent a shift in perioperative care, combining evidence-based interventions to reduce surgical stress to expedite recovery. ERAS requires cohesive team efforts to facilitate early discharge and reduce hospital stays. Anaesthesia and pneumoperitoneum management within ERAS play crucial roles in influencing postoperative outcomes. Laparoscopic cholecystectomy is widely acknowledged as the foremost approach for managing symptomatic gallstone disease due to its minimally invasive nature and favourable recovery. It has been demonstrated that increased abdominal pressures with prolonged CO2 exposure produce changes in cardio-vascular and pulmonary dynamics, which can be minimized by insufflating at minimum pressure required for adequate exposure, as advocated by European endoscopic guidelines. Dexmedetomidine, a highly selective alpha-2 adrenoreceptor agonist, has gained attention in anaesthesia armamentarium due to its sedative, analgesic, sympatholytic, and opioid-sparing properties. For multimodal opioid sparing postoperative pain management it's advantageous.
To evaluate combined effect of low-pressure pneumoperitoneum and intra-operative dexmedetomidine infusion in laparoscopic cholecystectomy for ERAS.
160 patients of American Society of Anaesthesiologists (ASA) score 1 and 2, undergoing elective laparoscopic cholecystectomy were randomized into low pressure pneumoperitoneum (10-12 mmHg) and standard pressure pneumoperitoneum (13-15 mmHg) groups. Each group is subdivided into, no Dexmedetomidine (ND) and with Dexmedetomidine (WD) infusion (0.7 mcg/kg/hr) intra-operatively. Thus, 40 patients in each of the 4 study arms. Perioperative variables were collected and analysed.
Low pressure pneumoperitoneum with intra-operative Dexmedetomidine infusion (0.7 mcg/kg/hr) resulted in stable hemodynamics, reduced post-operative pain, no requirement of additional analgesics and early discharge. Thus, synergistic impact of these interventions significantly improved postoperative outcomes when used as part of ERAS protocols.
术后加速康复（ERAS）计划代表了围手术期护理的转变，它结合了基于证据的干预措施以减轻手术应激，从而加速康复。ERAS需要团队的协同努力以促进早期出院并缩短住院时间。ERAS中的麻醉和气腹管理在影响术后结果方面起着关键作用。腹腔镜胆囊切除术因其微创性质和良好的恢复效果，被广泛认为是治疗有症状胆结石疾病的首要方法。已经证明，长时间暴露于二氧化碳导致的腹内压升高会引起心血管和肺部动力学变化，正如欧洲内镜指南所提倡的，通过以充分暴露所需的最低压力进行气腹可以将这种变化降至最低。右美托咪定是一种高度选择性的α-2肾上腺素能受体激动剂，因其镇静、镇痛、抗交感神经和节省阿片类药物的特性，在麻醉药物中受到关注。对于多模式节省阿片类药物的术后疼痛管理来说，它具有优势。
评估低压气腹和术中输注右美托咪定在腹腔镜胆囊切除术中对ERAS的联合效果。
160例美国麻醉医师协会（ASA）评分1级和2级、接受择期腹腔镜胆囊切除术的患者被随机分为低压气腹（10 - 12 mmHg）组和标准压力气腹（13 - 15 mmHg）组。每组再分为术中不使用右美托咪定（ND）组和术中使用右美托咪定（WD）输注（0.7 mcg/kg/hr）组。因此，4个研究组每组各有40例患者。收集并分析围手术期变量。
术中输注右美托咪定（0.7 mcg/kg/hr）的低压气腹导致血流动力学稳定、术后疼痛减轻、无需额外使用镇痛药以及早期出院。因此，当这些干预措施作为ERAS方案的一部分使用时，它们的协同作用显著改善了术后结果。
