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Skin marking of the level of periosteum is undertaken best 1pack slip inn herbs lower blood pressure, and a horizontal incision made through the lower border of the mandible is made buy slip inn once a day herbals dario, then a skin crease is the periosteum onto the mandible cheap slip inn on line vedantika herbals. Using periosteal elevators discount slip inn online herbs nutrition, the identifed in the submandibular region for the submandibular inci- surgeon exposes the buccal aspect of the posterior body and sion, and this is marked. The lingual periosteal fap is then elevated trated into the submandibular region and the buccal aspect of the to expose the inferior border region. The activation arm is pulled through the skin incision The distraction appliance is positioned on the mandible with the with the mosquito forceps, and the distraction appliance is posi- shaft placed below the level of the inferior border. Temporary self-tapping site of the exit point of the activation arm through the skin, in the screws are placed in both foot plates with two screws in each retromandibular region, is marked. The screws are removed, the appliance is rotated inferi- The superior margin of the corticotomy is performed with a fne orly out of the way, and the corticotomy is continued inferiorly. The corticotomy is performed until the appliance is mandible (see Figure 34-5, B). Superior placement of nasoendotracheal tube Anterior and posterior footplates with self-tapping screws C-shaped corticotomy Exit of activation arm Distraction appliance Gel horseshoe headrest A Submandibular incision Shoulder roll B Figure 34-5 A, Nasal intubation and positioning of the head in a gel headrest with a shoulder roll. B, Placement of the distraction appliance on the posterior body of the mandible, corticotomy, and exit of the activation arm in the retromandibular region. The distraction screwdriver is used to activate the serving the medullary tissue around the inferior alveolar nerve appliance with two to three turns to ensure that the corticotomy bundle. An osteotome may need to be gently tapped up the lingual site is opening and the appliance is not detaching from the bone. Around the activa- The submandibular wound is closed in layers; 3-0 Vicryl to the tion arms, an absorbent, nonadhesive antimicrobial dressing is periosteum and tissues overlying the appliance, subdermal 4-0 placed on the skin (e. A nasogastric tube should Vicryl, then a continuous 5-0 Monocryl subcuticular suture to the be in situ, and the patient remains nasally intubated and is trans- skin. Steri-Strip dressings are applied to the skin, covered by a ferred to the intensive care unit. This process usually takes 9 to approach of our unit is to do a full turn of each appliance (0. C Figure 34-5, cont’d C, Intraoperative image showing the opening of the mandibular corticotomy with activation of the distraction appliance, with the interior alveolar nerve bundle preserved. E, Postdistraction lateral oblique radiographic view of the mandible demonstrating the lengthening of the body of the mandible. Te advantage of this approach is as the advanced segment contains both the coronoid process that there is no risk of damage to the tooth buds. Intravenous antibiotics, usually a cephalosporin, are Intraoperative Complications administered at induction and continued for the frst 48 hours, then this is changed to the nasogastric route for In neonates and infants, methodical submandibular dissec- another 2 to 3 days. Te distraction appliances are activated tion and control of any bleeding is essential to reduce the on the frst postoperative day, with one full turn of each appli- need for transfusion. Te corticotomy cut should be C shaped ance three times a day until each distraction device is fully and curved posteriorly away from the tooth buds where pos- activated its full distance, usually 15 mm. Te bony cuts should be (20 and 25 mm) pediatric distraction appliances to select if monocortical on the buccal and lingual aspects of the man- required for individual cases. Excessive manipulation of instruments Allevyn Ag dressing (or a dressing of a similar nature) is ftted at the superior border of the mandible for mobilization of around the activation arm against the skin. A phase In the neonate, in particular, the mandible is relatively of oral feeding with supplemental nasogastric feeds will be “plastic” in nature and rather than a clear mobilization of the required, and the duration of this phase varies between segments, the edges of the corticotomy may bend or distort patients but may range from weeks to