• Journal of Korean Academy of Nursing
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• v.40 no.3
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• pp.433-441
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• 2010

Purpose: This study was performed to identify effects of pneumoperitoneum on hemodynamic changes of hypertensive patients undergoing laparoscopic colectomy under general anesthesia. Methods: Data collection was done from January 2 to June 10, 2008. Seventy-six patients, including 38 hypertensive patients, who had taken antihypertensive drugs more than 1 month and 38 normotensive patients undergoing laparoscopic colectomy were enrolled in this study. The hemodynamic parameters were heart rate (HR), mean arterial pressure (MAP) and cardiac output (CO) which were measured 7 times from before induction of anesthesia to 5 min after deflation of the pneumoperitoneum. Collected data were analyzed using Repeated Measures ANOVA and Bonferroni comparison method. Results: HR in the hypertensive group was significantly decreased at deflation of the pneumoperitoneum and 5 min after deflation of the pneumoperitoneum (p=.012). MAP in the hypertensive group was not different from the normotensive group (p=.756). CO in hypertensive group was significantly lower than normotensive group (p<.001) from immediately after pneumoperitoneum to 5 min after deflation of the pneumoperitoneum. Conclusion: The results indicate that pneumoperitoneum during laparoscopic surgery does not lead to clinically negative hemodynamic changes in heart rate, mean arterial pressure or cardiac output of hypertensive patients, who have taken antihypertensive drugs for more than 1 month.

• Journal of Yeungnam Medical Science
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• v.33 no.2
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• pp.90-97
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• 2016

Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

• Journal of Chest Surgery
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• v.10 no.1
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• pp.53-58
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• 1977

There are many procedures which treat pulmonary tuberculosis. Pneumoperitoneum of those which was begun by Banyai in 1934 is considered effective collapse therapy economically and socially in Korea. The author had studied 30 patients receiving pneumoperitoneum and/or chemotherapy who were moderatedly advanced pulmonary tuberculosis with positive sputum to AFB stain between Apt. 1, 1976 and Oct. 1, 1976. An attempt is to clarify the effects of pneumoperitoneum with chemotherapy [A group: 20 patients] in contrast with chemotherapy alone [B group: 10 patients] for 6 months. The results obtained were as follows: 1] All both groups showed the diminished pulmonary cavity size, but the effect of A group is prominent as 74% rather than 39% of B group. 2] Sputum conversion ratio is 55% in A group, and 20% in B group. 3] In Korea, the moderate amount of air is 1500cc in men, 1000cc in women. 4] Although pneumoperitoneum is in old hands, it is a relatively safe procedure, well tolerated, free from serious complications. 5] The advantages of pneumoperitoneum are evident in the treatment of bilateral lesion, with or without cavity, not too far advanced.

• Journal of Korean Biological Nursing Science
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• v.19 no.2
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• pp.76-85
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• 2017

Purpose: The purpose of this study was to compare the effects of $21^{\circ}C\;CO_2$ and $37^{\circ}C\;CO_2$ pneumoperitoneum on body temperature, blood pressure, heart rate, and acid-base balance. Methods: Data were collected at a 1300-bed university hospital in Incheon, from February through September 2012. A total of 74 patients who underwent laparoscopic colectomy under general anesthesia with desflurane were randomly allocated to either a control group or an experimental group. The control group received $21^{\circ}C\;CO_2$ pneumoperitoneum; the experimental group received $37^{\circ}C\;CO_2$ pneumoperitoneum. The pneumoperitoneum of the two groups was under abdominal pressure 15 mmHg. Body temperature, systolic blood pressure, heart rate and acid-base balance were assessed at 30 minutes and 90 minutes after pneumoperitoneum, and again at 30 minutes after arriving at the Post Anesthesia Care Unit. Results: Body temperature in the $37^{\circ}C\;CO_2$ pneumoperitoneum group was significantly higher (F= 9.43, p< .001) compared to the $21^{\circ}C\;CO_2$ group. However, there were no statistically significant differences in systolic blood pressure (p= .895), heart rate (p= .340), pH (p= .231), PaCO2 (p= .490) and HCO3- (p= .768) between the two groups. Conclusion: Pneumoperitoneum of $37^{\circ}C\;CO_2$ is effective for the increase of body temperature compared to pneumoperitonium of $21^{\circ}C\;CO_2$, and it does not result in a decrease of blood pressure, heart rate or acid-base imbalance.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.578-581
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• 2001

