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Study Solution (study + solution)
Selected AbstractsInfusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac functionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010V. L. KVALHEIM Objective: Peri-operative fluid accumulation resulting in myocardial and pulmonary tissue edema is one possible mechanism behind post-operative cardiopulmonary dysfunction. This study aimed to confirm an improvement of cardiopulmonary function by reducing fluid loading during an open-heart surgery. Materials and methods: Forty-nine elective CABG patients were randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl starch (HSH group) or Ringer's solution (CT group). Both groups received 1 ml/kg/h of the study solution for 4 h after baseline values were obtained (PICCO® transpulmonary thermodilution technique). Net fluid balance (NFB), hemodynamic and laboratory parameters were measured. Results: NFB was four times higher in the CT group compared with the HSH group during the first 6 h post-operatively. The total fluid gain until the next morning was lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group, 4298.7 (1059.3) ml (P<0.001). Normalized values (i.e., %-changes from the baseline) of the cardiac index and the global end diastolic volume index increased post-operatively in both groups. Both parameters were significantly higher at 6 h in the HSH group compared with CT group (P=0.002 and 0.005, respectively). Normalized values of the intrathoracic blood volume index were lower in the HSH group at 6 h post-operatively when compared with the CT group. The PaO2/FiO2 ratio decreased similarly in both groups early post-operatively, but recovery tended to be more rapid in the HSH group. Although serum-sodium and serum-chloride levels were significantly higher in the HSH group, the acid,base parameters remained similar and within the normal range. Conclusions: An intraoperative infusion of HSH during cardiac surgery contributes to reduced fluid loading and an improvement in the post-operative cardiac performance. No adverse effects of the HSH infusion were observed. [source] Perineural meperidine blocks nerve conduction in a dose-related manner: a randomized double-blind studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009E. ÖZTÜRK Background: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve. Materials and methods: The study was conducted in a double-blind, placebo-controlled fashion. Eighteen healthy volunteers were randomized into three groups (Saline, meperidine 1% and meperidine 2%). Three millilitre of the study solution was administered to the ulnar nerve perineurally at the level of the wrist by the guidance of a nerve stimulator. Sensory nerve action potential (SNAP) and compound motor action potential (CMAP) amplitudes were recorded. At least a 20% decrease in the initial response amplitude was accepted as a block. Results: The number of individuals with sensory and motor block with saline, meperidine 1% and meperidine 2% were 0/6, 6/6, 6/6 and 0/6, 5/6, 6/6, respectively (P<0.05). The maximum decrease in the median SNAP and CMAP amplitude values were 4.7% and 8.3% with saline; 38.5% and 46.4% with meperidine 1%; and 100% and 97.8% with meperidine 2%, respectively (P<0.05). Median values for the duration of sensory and motor block with meperidine 1% and meperidine 2% were 45, 52.5 and 30, 32.5 min, respectively. Conclusion: Meperidine blocks sensory and motor nerve conduction in a dose-related manner. [source] Continuous patient-controlled epidural infusion of levobupivacaine plus sufentanil in labouring primiparous women: effects of concentration*ANAESTHESIA, Issue 6 2010S. Tixier Summary The effects of two different concentrations of epidural levobupivacaine were compared when used to provide analgesia for labour. Primiparous women in spontaneous uncomplicated labour were enrolled in a prospective, randomised and partially double-blinded study. The study solutions were either 0.568 mg.ml,1 levobupivacaine (low concentration group) or 1.136 mg.ml,1 levobupivacaine (high concentration group), with sufentanil 0.45 ,g.ml,1 added to both solutions. Epidural analgesia was initiated with 20 ml of the study solution, followed by a standardised algorithm of top-up bolus injections. Epidural analgesia was then continued by self-administered boluses of 5-ml plus a continuous infusion of 5 ml.h,1. Analgesia was found to be more efficacious in the high-concentration group. The dose of levobupivacaine administered was higher and sometimes overstepping recommended limits in the high concentration group, but with no observed increase in side-effects. The choice between these two concentrations may still be made according to the patient's and the practitioner's preferences. The effects of an intermediate concentration should be studied in the future. [source] Oxytocin,ergometrine co-administration does not reduce blood loss at caesarean delivery for labour arrest,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008M Balki Objective, To determine if intravenous infusion of a combination of oxytocin and ergometrine maleate is better than oxytocin alone to decrease blood loss at caesarean delivery for labour arrest. Design, Prospective, double-blinded, randomised controlled trial. Setting, Mount Sinai Hospital, Toronto, Canada. Population, Women undergoing caesarean deliveries for labour arrest. Methods, Forty-eight women were randomised to receive infusion of either ergometrine maleate 0.25 mg + oxytocin 20 iu or oxytocin 20 iu alone, diluted in 1 l of lactated Ringer's Solution, immediately after delivery of the infant. Unsatisfactory uterine contractions after delivery were treated with additional boluses of the study solution or rescue carboprost. Blood loss was estimated based on the haematocrit values before and 48 hours after delivery. Main outcome measures, The primary outcome was the estimated blood loss, while the secondary outcomes included the use of additional uterotonics, need for blood transfusion and the incidence of adverse effects. Results, The estimated blood loss was similar in the oxytocin,ergometrine and oxytocin-only groups; 1218 ± 716 ml and 1299 ± 774 ml, respectively (P= 0.72). Significantly fewer women required additional boluses of the study drug in the oxytocin,ergometrine group (21 and 57%; P= 0.01). Nausea (42 and 9%; P= 0.01) and vomiting (25 and 4%; P= 0.05) were significantly more prevalent in the oxytocin,ergometrine group. Conclusions, In women undergoing caesarean delivery for labour arrest, the co-administration of ergometrine with oxytocin does not reduce intraoperative blood loss, despite apparently superior uterine contraction. [source] | ||||||||||