• anesthesia
• pneumoperitoneum
• robot-assisted surgery
• steep Trendelenburg position

• Humans
• Robotic Surgical Procedures/methods
• Anesthesia/methods
• Head-Down Tilt

• Gynecological cancer
• Laparoscopy
• Minimally invasive
• Obesity
• Surgery

• Humans
• Female
• Middle Aged
• Laparoscopy/methods
• Laparoscopy/instrumentation
• Laparoscopy/adverse effects
• Adult
• Prospective Studies
• Aged
• Obesity/complications
• Aged, 80 and over
• Abdominal Wall/surgery
• Endometrial Neoplasms/surgery
• Endometrial Neoplasms/complications
• Endometrial Hyperplasia/surgery
• Endometrial Hyperplasia/complications
• Genital Diseases, Female/surgery
• Genital Diseases, Female/complications
• Ovarian Neoplasms/surgery
• Ovarian Neoplasms/complications
• Hysterectomy/methods

• minimally invasive surgery
• patient outcomes
• pediatric anesthesia

• Analgesia
• Erector spinae plane block
• Hepatectomy
• Rectus sheath block
• Transversus abdominis plane block
• Ultrasound

• Humans
• Pain, Postoperative/prevention & control
• Pain, Postoperative/drug therapy
• Hepatectomy/methods
• Nerve Block/methods
• Female
• Laparoscopy/methods
• Male
• Middle Aged
• Ultrasonography, Interventional/methods
• Analgesics, Opioid/administration & dosage
• Adult
• Paraspinal Muscles
• Rectus Abdominis
• Abdominal Muscles
• Morphine/administration & dosage
• Aged
• Pain Measurement

• gastrointestinal surgery
• low-pressure laparoscopy
• pneumoperitoneum
• systematic review

• Humans
• Pneumoperitoneum, Artificial/methods
• Digestive System Surgical Procedures/methods
• Carbon Dioxide/administration & dosage
• Pressure
• Randomized Controlled Trials as Topic
• Laparoscopy/methods
• Pain, Postoperative

• field of view
• html
• image mosaicking
• javascript
• keyhole surgery
• laparoscopic surgery
• opensource
• serious games

• Wellcome Trust

• Haemodynamic monitoring
• perioperative echocardiography
• pressure field
• robotic surgery
• valvular heart disease

• Humans
• Aortic Valve Insufficiency/surgery
• Laparoscopy/methods
• Monitoring, Intraoperative/methods
• Echocardiography, Transesophageal/methods
• Robotic Surgical Procedures/methods
• Hemodynamic Monitoring/methods
• Male
• Colorectal Surgery/methods
• Hemodynamics
• Female
• Aged

• atrial myxoma
• gastrectomy
• general anaesthesia
• intraoperative complications
• laparoscopy

• blood pressure
• cardiac output
• cholecystectomy
• heart rate
• intra-abdominal pressure
• minimally invasive surgery

• VAT 27232142 Dunarea de Jos" University of Galati

• Airway management
• outpatient anaesthesia
• pediatric anaesthesia
• perioperative care
• pharmacology

• clonidine
• endotracheal intubation
• gabapentin
• hemodynamics
• laparoscopy

• anesthesia
• infection
• perioperative
• sepsis
• septic shock
• source control
• surgery

• anatomic landmarks
• body temperature
• decompression
• gastrointestinal
• intraoperative
• intubation
• monitoring
• regression analysis

• Humans
• Head-Down Tilt
• Stomach
• Body Temperature
• Laparoscopy
• Decompression

The aim of this study was to compare the effects of a sustained inflation alveolar recruiting maneuver (ARM) followed by 5 cmH₂O of PEEP and a stepwise ARM, in dogs undergoing laparoscopic surgery.

Twenty adult dogs were enrolled in this prospective randomized clinical study. Dogs were premedicated with methadone intramuscularly (IM); anesthesia was induced with propofol intravenously (IV) and maintained with inhaled isoflurane in pure oxygen. The baseline ventilatory setting (BVS) was as follows: tidal volume of 15 mL/kg, inspiratory pause of 25%, inspiratory to expiratory ratio of 1:2, and the respiratory rate to maintain the end-tidal carbon dioxide between 45 and 55 mmHg. 10 min after pneumoperitoneum, randomly, 10 dogs underwent sustained inflation ARM followed by 5 cmH₂O of PEEP (ARMi), while 10 dogs underwent a stepwise recruitment maneuver followed by the setting of the “best PEEP” (ARMc). Gas exchange, respiratory system mechanics, and hemodynamic were evaluated before the pneumoperitoneum induction (BASE), 10 min after the pneumoperitoneum (PP), 10 min after the recruitment (ARM), and 10 min after the pneumoperitoneum resolution (PostPP). Statistical analysis was performed with the ANOVA test (p < 0.05).