months. In patients without separation of the segments, and defnitive move- with other craniofacial conditions, such as Treacher Collins ments of the osteotomes should be undertaken to avoid this syndrome and craniofacial microsomia, other factors may result. Te mandibular segments should be mobile before infuence the ability to feed orally, and some of these patients application of the device to ensure that the distraction is not will require long-term nasogastric feeding or the insertion of impeded by persistent bony attachment, particularly on the a percutaneous endoscopic gastrostomy tube. Te Steri-Strip and waterproof plastic dressing are removed 7 to 10 days postoperatively. If a local infection develops around the activation arm sites, this can be managed Postoperative Considerations with oral antibiotics. Te distraction appliances are removed 6 to 8 weeks postoperatively via the previous submandibular Te infant remains nasally intubated and is transferred to incisions. Denny A, Amm C: New techniques for airway severe upper airway obstruction, Arch Otolar- Lengthening the human mandible by gradual correction in neonates with severe Pierre yngol Head Neck Surg 130:344, 2004. Denny A, Talisman R, Hanson P, Recinos R: craniofacial syndromes, Oral Maxillofac Surg 1996. Spicuzza L, Leonardi S, La Rosa M: Pediatric thetic implications of infants with mandibular 22. Hosking J, Zoanetti D, Carlyle A et al: Anes- mild sleep disordered breathing: a possible Pierre Robin sequence: secondary difculties thesia for Treacher Collins syndrome: a review association with abnormal neuropsychological and intrinsic feeding abnormalities, Laryno- of airway management in 240 pediatric cases, function, Pediatrics 118:1100, 2006. Tey should manage this informa- treated with surgery alone or surgery combined with dental tion to guide the patients according to the state of the art 1-5 extractions and orthodontics. Te experienced surgeon knows Indications for the Use of the Procedure the limitations of orthognathic surgery in several clinical situations, especially in large movements and particularly in Tis technology is indicated for patients who present patients with syndromic mandibles. Te orthodontist usually tries to increase advancing the mandible, and inadequate anatomy (syndromic 14,15 the intercanine distance with mechanical methods, confront- mandibles). Also, this technology 14,15 and pedodontist are the frst practitioners to evaluate patients requires patient and family collaboration. The periosteum is responsible for the distraction The incision is made 4 to 6 mm labial to the depth of the man- chamber healing and must be carefully refected inferiorly to the dibular vestibule through the orbicularis muscle. After the muscle lower border of the mandible; a small channel retractor is posi- is transected, the dissection is directed obliquely through the tioned to protect it throughout the osteotomy procedure. A step may be necessary to apices with a reciprocating saw, the soft tissue between the start in the symphyseal midline and fnish between the lateral and mandibular central incisors is carefully refected superiorly to the canine to avoid postsurgical chin asymmetry. Also, patients who alveolar crest, and a skin hook is used to retract and protect the need major widening (more than 8 mm) should have the genio- soft tissues while the interdental osteotomy is completed. The plasty osteotomy performed simultaneously so as not to widen procedure is initiated with a 701 bur mounted in a straight hand- the lower part of the face, an undesirable feature in most 16-18 piece; just the outer cortex and the sectioning are fnalized with women (Figure 35-1). Distractor appliance Fixation of Paulus plate Figure 35-1 Mandibular widening with simultaneous genioplasty. If a bone-borne done simultaneously by acutely widening the mandibular basal device is to be used, it must be fxed before the osteotomy bone with an instrument, fxating the chin segment, then releasing is completed. The upper arms of the prebent bone-borne appli- the instrument from the osteotomy site. Acrylic is placed prevent the teeth from “walking” into the distraction site second- over the wires around the teeth to provide more rigidity. Following distraction removal, the orthodontist The activation is initiated 7 days later, at a rate of 1 mm per day places a dental pontic or a plastic tooth, fxed with a bracket to and a rhythm of once per day. This maintains the space open for a obtained, acrylic is placed on the activation screw to stabilize it few weeks as the teeth are brought together with slow move- and the patient is advanced to soft diet.
