Safety and efficacy of pentastarch 6% versus albumin 5% for acute normovolemic hemodilution in patients undergoing major abdominal surgeries

Acute normovolemic hemodilution [ANH] has been used to decrease allogenic blood transfusion. ANH has different systemic effects that may include hemodynamic, oxygen transport variables, renal, hematological and acid base status. The effect of pentastarch [6% hydroxyethyl starch, MW: 200 kDa] versus human serum albumin [5%, MW: 69 kDa] as volume replacement solution after induction of anesthesia for major abdominnal surgery was assessed in this study. Eighty patients were divided into two groups; HES group [no = 40] received pentasarch and ALB group [no = 40] received albumin. Fifteen m1/kg of blood was removed and replaced simultaneously with the tested solutions to keep central venous pressure between 12-15 mmHg. Blood was reinfused before the end of operations. Total blood loss at 1st postoperative day was significantly higher in HES group [1198.5 +/- 354.3 vs. 1044.2 +/- 288.3 m1 in ALB group]. Significantly Higher amounts of the tested colloid [2084.7 +/- 408.6 in HES group vs. 1766.6 +/- 574.3 ml in ALB groups, 4 hrs postoperatively], crystalloids [5748.8 +/- 1165.3 in HES group vs. 5116.8 +/- 1309.8 ml in ALB group at 1 st postoperative day], FFP [243.6 +/- 29.7 in HES group vs. 123.5 +/- 25.3 ml in ALB group, at the end of surgery] and packed RBC [988.8 +/- 47.8 in HES group vs. 645.9 +/- 44.8 ml in ALB group, at the end of surgery] were used in HES group. HES group showed significantly higher cardiac index [3.9 +/- 0.9 in HES group vs. 3.4 +/- 1.0 1/min.m 2 in ALB group, at the completion of ANH], better preservation of SVRI [2052.3 +/- 251.5 in 5HES2 group vs. 1729.6 +/- 159.4 dyne.sec/cm5. m 2 in ALB group, at the completion of ANH]. Renal functions were better preserved in ALB group. Serum creatinine was significantly higher HES group [1.41 +/- 0.35 vs. 0.98 +/- 0.31 mg% in ALB group, at 3rd postoperative day]. Urinary N-acetyl-beta-glucosaminidase [beta-NAG] was significantly higher in HES group [1.38 +/- 0.52] compared with ALB group [0.97 +/- 0.52] u/mmol creatinine] at the 3rd posstoperative day. alpha-1-microglobulin was significantly higher in HES group [19.7 +/- 9.3] compared with ALB group [15.2 +/- 9.3 mg/1] at the 3rd postoperative day. Activated PTT was significantly higher in HES group [44.8 +/- 4.4] compared with ALB group [40.5 +/- 4.7 sec] 4 hrs postoperatively. D-dimer was significantly higher in HES group [2.4 +/- 0.2] compared with ALB group [3.0 +/- 0.6 ng/1] at the 1st postoperative day. Thrombin/antithrombin III [TAT] was statistically higher in HES group [2.2 +/- 0.7] compared with ALB group [1.9 +/- 0.6 micro g/1] at the 1st postperative day. There was a state of metabolic acidosis in both groups with a significant difference in base-excess results [-3.2 +/- 1.5 in HES group vs. -4.1 +/- 1.3 mmo1/1 in ALB group] at the completion of ANH. We can conclude that both solution were safe and effective for performing ANH before major abdominal operations with the superiority of albumin over pentastarch