Static compliance decreased in both groups at PP (ARMc = 1.35 ± 0.21; ARMi = 1.16 ± 0.26 mL/cmH₂O/kg) compared to BASE (ARMc = 1.78 ± 0.60; ARMi = 1.66 ± 0.66 mL/cmH₂O/kg) and at ARM (ARMc = 1.71 ± 0.41; ARMi = 1.44 ± 0.84 mL/cmH₂O/kg) and PostPP (ARMc = 1.75 ± 0.45; ARMi = 1.89 ± 0.59 mL/cmH₂O/kg), and it was higher compared to PP and similar to BASE. The PaO₂/FiO₂, in both groups, was higher at ARM (ARMc = 455.11 ± 85.90; ARMi = 505.40 ± 31.70) and PostPP (ARMc = 521.30 ± 66.20; ARMi = 450.90 ± 70.60) compared to PP (ARMc = 369.53 ± 49.31; ARMi = 394.32 ± 37.72).

The two ARMs improve lung function in dogs undergoing laparoscopic surgery similarly. Application of PEEP at the end of the ARMs prolonged the effects of the open-lung strategy.

• Laparoscopic surgery
• nephrectomy
• regional anaesthesia

Robotic surgery is increasingly prevalent as an advancement in care. Steep head-down positions in pelvic surgery can increase the ventilation-perfusion mismatch and increase ventilatory requirements to offset carbon dioxide (CO₂) increases consequent to pneumoperitoneum. The primary objective was to assess the impact of two ventilatory strategies, volume versus pressure-controlled ventilation on the arterial to end-tidal carbon dioxide gradient P (a-ET)CO₂ in patients undergoing robotic surgery in the Trendelenburg position. The effects on alveolar to arterial oxygen gradient P (A-a)O₂, peak airway pressure (P_aw)_, dynamic compliance (C_dyn) and haemodynamics were also assessed.

Fifty-one patients, 18-75 y, American Society of Anesthesiologists I-III undergoing robotic surgery in Trendelenburg position were randomised to volume-controlled ventilation (Group VCV) or pressure-controlled ventilation (Group PCV). The P (a-ET)CO₂ was measured at baseline T0, 10 min after Trendelenburg position T1, 2 h of surgery T2, 4 h T3 and at T_e, 10 min after deflation. The P (A-a) O₂, P_aw, C_dyn, heart rate and blood pressure were also measured at the same time.

The P (a-ET)CO₂ at T1, T2, T3 and at T_e was lower in Group PCV versus Group VCV. The P_aw was lower at T1, T2, and T3 and C_dyn higher at T3 and Te in Group PCV at comparable minute ventilation. Haemodynamics and P (A-a)O₂ were comparable between the groups.

Pressure-controlled ventilation reduces P (a-ET)CO₂ gradient, P_aw and improves C_dyn but does not affect P (A-a) O₂ or haemodynamics in comparison to volume-controlled ventilation in robotic surgeries in the Trendelenburg position.

General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient.

The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery.

Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method.

Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001).

Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.

• Aspiration
• hemodynamic
• intubation
• laparoscopic
• mask

• gynae
• low-pressure
• minimally invasive laparoscopy
• pneumoperitoneum
• postoperative pain

• general anesthesia
• indoor air
• laminar airflow
• laparoscopic cholecystectomy
• operating room
• patient safety
• perioperative hypothermia

• Baska Mask
• endotracheal intubation
• laparoscopic cholecystectomy
• supraglottic airway

• endometrial carcinoma
• hysterectomy
• intraoperative complications
• obesity
• robotics

