Publications by authors named "Matthew R Brackman"

3 Publications

  • Page 1 of 1

Helium pneumoperitoneum ameliorates hypercarbia and acidosis associated with carbon dioxide insufflation during laparoscopic gastric bypass in pigs.

Obes Surg 2003 Oct;13(5):768-71

Department of Surgery, Washington Hospital Center, Washington, DC, USA.

Background: In the morbidly obese patient undergoing laparoscopic gastric bypass (LGBP), insufflation with carbon dioxide to 20 mmHg for prolonged periods may induce significant hypercarbia and acidosis with attendant sequelae. We hypothesize that the use of helium as an insufflating agent results in less hypercarbia and acidosis.

Methods: The study was performed between May and November 2002. A Paratrend 7 fiberoptic probe was placed via a carotid artery catheter in 5 adult Yorkshire swine as continuous pH and pCO2 levels were measured. Animals were ventilated to a constant pCO2, after which LGBP was performed. Blood gas values were measured during the procedure and for 1 hour after release of pneumoperitoneum. Helium was used for insufflation in 3 of the pigs and CO2 in 2. Comparison of arterial pH and pCO2 were made between groups.

Results: Mean maximum pCO2 for the control group (CO2 insufflation) was 99.75 +/- 22.98 mmHg, while for the experimental group (helium insufflation) was 52.86 +/- 6.27 mmHg (P=.036). Mean low pH for the groups were 7.10 +/-.056 and 7.36 +/-.015 (P =.004) respectively. Normalization of pCO2 in the helium group occurred at a mean of 14.58 min (SD 13.3 min) after release of pneumoperitoneum, while in the control group levels did not normalize (mean final pCO2= 71.5 mmHg).

Conclusions: Helium pneumoperitoneum in LGBP is associated with less intraoperative hypercarbia and acidosis than is the use of CO2. In addition, pCO2 returns to normal more rapidly postoperatively with the use of helium insufflation. Study of helium insufflation in humans undergoing LGBP is needed to prove its benefits in the clinical setting.
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October 2003

Acute lower gastroenteric bleeding retrospective analysis (the ALGEBRA study): an analysis of the triage, management and outcomes of patients with acute lower gastrointestinal bleeding.

Am Surg 2003 Feb;69(2):145-9

Department of Surgery, Division of Colorectal Surgery, Washington Hospital Center, Medlantic Research Institute, Washington, DC 20010, USA.

Many algorithms have been developed for patients with acute lower gastrointestinal hemorrhage (ALGIH). Their clinical usefulness is not readily apparent. It is important first to observe patterns in admission, triage, and management to formulate hypotheses as to how outcomes might be affected. We reviewed patient charts with the diagnosis of gastrointestinal hemorrhage from June 1998 to January 2001. Patients with ALGIH were entered into a database. We defined patients as having ALGIH if presentation included melena or hematochezia. Patients with hematemesis, bloody nasogastric aspirate, or occult fecal blood were excluded. Observations were made on 420 patients. Seventy-six per cent of patients were admitted to the medical service. Lower endoscopy was the first diagnostic method in 33 per cent. Medical management comprised 52 per cent of first management strategies. Surgeons used angiography (3% vs 1%) or surgery (25% vs 5%) more than other services. Fourteen per cent of patients managed with endoscopy, 16 per cent medically, 17 per cent with surgery, and 67 per cent with interventional radiology required two or more subsequent packed red blood cell transfusions. Mean admission Acute Physiology and Chronic Health Evaluation II score was 9.2 whereas that for those with mortality was 13.5. We conclude that the construction of a database will allow for formation and testing of hypotheses in managing ALGIH.
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February 2003

Bare bones laparoscopy: a randomized prospective trial of cost savings in laparoscopic cholecystectomy.

J Laparoendosc Adv Surg Tech A 2002 Dec;12(6):411-7

Washington Hospital Center Department of Surgery, and Division of Surgery, Kaiser Permanente, Washington, DC, USA.

Objective: Rising costs and lowered reimbursements make value essential if laparoscopic cholecystectomy (LC) is to be offered to patients without condemning providers to financial loss. We hypothesize that our protocol increases this value. Once practiced, operative time, complications, and patient satisfaction compare with those of the typical method.

Methods: We prospectively randomized 50 consecutive patients equally to control or experimental LC according to our protocol. Equipment costs, operative time, conversions, complications, pain, and return to work were compared. The student's t test was used for comparisons.

Results: Mean disposable equipment costs were 173.00 dollars +/- 43.45 dollars and 434.42 dollars +/- 50.54 dollars for the study and control groups, respectively (P < .0001). Mean operative times were 67.26 +/- 15 and 70.60 +/- 19 minutes, respectively.

Conclusions: The "bare bones" protocol is safe. It has a short learning curve, demonstrates a cost advantage over the common method, and requires no additional operative time. Pain, time to return to work, and satisfaction are equivalent.
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December 2002