Caudal levobupivacaine with and without fentanyl in pediatric surgery

Single dose caudal analgesia is one of the most useful and popular regional blocks used in modem pediatric anesthetic practice. Racemic bupivacaine is commonly used for caudal analgesia however, there have been reports of systemic toxicity. Levobupivacaine was found tobe less toxic than bupivacaine, and produces a block clinically similar to bupivacaine. This study was designed to evaluate the effects of two doses of caudal levobupivacaine with and without fentanyl in children. 90 children ASA 1-11 aged 1-5 yr, undergoing elective hypospedius, circumcision andhemia repair were studied. Anesthesia was induced and maintained with sevoflurane. Spontaneous ventilation was chosen using a laryngeal mask airway. After induction patients were turned to the left lateral position and a caudal block was performed. Patients were randomly divided into three groups to receive a volume of 1 ml.kg[-1] of: levobupivacaine 0.25% [group I], 0.125% [Group II] and 0.125% plus fentanyl 2micro g.mL[-1] [group III]. Successful blockade was defined by absence of gross movement or significant [>20%] change in HR, NIBP and/or RR on application of surgical stimulus which was allowed 10 mm after caudal injection. Postoperative analgesia was evaluated by the Children and Infants Postoperative Pain Scale [CHIPPS]. Duration of postoperative analgesia was recorded and CHIPPS and motor weakness were measured every 30 min for the first 6h and every 2h thereafter until the end of the study [24 h]. lntraoperative analgesia was adequate in 96.5%, 93.3% and 93.3% in group 1, 2 and 3, respectively. The duration of postoperative pain relief was significantly prolonged in group I [10.3h] compared with group 2 [6.1 h] and group 3 [6.8h] while no difference was found between group 2 and group 3. Motor blockade score of 1 was observed in 30% of patients in group I during the first postoperative hour and was not observed in any patients in the other two groups P<0.05. Caudal levobupivacaine 0.125% and 0.25% are safe and effective as adjuvant to general anesthesia in children and the higher concentration was associated with early mild motor blockade and longer postoperative analgesia. Fentanyl did not provide any additional benefit when combined with levobupivacaine 0.125%

Infiltration with tramadol [1-5%] in comparison with lidocaine [1%] for minor surgery

Previous studies have shown that intradcrrnal tramadol 5% can provide a local anesthetic effect similar to prilocaine 2%. The aim of our study was to determine the most effective local anesthetic concentration of tramadol hydrochloride [1, 3, or 5%] without adverse effects compared with lidocaine 1%. Eighty adult patients scheduled for excision of cutaneous lesion under local anesthesia were randomly divided into four groups. The patients were assigned to receive intradermally either 1 ml of tramadol 1% [group I, n=20], lml of tramadol 3% [group II, n=20], 1 ml of tramadol 5% [group III, n=20] and 1 ml of lidocaine 1% [group IV, n=20]. The degree of sensory block to pin prick, light touch and cold were assessed after I minute of drug administration. Pain to surgical incision was evaluated by the patients using four point scale [0-3]. Local or systemic adverse effects of the drugs were recorded. There is no significant difference as regard to quality of the block between group III and IV in comparison to group I and II [tramadol 1-3%] fail to produce local anesthetic effect similar to that in group III and IV. There is increased incidence of local reaction [rash] in group III [five patients] when compared with group IV [one patient] P<0.05. Five patients complained of burning at site of injection in group III in comparison to three patients in group IV [P>0.05]. We conclude that intradermal tramadol 5% can produce a local anesthesia similar to lidocaine 1% but with high incidence of local adverse effect

Effect of laparoscopy on hepatic function

To asses the effects of laparoscopic surgery on liver function, plasma concentration of alcoholic dehydrogenase [AD] and glutathione s- transferase [GST] was measured, which are highly concentrated into centrilobular acinus of liver and are sensitive enzymes of hepatic hypoperfusion and hepatocellular damage. Fifty patients underwent laparoscopic cholecystectomy [group A, n=25] or laparoscopic hysterectomy [group B, n=25] were studied. Perioperative AD, GST, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] in both groups was compared. Although the duration of pneumoperitoneum was longer in laparoscopic hysterectomy there was significant postoperative increase in AD and GST in the laparoscopic cholecystectomy group at the end of procedure and 1 hour after surgery compared with the laparoscopic hysterectomy group. AST and ALT concentration were significantly higher in first postoperative day in the laparoscopic cholecystectomy group than in the laparoscopic hysterectomy group. These results indicated that patient position and surgical manipulation of the liver affect significantly hepatic perfusion