Page 4 - Peer Reviewed Laparoscopic Jornal

Swapan Kumar Maiti et al

surgery. The animals were evaluated on the basis following procedure. The postsurgical recovery from anesthesia in all
observations. of the animals of three groups was smooth and uneventful.
• Intraoperative and postoperative observations: Establishment CP in each animal was easy and safe.
Visualization of different peritoneal organs namely liver, Insufflation of the abdominal cavity with CO gas at the
2
spleen, urinary bladder, uterus, ovary, pancreas, gall flow rate of 2 L/min was found sufficient for establishment
bladder, stomach and intestine were assessed on the basis of CP within 1 to 2 minutes in all of the animals of three
of scoring for each organ as: 0-no visualization of an groups. All animals were closely monitored for their
organ; 1-difficult visualization of an organ; 2-moderate respiration and capillary perfusion. Each animal tolerated
visualization of an organ and 3-optimum visualization well during insufflation even at Trendelenburg position.
of an organ. Insufflation by CO at 6, 10 and 14 mm Hg was maintained
2
• Clinical observations: The heart rate (beats/min), for 30 minutes in each animal of groups A, B and C
respiratory rate (breaths/min), and rectal temperature respectively. During this period complication like emphysema
(°F) were recorded before and after anesthesia, 30, or respiratory distress was not noticed in any animal.
60 and 120 minutes after establishment of CP and The urinary bladder was visualized first by its
24 hours postlaparoscopy. characteristic tortuous structures of blood vessels. Uterine
• Electrocardiographic observations: A lead II ECG was body was visualized next and it depended on the distension
recorded at 1 mV and 25 mm/s paper speed before and of the urinary bladder. The uterus and ovarian structure were
after anesthesia, 30, 60 and 120 minutes after thoroughly visualized with their characteristic ivory-colored,
cord-like structure. Both the kidneys were identified by the
establishment of CP and 24 hours after laparoscopy. The presence of perirenal fat at the corresponding level of last
ECG was analyzed for heart rate, duration and amplitude costochondral junction (Fig. 1). Spleen was visualized in
of P-wave, QRS complex, T-wave and RR, P-R, S-T the upper left abdominal quadrant, cranial to the left kidney.
and Q-T intervals. It was tongue shaped and in close exposure its diaphragmatic
• Hematological and biochemical observations: surface was converse and cobbled. In the upper right
Heparinized blood was collected before and after abdominal quadrant, liver was identified by its bright red
anesthesia, 30, 60 and 120 minutes after establishment color and uniform smooth surfaces. Gallbladder was
of CP and 24 hours postlaparoscopy for estimation of visualized in between right medial and right lateral lobes
packed cell volume (PCV), hemoglobin (Hb), total and appeared as distended, round and whitish to bluish in
leukocyte count (TLC), differential leukocyte count color (Fig. 1). The empty stomach appeared as dense, pale-
(DLC), aspartate aminotransferase (AST), alanine red in color and was situated toward the mid-abdominal
aminotransferase (ALT), creatinine, blood urea nitrogen plane. Visualization of pancreas was found most difficult
and uric acid using standard procedures. in this study. In contrary, intestine was visualized very easily
• Acid-base observations: Different acid-base parameters and appeared as loop like structures (Fig.1) Different
like pH, partial pressure of oxygen (pO ), partial pressure abdominal organs were evaluated in respect of their
2
of carbon dioxide (pCO ), sodium, potassium, chloride visualization pattern during laparoscopy in three groups.
2
and base excess were estimated by using 0.5 ml an Observations were recorded on the basis of numerical score
aerobically collected heparinized venous blood in blood from ‘0’ to ‘3’ depending on the degree of visualization
gas analyzer. (Table 1). No differences in scores have been observed in
• Hormonal observations: The plasma samples were used groups B and C, but they significantly (p < 0.05) differed
to estimate the cortisol by radioimmunoassay assay using from group A.
RIA kit. Normal appetite returned within 2 to 4 hours after
• Statistical analysis: The data were subjected to two-way surgical intervention in all animals. No postoperative
analysis of variance (ANOVA) and the paired t-test, as complications like emphysema, portal herniation, peritonitis,
per standard statistical methods. ascites, or stitch abscess were recorded in any animals of
the three groups.
RESULTS
Clinical Observations
Intraoperative and Postoperative Observations
The respiration rate (breaths/min), heart rate (beats/min),
The surgical phase of anesthesia in all the animals of and rectal temperature (°F) recorded in all of the animals of
different groups was achieved by administering xylazine three groups are presented in Table 2. Respiration rate
and ketamine in combination. No additional anesthesia was decreased significantly (p < 0.05) in all the animals of three
required in any animal to complete the intraoperative groups after anesthesia. However, in group C, it was
54