We successfully treated a 59-year-old male with adenocarcinoma in the right lower lobe who had developed a dead space with prolonged air-leak, which continued for 21 days after lower and middle lobectomy, by creating artificial pneumoperitoneum. He had a history of subtotal gastrectomy due to stomach cancer 5 years ago. Artificial pneumoperitoneum was made after introducing a peritoneal dialysis catheter into the right upper quardrant. The chest tube was removed 14 days after creating pneumoperitoneum.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.83-85
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• 2024

Pneumoperitoneum usually presents as a surgical emergency, especially in patients with a history of trauma. However, we recently encountered an atypical case of pneumoperitoneum at a hysterectomy site following blunt trauma, indicating that immediate laparotomy may not always be necessary. In this report, we present the case of a 45-year-old woman who was transferred to our trauma center from a local hospital after being involved in a traffic accident the day before. Although she underwent an emergency laparotomy, no bowel perforation was detected. Instead, a rupture was found at the site of a hysterectomy that had been performed 8 months earlier. After repairing the hysterectomy site, the pneumoperitoneum resolved, and the patient was subsequently discharged without further complications.

• Journal of Korean Biological Nursing Science
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• v.19 no.3
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• pp.123-130
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• 2017

Purpose: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. Methods: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. Results: Explanatory factors of intra-operative hypothermia (< $36^{\circ}C$) were weight (${\beta}=.361$, p< .001) and pre-operative CBT (${\beta}=.280$, p= .001) 1 hour after pneumoperitoneum (Adjusted $R^2=.198$, F= 7.56, p< .001). Weight was (${\beta}=.423$, p< .001) and pre-operative CBT was (${\beta}=.206$, p= .011) 2 hours after pneumoperitoneum (Adjusted $R^2=.177$, F= 5.93, p< .001). The researchers developed a predictive model for intra-operative CBT ($^{\circ}C$) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. Conclusion: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.

• Korean Journal of Radiology
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• v.24 no.6
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• pp.541-552
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• 2023

Objective: Detection of pneumoperitoneum using abdominal radiography, particularly in the supine position, is often challenging. This study aimed to develop and externally validate a deep learning model for the detection of pneumoperitoneum using supine and erect abdominal radiography. Materials and Methods: A model that can utilize "pneumoperitoneum" and "non-pneumoperitoneum" classes was developed through knowledge distillation. To train the proposed model with limited training data and weak labels, it was trained using a recently proposed semi-supervised learning method called distillation for self-supervised and self-train learning (DISTL), which leverages the Vision Transformer. The proposed model was first pre-trained with chest radiographs to utilize common knowledge between modalities, fine-tuned, and self-trained on labeled and unlabeled abdominal radiographs. The proposed model was trained using data from supine and erect abdominal radiographs. In total, 191212 chest radiographs (CheXpert data) were used for pre-training, and 5518 labeled and 16671 unlabeled abdominal radiographs were used for fine-tuning and self-supervised learning, respectively. The proposed model was internally validated on 389 abdominal radiographs and externally validated on 475 and 798 abdominal radiographs from the two institutions. We evaluated the performance in diagnosing pneumoperitoneum using the area under the receiver operating characteristic curve (AUC) and compared it with that of radiologists. Results: In the internal validation, the proposed model had an AUC, sensitivity, and specificity of 0.881, 85.4%, and 73.3% and 0.968, 91.1, and 95.0 for supine and erect positions, respectively. In the external validation at the two institutions, the AUCs were 0.835 and 0.852 for the supine position and 0.909 and 0.944 for the erect position. In the reader study, the readers' performances improved with the assistance of the proposed model. Conclusion: The proposed model trained with the DISTL method can accurately detect pneumoperitoneum on abdominal radiography in both the supine and erect positions.

• Clinical and Experimental Pediatrics
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• v.58 no.8
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• pp.288-293
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• 2015

Purpose: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. Methods: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. Results: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was $4.4{\pm}1.7days$ of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. Conclusion: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.

• Advances in pediatric surgery
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• v.18 no.2
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• pp.83-88
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• 2012

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.