Impaired postural stability after laparoscopic surgery.
BACKGROUND
Early postoperative mobilisation may reduce patient morbidity and improve hospital efficiency by accelerated discharge. The aim of this study was to measure postural stability early after laparoscopic surgery in order to assess how early it is safe to mobilise and discharge patients.


METHODS
We included 25 women undergoing outpatient gynaecological laparoscopic surgery in the study. Patients received standardised anaesthesia with propofol, remifentanil and rocuronium. Postural stability was assessed preoperatively, at 30 min after tracheal extubation, and at discharge from the post-anaesthesia care unit using a force platform where sway area, mean sway and sway velocity were determined. The assessments were done with eyes closed and with eyes open. The primary outcome was the change in sway area with eyes closed 30 min after extubation. Data are reported as median (25-75% range).


RESULTS
Three patients could not perform all the test's 30 min after extubation. Thirty minutes after extubation, sway area with eyes closed had increased significantly with 84 mm(2) (9-172, P = 0.011) and 108 mm(2) with eyes open (25-295, P = 0.0017). Median mean sway had also increased significantly 30 min postoperatively. No significant changes were found for sway velocity. We found no significant changes in mean sway, sway area or sway velocity at discharge from the post-anaesthesia care unit approximately 2 h after surgery.


CONCLUSIONS
Postural stability was significantly impaired 30 min after outpatient gynaecological laparoscopic surgery. However, the postural stability was normalised at discharge from the post-anaesthesia care unit 2 h after surgery.
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
K Z
KZ
Eskildsen
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
A K
AK
Staehr-Rye
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Herlev, Denmark.
L S
LS
Rasmussen
Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
J
J
Rosenberg
Department of Intensive Care 4131, Abdominal Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
C
C
Claudius
Department of Physical- and Occupational Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
B H
BH
Kjaer
Department of Gynaecology and Obstetrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
H V
HV
Clausen
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
M R
MR
Gätke
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000732:Androstanols; D000762:Anesthesia Recovery Period; D004434:Early Ambulation / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010880:Piperidines; D004856:Postural Balance / Q000502:physiology*; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium; D013997:Time Factors
D000732:Androstanols; D010880:Piperidines; D000077208:Remifentanil; D000077123:Rocuronium; D015742:Propofol