Effects of perioperative goal-directed fluid therapy combined with the deep neuromuscular block on laparoscopic colorectal surgery
Ontology highlight
ABSTRACT:
DISEASE(S): Colorectal Cancer Patients
PROVIDER: 2698979 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
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Project description:This is a two period cross-over study randomizing patients undergoing laparoscopic surgery into 2 different groups: group 1 in which patients receive "deep neuromuscular blockade" in the beginning portion of their laparoscopic surgery followed by a period of "moderate blockade" and, group 2 in which patients receive "moderate neuromuscular blockade" in the beginning portion of their laparoscopic surgery followed by a period of "deep blockade". The deep neuromuscular block is defined as post tetanic count of 1 to 2 and the moderate neuromuscular block is defined as 1-2 twitches. In all patients, sugammadex is used to reverse the block at the end of surgery in order to obtain optimal extubating conditions.
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Project description:Interventions: moderate neuromuscular blockade:TOF count=1;deep neuromuscular blockade:posttetanic count=1
Primary outcome(s): Analgesic dosage;VAS score
Study Design: Randomized parallel controlled trial
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Project description:Interventions: Group 1:neuromuscular monitoring, TOF=0,PTC=1-2,pneumoperitoneal pressure 12 mmHg;regular neuromuscular blockade:neuromuscular monitoring, TOF=1-2, pneumoperitoneal pressure 15 mmHg
Primary outcome(s): cerebral oxygen saturation;tissue oxygen saturation;S100B protein
Study Design: Parallel
| 39594 | ecrin-mdr-crc
Project description:Interventions: Group 1:Lung-protective ventilation combined with deep neuromuscular blockade and low pneumoperitoneum pressure;Group 2:Conventional pulmonary ventilation combined with moderate NMB (neuromuscular blockade) and conventional pneumoperitoneum pressure
Primary outcome(s): Postoperative Pulmonary Complications
Study Design: Parallel
| 35013 | ecrin-mdr-crc
Project description:Pneumoperitoneum, the use of carbon dioxide, presents some disadvantages, including a risk of hypercarbia and respiratory acidosis during surgery in the respiratory system, and of an increased mean arterial pressure and systemic vascular resistance due to sympathetic excitation in the cardiovascular system. 10~15 mmHg intra-abdominal pressure is required in order to achieve a pneumoperitoneum, and increased abdominal pressure following a pneumoperitoneum causes hemodynamic changes leading to a reduced cardiac function by increasing the left ventricular end systolic wall stress and the right and left ventricular filling pressure, while decreasing the stroke volume and cardiac index. The author compared the intra-abdominal pressure necessary to achieve a pneumoperitoneum under deep muscle relaxation and medium muscle relaxation in ten patients undergoing laparoscopic surgery for colorectal cancer as part of preliminary research. The results showed that deep muscle relaxation, compared to medium muscle relaxation, was able to lower the intra-abdominal pressure by an average of 5.6 mmHg (13.2 ± 0.8 vs 7.6 ± 1.1) and the inspiratory pressure by an average of 8. Above all, even after lowering the intra-abdominal pressure with deep muscle relaxation, the surgeon was able to maintain a view almost identical to the one afforded by medium muscle relaxation. However, up until now, no reports have clearly indicated the change in pneumoperitoneum pressure, the patient’s hemodynamic change, post-operative recovery, and surgical prognosis depending on the depth of muscle relaxation.Against this background, this study aims to identify the degree to which intra-abdominal pressure in laparoscopic colorectal surgery can be reduced by deep muscle relaxation, and the corresponding advantages this method presents in terms of physiological changes such as hemodynamic and respiratory system changes. In addition, the study intends to examine the difference between deep muscle relaxation and medium muscle relaxation in terms of surgical prognosis, including their effects on post-operative pain and on the patient’s recovery of intestinal mobility.