- Sternal cleft
- Adie syndrome
- Rigid spine syndrome
- Garret Tripp syndrome
- Patterson Stevenson syndrome
- Emery Dreifuss muscular dystrophy, dominant type
- Mehta Lewis Patton syndrome
- 3 alpha methylglutaconic aciduria, type 3, rare (NIH)
- Laryngeal papillomatosis
The choice of an antiseptic depends on the expected pathogens buy 1pack slip inn otc potters 150ml herbal cough remover, acceptability by health-care workers purchase slip inn american express vindhya herbals, and cost buy generic slip inn from india godakanda herbals. In general order slip inn online pills herbs pregnancy, antiseptics cost about $1 per patient day, far less than the cost of health-care–associated infections. In nine studies that examined the effect of improved hand hygiene adherence on health-care–associated infections, the majority demonstrated that as hand hygiene practices improved, infection rates decreased. Although alcohol-based agents have long been believed to cause more skin irritation, several recent trials have demonstrated less skin irritation and better acceptance with emollient-containing, alcohol- based hand rubs compared with either antimicrobial or nonantimicrobial soaps. The use of appropriate (glove-compatible) lotions twice a day also reduces skin irritation—as well as leading to a 50% increase in hand hygiene frequency in one study. Alcohol-based gels and foams are also generally6 more accessible than antiseptic soap and water, as the dispenser may be pocket-sized or placed conveniently near sites of patient care. It has been estimated that alcohol-based gels and foams require only about 25% of the time of going to a sink to wash one’s hands. However, soap and water should be used to remove particulate matter including blood and other body fluids or after five to ten applications of alcohol-based agent. Adherence to hand hygiene guidelines (Tables 8-2 to 8-4) generally decreases as the frequency of indicated hand washing increases, as the workload increases, and as staffing decreases. More recently, the World Health Organization has developed a campaign highlighting the “5 Moments” of hand hygiene (Fig. The campaign emphasizes the need to perform hand hygiene after each contact with a patient or their immediate environment. Therefore, alcohol-based agents should be available within hand’s reach of the anesthesia machine. They found an average increase in bacterial contamination of the work area of 115 colonies per surface area sampled during cases (95% confidence interval: 62–169; p < 0. A high level of contamination of the work area (>100 colonies per surface area sampled) increased the risk of stopcock contamination 4. Opportunities were not measured and hand hygiene episodes were not necessarily coordinated with one of the 5 Moments. Thus, transmission of bacterial contamination by the anesthesia provider appears to be common, a potential source of nosocomial infections, and largely preventable. More recent11 studies by the same group demonstrate anesthesia provider hands as a source of cross-contamination between patients. Frequent hand hygiene by12 anesthesia providers has a direct and positive impact on patient outcomes. Although gloves provide protection, bacterial flora from patients may be cultured from up to 30% of health-care workers who wear gloves during patient contact. Moreover, gloves should be removed or changed immediately after each procedure, including vascular access, intubation, and neuraxial anesthesia, because gloves become contaminated by patient contact just as hands do. Balancing hand hygiene with close attention to the patient during critical portions of the case (e. Double gloving and providing a convenient location for contaminated equipment have been suggested as effective approaches. It may also be appropriate to6 counsel patients scheduled for surgery that artificial nails may increase their risk of infection, although this has not been investigated. On the other hand, wearing a ring does not increase overall bacterial levels measured on the hands of health-care workers. Therefore, it remains unclear whether transmission of infection could be reduced by prohibiting health-care workers from wearing rings. However, when the head cover but not the mask was omitted, contamination increased three- to fivefold. Moreover, the mask does serve the purpose of protecting the health- care provider, particularly when combined with eye protection, and thus should most likely be used during tracheal intubation, emergence from anesthesia, and at other times when exposure to body fluids is likely. Although the preponderance of postoperative surgical infections is caused by flora that are endogenous to the patient, environmental and airborne contaminants may also play a causative role. Contributing factors appeared to be site of placement and the stringency of aseptic technique. Chlorhexidine–alcohol