Research has shown that teaching individuals to experience pain and anxiety as inevitable products of the actions they freely and responsibly undertake yields healthier reactions to suffering. This preliminary study assesses whether a brief acceptancebased psychological intervention along with the usual presurgical protocol for a laparoscopic cholecystectomy will produce healthier reactions to postsurgical pain, and will reduce anxiety, duration of postsurgical hospitalization, and demand of analgesics. After admission, screening, and consent procedures, we assessed pain and anxiety. Patients in the experimental condition (n = 6) then received a brief acceptance-based nursing intervention addressing the individual meaning of surgery, and including a metaphor and defusion practice, along with routine care. Patients in the control condition (n = 7) received routine care only. Twenty-four hr following the intervention, surgery took place. Pain, anxiety, and patients' demand for analgesics were assessed 24 hr or 48 hr after surgery. All six experimental patients, as compared to three of seven control patients, demanded fewer analgesics and left the hospital within 24 hr or 48 hr from surgery even in the presence of frequent and/or intense pain. Anxiety slightly decreased in the experimental patients. The brief acceptance-based intervention was effective in improving postsurgical recovery. These preliminary findings support the potential of this type of intervention as a cost-effective strategy to be implemented in the sanitary context.

A 92-year-old female was scheduled for laparoscopic cholecystectomy. Following intraperitoneal carbon dioxide insufflation and removal of her gallbladder, the patient developed serious haemodynamic deterioration associated with a decrease of both end-tidal carbon dioxide concentration (ETCO2) and chest compliance. Carbon dioxide embolism was suspected and the diagnosis was confirmed by aspiration of 20 mL of foamy blood from the central venous line. The patient was successfully resuscitated after discontinuation of carbon dioxide insufflation and ventilation of the lungs with 100% oxygen. Carbon dioxide embolization must always be suspected during laparoscopic surgery whenever sudden haemodynamic deterioration associated with a decrease in ETCO2 and chest compliance occur.

Prolonged nerve conduction blockade has been proposed to result from the summed effects of charged and neutral local anaesthetics. Thirty-seven patients were randomly allocated to receive intravenous patient-controlled analgesia alone or combined with intercostal blockade (T7–T11) with a mixture of 0.45% bupivacaine and 0.6% phenol for post-cholecystectomy analgesia. Adequacy of pain relief was measured by patient scores on a 10-cm visual analogue scale and by dose–demand ratio, amounts of loading dose and total consumption of morphine and also the duration of patient-controlled analgesia in each group. No differences were found between groups in post-operative scores, dose–demand ratios and loading doses of morphine. However, in the combined treatment group, a significantly lower total consumption of morphine (P<0.05), associated with a shorter duration of patient-controlled analgesia (P<0.02) and a decreased mean number of unsuccessful demands (P<0.001) were recorded. Intercostal blockade with bupivacaine–phenol supplements intravenous patient-controlled analgesia for post-cholecystectomy pain relief.