Does preloading with hydroxyethyl starch 130/0.4 prevents post spinal hypotension in elective caesarsan deliveries

The aim of the study was to compare the efficacy of the normal saline preloading versus 6% hydroxyethyl starch 130/0.4 [voluven] in preventing post spinal hypotension in women undergoing elective caesarian section. 20 patients ASA I or II undergoing elective caesarian section were included in the study. Previous caesarian section patients were excluded from the study. Patients were fasting for 8 hours as regards the solid and semisolid food and 6 hours for the fluids. Patients were divided into 2 groups the first group received one liter 6% hydroxyethyl starch 130/0.4 [voluven] within 60 minutes before the spinal intrathecal anaesthesia. The second group received two liters normal saline solution within 60 minutes before the spinal anaesthesia. Measurements included systolic and diastolic blood pressure every 3 minutes during the first 15 minutes and then every 5 minutes till the end of surgery. Incidence of hypotension and the total dose of ephedrine sulfate given to each patient were recorded. Facial outcome was judged using Apgar scoring after one and 5 minutes and umbilical artery pH immediately after delivery. The results of the present study showed significant difference between the 2 groups in the systolic blood pressure at the times of 12, 15 and 20 minutes after induction of spinal anaesthesia, blood pressure was significantly higher in the hydroxyethyl starch group. As regards the diastolic blood pressure there was a significant difference between the 2 groups at the time of 12, 15, 20, 25, 30,35 and 40 minutes after induction of spinal anaesthesia. Blood pressure was significantly higher in the hydroxyethyl starch group. Regarding the dose of the ephedrine used in the 2 groups there was a significant difference between the 2 groups only 3 patients in the first group received ephedrine sulfate when the blood pressure decrease to less than 80% of the baselines. While in the second group more patients received ephedrine sulfate in response to the attacks of the hypotension. There was no significant difference between the 2 groups in the Apgar scoring at one and 5 minutes after delivery. Also the umbilical artery pH was within normal in the 2 groups with no significant difference. The study recommends the use of one liter hydroxyethylstarch [130/0.4] as a volume preload before spinal anaesthesia as this will lead to lesser incidence of hypotension and lesser need for vasopressor therapy

Remifentanil as a single sedative agent for short-term mechanically ventilated postoperative patients in surgical intensive care

Remifentanil hydrochloride is a selective mu-opioid receptor agonist. metabolised by non-specific esterases in the blood and tissues resulting in a short effective biological half-life of less than 10 minutes without cumulative effects even after prolonged infusion. This study tried to use the advantage of this novel pharmacokinetics investigating the sedative effects of remifentanil in surgical intensive care unit [SICU] setting. Twelve post oesaphagectomy patients received remifentanil infusion for short-term mechanical ventilation [<12h]. The infusion rate started by 0.1 micro g/kg/min for 6 hand then decreased to 0.05, 0.025, 0.0125, and 0.0 micro g/kg/min every hour. Basally and 20 min. after each decrease we measured: The Ramsey sedation score [RSS] and the respiratory response sub-score of comfort scale [CSRR]. Respiratory, and haemodynamic variables as well as plasma catecholamines were also measured at the same time intervals. Infusion rate of 0.l micro g/kg.min was effective against agitation and achieved a good degree of adaptation to the ventilator in all patients [RSS: median; 5.5 and CSRR: median; 1.0]. Plasma adrenaline level significantly decreased [median 6.0 pg/ml] [p<0.05]. Respiratory and haemodynamic variables were not affected. At infusion rates lower than 0.1 micro g/kg/min RSS decreased and CSRR increased but the rest of the measures were unaffected. All patients were extubated safely within 12 h [median; 10 h]. Recoverable sinus bradycardia was noted in one patient only. No other side effects were observed in all patients. Remifentanil can be useful in SICU setting. Doses could be titrated according to the clinical requirements; low doses [up to 0.05 micro g/kg/min] can achieve adequate sedation. Higher doses [0.1 g/kg min] can inhibit respiratory drive and require controlled mechanical ventilation [CMV]