skin preparation results in a lower22 rate of central venous catheter–associated bloodstream infection than povidone-iodine with alcohol and should be used preferentially. Therefore, gowning and gloving, careful aseptic technique, and use of a wide sterile field should be routine. Use of ultrasound guidance for placement is not25 associated with an increased infection rate, and therefore is recommended since it decreases mechanical complications during placement. In26 anesthetized patients, the central line is ideally placed before the surgical site is draped in order to avoid contamination of the wire on the underside of the surgical drape. Epidural abscess formation is an extremely rare but potentially catastrophic complication of neuraxial anesthesia and epidural catheter placement. Therefore, careful attention to aseptic technique and infection control is required. The most important consideration is to prevent contamination of the needle and catheter. Thus, hand washing, skin preparation, draping, and maintenance of a sterile field should be carefully observed. Gowning and wearing a mask likely play a smaller role, but are reasonable given the devastating consequences of infection. Finally, epidurals should probably be avoided in patients known or suspected to have bacteremia or deferred until after appropriate antibiotics are administered. When appropriate antibiotics were given within 2 hours before or after intradermal injection of bacteria, they were effective in preventing invasive infection and necrosis. This gave rise to the concept of a “decisive period” in which antibiotics will be effective, which remains a guiding principle of antibiotic prophylaxis. This demonstrated the crucial role of local perfusion in delivering antibiotics to the site. Thus, the decisive period for oxygen is considerably longer than that for antibiotics. Figure 8-3 The effect of oxygen and/or antibiotics on lesion diameter after intradermal injection of bacteria into guinea pigs. Note that at every level, oxygen adds to the effect of antibiotics and that increasing oxygen in the breathing mixture from 12% to 20% or from 20% to 45% exerts an effect comparable to that of appropriately timed antibiotics. Louis, Harvey Bernard and William Cole, reported on the first controlled clinical trial of the efficacy of30 antibiotic prophylaxis in 1964 and demonstrated a benefit in abdominal operations. Thereafter, numerous clinical trials were performed with somewhat variable results. Eventually these served to define the timing and population in which prophylactic antibiotics work. By the 1970s, antibiotic 514 prophylaxis for high-risk surgery—meaning clean-contaminated and contaminated cases—was becoming well accepted and widely used, although some skeptics remained. The best results, though only by a small margin and not statistically significant, were within 0 and 60 minutes of surgery, and this subsequently became the clinical standard. Antibiotic prophylaxis has now become standard for surgeries in which there is more than a minimum risk of infection.
Causes include an idiopathic dis- nuria purchase slip inn 1pack on-line euphoric herbs, low serum complement levels slip inn 1pack overnight delivery herbals product models, and negative serologies ease; a familial disease associated with membranous glom- for automimmune diseases generic 1pack slip inn overnight delivery kan herbals relaxed wanderer. The disease usually pursues a pro- changes with tubulointerstitial scarring in advanced cases order slip inn no prescription herbals shoppes. In contrast to IgG4-related disease, IgG4 levels are not elevated in the serum, IgG4-positive plasma cells are not increased in the tissue, nodular densities are not detected when the kid- neys are imaged, and other organs are not affected. This idiopathic example shows intersti- tial inﬂammation associated with extensive interstitial ﬁbrosis widely separating the small atrophic tubules Fig 3. Alternatively, indirect immunoﬂuorescence using the patient’s serum and normal kidney sec- tions may be performed 106 3 Tubulointerstitial Diseases 3. The nuclei do not stain with proliferation karyomegalic cells are present in the kidney, brain, lung, and markers Ki-67 and proliferating cell nuclear antigen. Many patients present with recurrent diagnosis requires exclusion of toxin exposure and of treat- respiratory infections and renal failure. Many of the karyomegalic nuclei appear degenerative, with jagged nuclear contours. This case shows the impressive tubular tain a prominent nucleolus, most nuclei have smudgy appearing chro- cell nuclear enlargement and hyperchromasia. Vessels and glomeruli are not affected by karyomegaly; however, occa- sional cells within the interstitium may have enlarged nuclei. Phenacetin-containing preparations, often mixed cortical histologic changes are largely