• Ambulatory care
• BRCA
• Oophorectomy
• Patient reported outcomes

• ERAS
• Laparoscopy
• Pneumoperitoneum
• Postoperative pain
• Robotic surgery

Laparoscopic cholecystectomy is one of the most frequently performed interventions in general surgery departments. Some of the most important aims in achieving perioperative stability in these patients is diminishing the impact of general anesthesia on the hemodynamic stability and the optimization of anesthetic drug doses based on the individual clinical profile of each patient. The objective of this study is the evaluation of the impact, as monitored through entropy (both state entropy (SE) and response entropy (RE)), that the depth of anesthesia has on the hemodynamic stability, as well as the doses of volatile anesthetic. A prospective, observational, randomized, and monocentric study was carried out between January and December 2019 in the Clinic of Anesthesia and Intensive Care of the “Pius Brînzeu” Emergency County Hospital in Timișoara, Romania. The patients included in the study were divided in two study groups: patients in Group A (target group) received multimodal monitoring, which included monitoring of standard parameters and of entropy (SE and RE); while the patients in Group B (control group) only received standard monitoring. The anesthetic dose in group A was optimized to achieve a target entropy of 40–60. A total of 68 patients met the inclusion criteria and were allocated to one of the two study groups: group A (N = 43) or group B (N = 25). There were no statistically significant differences identified between the two groups for both demographical and clinical characteristics (p > 0.05). Statistically significant differences were identified for the number of hypotensive episodes (p = 0.011, 95% CI: [0.1851, 0.7042]) and for the number of episodes of bradycardia (p < 0.0001, 95% CI: [0.3296, 0.7923]). Moreover, there was a significant difference in the Sevoflurane consumption between the two study groups (p = 0.0498, 95% CI: [−0.3942, 0.9047]). The implementation of the multimodal monitoring protocol, including the standard parameters and the measurement of entropy for determining the depth of anesthesia (SE and RE) led to a considerable improvement in perioperative hemodynamic stability. Furthermore, optimizing the doses of anesthetic drugs based on the individual clinical profile of each patient led to a considerable decrease in drug consumption, as well as to a lower incidence of hemodynamic side-effects.

• general anesthesia
• patient safety
• recovery
• response entropy
• state entropy

• complication
• conversion to laparotomy
• endometrial cancer
• hysterectomy
• laparoscopy
• obesity

• Blood Transfusion
• Body Mass Index
• Conversion to Open Surgery
• Endometrial Neoplasms/complications
• Endometrial Neoplasms/surgery
• Female
• Humans
• Hysterectomy
• Intra-Abdominal Fat
• Laparoscopy
• Obesity/complications
• Patient Positioning/adverse effects
• Postoperative Complications
• Robotic Surgical Procedures
• Tissue Adhesions/complications
• Vascular System Injuries
• Venous Thromboembolism

We aimed to investigate operating conditions, postoperative pain, and overall satisfaction of surgeons using deep neuromuscular blockade (NMB) vs. no NMB in patients undergoing lumbar spinal surgery under general anesthesia. Eighty-three patients undergoing lumbar fusion were randomly assigned to receive deep NMB (n = 43) or no NMB (n = 40). In the deep-NMB group, rocuronium was administered to maintain deep NMB (train-of-four count 0, post-tetanic count 1–2) until the end of surgery. In the no-NMB group, sugammadex 4 mg/kg at train-of-four (TOF) count 0–1 or sugammadex 2 mg/kg at TOF count ≥2 was administered to reverse the NMB 10 min after placing the patient prone. Peak inspiratory airway pressure, plateau airway pressure, lumbar retractor pressure significantly were lower in the deep-NMB group. Degree of surgical field bleeding (0–5), muscle tone (1–3), and satisfaction (1–10) rated by the surgeon were all superior in the deep-NMB group. Pain scores, rescue fentanyl consumption in post-anesthesia care unit (PACU), and postoperative patient-controlled analgesia consumption were significantly lower in the deep-NMB group, and this group had a shorter length of stay in PACU. Compared to no NMB, deep NMB provides better operating conditions, reduced postoperative pain and higher overall satisfaction in lumbar spinal surgery.

• neuromuscular blockade
• neuromuscular monitoring
• neurosurgical procedures

• General anesthesia
• Hemodynamic changes
• Laparoscopic inguinal hernia repair
• Spinal anesthesia
• Transabdominal preperitoneal (TAPP) repair

• BMI
• complications
• gynaecological malignancies
• laparoscopy
• obesity
• physiology

• Adolescent
• Adult
• Aged
• Female
• Fluid Therapy
• Graft Survival
• Humans
• Hypothermia, Induced
• Immunosuppressive Agents/therapeutic use
• India
• Kidney Failure, Chronic/surgery
• Kidney Transplantation/adverse effects
• Kidney Transplantation/methods
• Kidney Transplantation/mortality
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Male
• Middle Aged
• Postoperative Complications/prevention & control
• Risk Factors
• Robotics
• Surgery, Computer-Assisted/adverse effects
• Surgery, Computer-Assisted/mortality
• Tertiary Care Centers
• Time Factors
• Treatment Outcome
• Warm Ischemia
• Young Adult

• Advances
• Anaesthesia
• Complications
• Laparoscopy
• Pathophysiological changes
• Robotic

• Anesthesiology/trends
• Carbon Dioxide/administration & dosage
• Clinical Competence
• Diffusion of Innovation
• Humans
• Insufflation/trends
• Laparoscopy/adverse effects
• Laparoscopy/trends
• Learning Curve
• Monitoring, Intraoperative/trends
• Patient Positioning
• Patient Safety
• Postoperative Complications/etiology
• Preoperative Care/trends
• Robotics/trends
• Surgery, Computer-Assisted/trends
• Treatment Outcome