Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 OF THE PERITONEUM The peritoneum is the serous membrane that forms the lining of the abdominal cavity, and it covers most of the intra-abdominal organs. It is composed of a single layer of mesothelium, generally 2.5 to 3 pm thick, supported by a thin layer of connective tissue (Slater et al. 1989). Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 With a surface area of some 14,000 cm3 in adults (Albanese Ct al. 2009), almost equal to that of the skin, this membrane may be the largest organ in hEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
umans. Its primary function is to diminish the friction among abdominal viscera, enabling their free movement, it also serves as a barrier to infectio27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 st beneath its surface there is an elastin layer that gives the peritoneum mobility. The surface lining of the peritoneum consists of highly differentiated mesothelial cells (diZcrcga 1997).Mesothelial cells are predominantly flattened, squamous-like, approximately 25 pm in diameter, with the cytopl Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 asm raised over a central round or oval nucleus (Mutsacrs 2004) (Figure 27.1). Long microvilli are projected from the apical surface of the mesotheliaEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
l cells (Slater et al. 1989). The)' have well-developed ccll-to-cell junctional complexes including tight junctions, adherent junctions, gap junctions27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 emipermcable diffusion barrier (Mutsacrs 2004). They secrete glycosaminoglycans, proteoglycans, and phospholipids to provide a slippery, nonadhesive glycocalyx that protects the serosal surface from abrasion, infection, and tumor dissemination. Mesothelial cells rest on a basement membrane with subm Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 csothelial stroma cells embedded within extracellular matrix (Mutsaers et al. 2015) and with abundant vascular channels that deliver oxygen and otherEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
nutrients to them.LAPAROSCOPIC SURGERYDuring laparoscopic surgery the abdominopelvic cavity is inflated with carbon dioxide (CO,). Currently, dry co, 27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 dry and cold gas. Significant evidence suggests that the use of humidified and warmed gas may reduce at least two of the major morbidities associated with Laparoscopic surgery: postoperative pain and hypothermia (Sajid et al. 2008, Sammour Ct al. 2008). Humidifying insufflation gas provides a more Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 physiologically normal pneumoperitoneum. These principles can also be extended to other types of endoscopic surgery where other cavities are inflatedEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
to enable surgery, i.e., gastrointestinal endoscopy (Dellon et al. 2009), thoracoscopic (Mouton et al. 2001), colonoscopic (Yamano et al. 2010), andhy27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 r Linden 2009). In all of these situations the tissue desiccation is of equal consequence.Impact of the Dry Insufflation Gas on Body Temperature: HypothermiaWhen standard dry and cold gas is insufflated into the warm abdomen, the gas is humidified and wanned up by the body in order to reach an equil Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 ibrium of humidity and temperature within the peritoneum. This means that the gas is warmed up until its temperature is equal to that of the peritoneuEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
m and it is humidified until it is as humid as the peritoneum. Both processes affect the patient's thermal condition, and more specifically, that of t27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 consumes energy and consequently induces hypothermia (Bcssell et al. 1999). This hypothermia is mainly due to the energy spent to humidify the dry gas (577 cal to vaporize 1 g of water) rather than to the energy required to warm the cold gas (0.00003 cal to heat 1 inL of co, by 1°C) (Binda Ct al. 20 Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 06). Therefore, the pneumoperitoneum will systematically induce hypothermia (Bessell et al. 1999, Hazebroek et al. 2002, Ott 1991) that is to a largeEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
extent caused locally by the pneumoperitoneum-induced desiccation (Gray et al. 1999).Since there are adverse clinical effects due to core temperature 27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 esthetic recovery and of hospitalization, myocardial complications, increased surgical wound infection, intraoperative blood loss, impaired platelet and immune functions, including T-cell-mediated antibody production and nonspecific oxidative bacterial killing by neutrophils (Sessler 2001).Numerous Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 studies have compared the effects of different gas conditions upon body temperature. Research into the effect of heating the dry gas (with no humidifiEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
cation) to body temperature has led to mixed results. Heating the insufflation gas has been shown to reduce hypothermia (Backlund Ct al. 1998, Ott 19927 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 hypothermia (Nelskyla et al. 1999). When the effect of four kinds of gas (dry and cold, dry and warm, humidified and cold, humidified and warm) upon body temperature was analyzed in the same study, insufflation with warm, dry gas did not prevent hypothermia; in addition, when cold co, was humidified Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 , the decrease in core temperature was smaller than when cold, dry gas was used (Hazebroek et al. 2002). This can208HUMIDIFICATION DURING SURGERYSerouEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
s fluidFrgurr 27.1 (Al Normal peritoneum consists of a monoliycr of meMXhelial cell* with long microvilli and tight juiKtioni resting on a basement me27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 elial cells are bulgcd-up, the microvilli are destroyed, the junctions are broken, and the basement membrane is exposed.be explained by the fact that the capacity of a gas to hold water vapor increases with its temperature.Some studies have shown that cold humidification of insufflating CO, prevents Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 heat loss associated with pncumopcrito-neal insufflation as efficaciously as warmed humidification of the gas (Noll et al. 2012), and this is consistEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
ent with the observation that much more energy is used to humidify the gas than is needed to heat it. However, for procedures greater than 60 minutes,27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 arm gas, as shown in animal models (Bessell et al. 1999, Binda et al. 2006, Hazebroek et al. 2002, Noll et al. 2012, Peng et al. 2009), in clinical trials (Mouton Ct al. 1999b), and as confirmed in a mcta-analysis in humans (Sajid Ct al. 2008).Impact of the Dry Insufflation Gas on the Peritoneum Int Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 egrity: Tissue DamageSeveral animal studies have shown that dry and cold gas is deleterious to the peritoneum, i.e., it destroys the microvilli,causesEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
the mesothelial cells to retract and bulge, and exposes the basal lamina (Erikoglu Ct al. 2005, Hazebrock Ct al. 2002, Moutonet al. 1999b, Peng et al27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 ere observed in comparison to using dry and cold gas (Erikoglu Ct al. 2005, Mouton et al. 1999b, Peng et al. 2009).Following the peritoneal trauma due to the desiccating nature of the dry gas, an inflammatory reaction is produced. Two hours after a laparoscopy was performed with dry and cold CO,, an Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 inflammatory cell infiltration in the parietal and visceral peritoneum was observed (Papparella et al. 2007). Volz Ct al. (1999) showed that 12 hoursEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
after the laparoscopy, peritoneal macrophages and lymphocytes filled all gaps, recovering the basal lamina where it had been exposed. These results i27 Humidification during surgery: Benefits of using humidified gas during laparoscopic and open surgery Maria Mercedes BindaBASICS OF THE PHYSIOLOGY O Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 d macrophages were found in the intercellular clefts. Humidified and heated gas reduces the inflammatory response as seen in the reduction of tumor necrosis factor alpha (TNF-a) (Clew Ct al. 2004) and increased lymphocytes during laparoscopy (Erikoglu et al. 2005). Tins shows that less trauma occurs Ebook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2 in the peritoneum with humidified gas.noImpact of the Temperature and Humidification of the Insufflation Gas on PainThe effect of the insufflation gaEbook An atlas of gynecologic oncology: Investigation and surgery (Fourth edition) - Part 2
s temperature on postoperative pain is controversial (Kissler Ct al. 2004, Korcll Ct al. 1996, slim el al. 1999, Wills and Hunt 2000). Korell el al. (Gọi ngay
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