nonspeciﬁc with chronic with other agents such as caffeine, initially were implicated. Capillary sclerosis in the pelvic mucosal and medullary Acetaminophen and nonsteroidal anti-inﬂammatory drugs are small vessel are well described, associated with thickening of responsible for more recent cases. Presumably, many of granuloma—that is, vague, well-demarcated, or caseating— cases represent exogenous sources of injury; thus, a clini- and the context, such as an inﬂammatory process elsewhere in cal history of environmental and work-related exposure, as the kidney, coexistent stone formation, and clinical history, are well as drug and other medicinal treatments, such as unregu- powerful discriminating features. In the absence of another identiﬁable cause, treatment is tailored toward an allergic reaction. This case shows intense inﬂammation most cases of allergic reaction–associated granulomatous and tubular effacement. However, the cytology is bland and a clonal process was excluded by immunohistochemistry. They may present with acute renal failure most fre- quently due to hypercalemia-associated injury without a morphologic abnormality. The granulomas may be numer- ous or infrequent and may contain multinucleated giant cells. To the right of the glomerulus is a granuloma with several multinucleated giant cells. This ﬁeld con- tains three granulomas in a patient with sarcoidosis biopsied for acute renal failure. The surrounding nongranulomatous areas contain a mono- nuclear cell inﬁltrate similar to an allergic etiology. However, eosino- phils tend to be infrequent in sarcoidosis interstitial nephritis. Interstitial edema or interstitial ﬁ brosis with calci ﬁ cations also may be present Fig 3. The granulomas in allergic etiologies may be vague or well formed, and multinucleated giant cells may be present, as in this case, or absent. The granulomas typically lack necro- sis, useful in reducing the likelihood of an infectious etiology. Regardless of the presence or absence of central necrosis, staining for organisms should be performed Fig. In sarcoidosis, the granulomas tend to be more dis- crete than in allergic etiologies, with less intense and generalized in ﬂ ammation outside the granulomas 110 3 Tubulointerstitial Diseases 3. The xanthogranulomatous process primarily affects the collect- ing system and renal pyramids but may extend into the cor- tex, or even beyond the kidney into adjacent organs. Xanthogranulomatous pyelonephritis may involve the cortex and extend through the capsule involving perinephric fat, as in this case. When this occurs, it may simulate an invasive renal neoplasm on imaging studies Fig. This end-stage kid- ney disease was caused by nephrolithiasis with xanthogranulomatous pyelonephritis developing as a complication. Note, the collecting sys- tem is dilated and its wall is thickened with a yellow rind. Xanthogranulomatous pyelonephritis also may extend beyond Gerota’s fascia and into adja- cent organs. This is a case that extended into the colon (right ), involving the muscularis propria and submocosa, necessitating partial colectomy Fig. If the obstruction affects only a portion of the kidney, the xanthogranulomatous process will similarly be focal. This example shows end-stage xanthogranu- lomatous pyelonephritis affecting two thirds of this kidney. Xanthogranulomatous pyelonephritis usually is associated with severe nephrolithiasis, often in the form of a staghorn calculus. This is an example of a staghorn calculus, which derives its name from its branch- ing antler-like structure representing a cast of the calyceal system of the involved kidney 3. The periphery of the masses in xanthogranulomatous pyelonephritis tend to show zonal xanthomatous portions consists of a zone of ﬁbrosis and chronic changes. The rounded by large collections of foamy macrophages (xanthoma cells) clinical context, knowledge of the gross ﬁndings, lack of severe atypia, present at the bottom of the image and presence of inﬂammation usually permit the correct interpretation Fig. The cytoplasm of the case of xanthogranulomatous pyelonephritis in which the ﬁbrosis foamy macrophages contains numerous tiny lipid vacuoles. This is a extends well beyond the renal capsule into the perinephric fat useful feature if a diagnosis of clear cell renal cell carcinoma is consid- ered, because clear cell carcinoma usually shows completely cleared- out areas of cytoplasm lacking a foamy appearance. If cell lineage is in doubt, a cytokeratin stain will resolve the issue, because it will be nega- tive in xanthogranulomatous pyelonephritis 112 3 Tubulointerstitial Diseases 3. It is deﬁned by the presence of sheets of large mac- rophages known as von Hansemann histiocytes that contain mineralized bacterial remnants known as Michaelis-Gutmann bodies, the essential diagnostic feature. Malakoplakia most often is a mucosal-based disease