| 2176371 | ecrin-mdr-crc
Project description:Interventions: Group 1:protective mechanical ventilation combined deep neuromuscular block and low pneumoperitoneum pressure ;Group 2:routine mechanical ventilation combined with routine neuromuscular block and pneumoperitoneum pressure
Primary outcome(s): Neutrophil Elastase, NE;Modified Clinical Pulmonary Infection Score, mCPIS;surgical rating scale, SRS
Study Design: Parallel
| 2683007 | ecrin-mdr-crc
Project description:Neuromuscular networks assemble during early human embryonic development and are essential for the control of body movement. Previous neuromuscular junction modeling efforts using human pluripotent stem cells (hPSCs) generated either spinal cord neurons or skeletal muscles in monolayer culture. Here, we use hPSC-derived axial stem cells, the building blocks of the posterior body, to simultaneously generate spinal cord neurons and skeletal muscle cells that self-organize to generate human neuromuscular organoids (NMOs) that can be maintained in 3D for several months. Single-cell RNA-sequencing of individual organoids revealed reproducibility across experiments and enabled the tracking of the neural and mesodermal differentiation trajectories as organoids developed and matured. NMOs contain functional neuromuscular junctions supported by terminal Schwann cells. They contract and develop central pattern generator-like neuronal circuits. Finally, we successfully use NMOs to recapitulate key aspects of myasthenia gravis pathology, thus highlighting the significant potential of NMOs for modeling neuromuscular diseases in the future.
2020-01-20 | GSE128357 | GEO
Project description:Introduction:Optimal fluid balance is critical to minimize anastomotic edema in patients undergoing pancreaticoduodenectomy. We examined the effects of decreased fluid administration on rates of postoperative pancreatic leak and delayed gastric emptying. Methods:Retrospective study of 105 patients undergoing pancreaticoduodenectomy at a single institution from January 2015 through July 2016. Stroke volume variation (SVV) was tracked and titrated during the procedure. A comparative analysis of postoperative complications was performed between patients with a median SVV?<?12 during the extirpative and reconstructive phases of the procedure compared with patients with an SVV???12. Results:Of 64 patients who met selection criteria, 42 (65.6%) had a SVV?<?12 and 22 (34.4%) had a SVV???12. Patients with an SVV???12 during the extirpative phase of the procedure had lower rates of postoperative pancreatic leaks compared to patients with an SVV?<?12 (5.9% vs 21.3%)). Patients with an SVV???12 during the extirpative phase had lower rates of postoperative delayed gastric emptying compared to patients with an SVV?<?12 (41.2% vs 46.8%). Conclusion:Goal-directed fluid restriction before the reconstructive phase of pancreaticoduodenectomy may contribute to lower postoperative rates of pancreatic leak and delayed gastric emptying.
| S-EPMC6199772 | biostudies-literature
Project description:Muscle denervation due to injury, disease or aging results in impaired motor function. Restoring neuromuscular communication requires axonal regrowth and regeneration of neuromuscular synapses. Muscle activity inhibits neuromuscular synapse regeneration. The mechanism by which muscle activity regulates regeneration of synapses is poorly understood. Dach2 and Hdac9 are activity-regulated transcriptional co-repressors that are highly expressed in innervated muscle and suppressed following muscle denervation. Here, we report that Dach2 and Hdac9 inhibit regeneration of neuromuscular synapses. Importantly, we identified Myog and Gdf5 as muscle-specific Dach2/Hdac9-regulated genes that stimulate neuromuscular regeneration in denervated muscle. Interestingly, Gdf5 also stimulates presynaptic differentiation and inhibits branching of regenerating neurons. Finally, we found that Dach2 and Hdac9 suppress miR206 expression, a microRNA involved in enhancing neuromuscular regeneration. RNAseq on innervated and 3 day denervated adult soleus muscle from wildtype mice is compared with that from 3 day denervated soleus muscle from Dach2/Hdac9 deleted mice to identify Dach2/Hdac9-regulated genes.
2015-10-29 | E-GEOD-58669 | biostudies-arrayexpress
Project description:Muscle denervation due to injury, disease or aging results in impaired motor function. Restoring neuromuscular communication requires axonal regrowth and regeneration of neuromuscular synapses. Muscle activity inhibits neuromuscular synapse regeneration. The mechanism by which muscle activity regulates regeneration of synapses is poorly understood. Dach2 and Hdac9 are activity-regulated transcriptional co-repressors that are highly expressed in innervated muscle and suppressed following muscle denervation. Here, we report that Dach2 and Hdac9 inhibit regeneration of neuromuscular synapses. Importantly, we identified Myog and Gdf5 as muscle-specific Dach2/Hdac9-regulated genes that stimulate neuromuscular regeneration in denervated muscle. Interestingly, Gdf5 also stimulates presynaptic differentiation and inhibits branching of regenerating neurons. Finally, we found that Dach2 and Hdac9 suppress miR206 expression, a microRNA involved in enhancing neuromuscular regeneration.
2015-10-29 | GSE58669 | GEO