in the bladder but occasion- ally produces a mass lesion in the kidney that may elicit clinical concern about a neoplastic process. The von Hansemann histiocytes in this case have more densely eosinophilic cytoplasm. This example of renal parenchymal malako- plakia shows a ﬁeld of von Hansemann histiocytes. There are numerous pale basophilic Michaelis-Gutmann bodies present, but they are difﬁcult to see at this magniﬁcation. However, most will not demonstrate the classic targetoid inclusion, which requires careful search and ﬁne focusing up and down. Many of these cells contain pale basophilic intracellular inclu- sions known as Michaelis-Gutmann bodies (arrows) 3. Mycobacterial infections of the kidney most often are caused byMycobacterium tuberculosis. However, rarely Mycobacterium bovis may involve the kidney and Mycobacterium avium-intracellulare may involve the kidney in an immunocompromised host.
For the anesthetists purchase slip inn american express herbals used for abortion, “minimally invasive” surgery requires maximally attentive anesthesia purchase slip inn without prescription herbals in the philippines. Pneumoperitoneum in conjunction with extreme patient positioning induces transient discount slip inn 1pack with mastercard ratnasagar herbals pvt ltd, but significant discount 1pack slip inn mastercard herbals 2015, multiorgan derangements that require short-term manipulation of physiology to minimize complications. Because serious complications related to surgery can occur at any stage during the intraoperative and postoperative course, constant vigilance and action are critical to avoiding permanent injury or death. Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Systematic review of 23-hour (outpatient) stay laparoscopic gastric bypass surgery. Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Selection of obese patients undergoing ambulatory surgery: a systematic review of the literature. Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling. Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis. Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position. Carbon dioxide absorption during laparoscopic donor nephrectomy: a comparison between retroperitoneal and transperitoneal approaches. Pulmonary gas exchange is well preserved during robot assisted surgery in steep Trendelenburg position. Ventilation-perfusion distributions and gas exchange during carbon dioxide pneumoperitoneum in a porcine model. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Carbon dioxide elimination pattern in morbidly obese patients undergoing laparoscopic surgery. Acid-base alterations during laparoscopic abdominal surgery: a comparison with laparotomy. Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Effect of prolonged pneumoperitoneum on intraoperative urine output during laparoscopic gastric bypass. Vasopressin release during laparoscopy: role of increased intra-abdominal pressure. Overcoming reduced hepatic and renal perfusion caused by positive-pressure pneumoperitoneum. Unpredicted neurological complications after robotic laparoscopic radical cystectomy and ileal conduit formation in steep Trendelenburg position: two case reports. The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy. The effects of steep Trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Total intravenous anesthesia with propofol reduces postoperative nausea and vomiting in patients undergoing robot-assisted laparoscopic radical prostatectomy: a prospective randomized trial. Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis. High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy. Dexmedetomidine infusion during 3175 laparoscopic bariatric surgery: the effect on recovery outcome variables. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Local anaesthesia for pain relief after laparoscopic cholecystectomy–a systematic review. Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and meta-analysis of randomized controlled trials. Systematic review and meta- analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Surgical space conditions during low-pressure laparoscopic cholecystectomy with deep versus moderate neuromuscular blockade: a randomized clinical study. Deep neuromuscular block reduces intra-abdominal pressure requirements during laparoscopic cholecystectomy: a prospective observational study. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy: a randomised controlled trial. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Respiratory and haemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment. End-tidal carbon dioxide tension during laparoscopic cholecystectomy: correlation with the baseline value prior to carbon dioxide insufflation. Inert gas exchange during pneumoperitoneum at incremental values of positive end-expiratory pressure.
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