Assessment of intraoperative use of ringer acetate in patients with liver cirrhosis

In this study, Acetated Ringer [AR] and Lactated Ringer [LR] were used as intraoperative infusions in patients with liver cirrhosis during elective surgery under general anaesthesia Their effect on acid- base balance, serum pyruvate, serum lactate, ketone bodies concentration, liver function, blood glucose level and haemodynamic parameters were evaluated intra and postoperatively. Thirty patients [grade A, Child-Pugh classification] were divided into two groups according to the type of the infused solution; LR or AR. Postoperative Pyruvate level in AR [1 21 +/- 0 39 mg/dl] was significantly higher than in LR group [0.47 +/- 0.11 mg/dl]. However, the level of lactate in LR group postoperatively [16.80 +/- 1.61 mg/dl] increased significantly in comparison to that in AR group [8.87 +/- 0.92 mg/dl]. The ketone bodies concentration was significantly higher in AR group [2.33 +/- 0.42 mg/dl] than in LR group [0.40 +/- 0.20 mg/dl]. There was no significant changes in pH, HCO3, base excess, liver function, blood glucose level and haemodynamic parameters in both groups either tntraoperatively or at the end of the infusion These results suggest that AR may be more beneficial as an intraoperative fluid than LR. Acetated ringer decreased the metabolic load to the liver and improved hepatic energy status in patients with liver dysfunction

comparative evaluation of different supraglottic ventilatory devices during general anaesthesia with controlled ventilation

Laryngeal mask airway [LMA], esophageal tracheal combitube [OTC], and laryngeal tube [LT] are ventilatory devices that are inserted easily and blindly as an alternative method to endotracheal intubations. They allowed safe ventilation with lesser pressor response. Sixty adult patients with mallampati score I and II scheduled for elective surgery under general anaesthesia with controlled ventilation. Patients were randomly divided into three equal groups, LMA was used in the first, OTC was used in the second and LT was used in the third group. The three devices were compared as regard insertion parameters, cardiovascular responses, adequacy of ventilation [oxygen saturation, end tidal carbon dioxide, air leak] and post removal complications. The three devices were effective in controlled ventilation with haemodynamic stability and adequate ventilation parameters. Manual manipulations needed to maintain a patent air way was less in LMA group [10%] in comparison to OTC [30%] and LT [30%] groups. However, air leak fraction was more evident in LMA group. After removal of the devices postoperative sore throat occurred more frequently with OTC and LT

Clinical evaluation of single injection thoracic paravertebral block as A preemptive analgesia in major breast surgery

In the current study, we evaluated the use of single injection paravertebral block [PVB] at T4 in females undergoing major breast surgery and to compare it to the conventional method using fentanyl preoperatively. Sixty females ASA I, II were divided into two groups. Group I included 30 females were given Para vertebral block as preemptive analgesia followed by general anaesthesia without any narcotic. Group II included 30 females were given balanced general anesthesia with fentanyl 2micro g/kg. Measurements included continuous ECG, HR, Spo2, NIBP, postoperative nausea and vomiting and postoperative verbal rating score [VRS] for pain hourly postoperatively for the 1st 6 hours then 6 hourly for the first day. Stress hormones [Cortisol, epinephrine and nor epinephrine] and postoperative pulmonary functions were also compared in the two groups. Group II patients [control group] developed a significantly higher incidence of nausea and vomiting. There was no significant difference between heart rates of the two groups at 0 time, whereas there was a significant increase in heart rate in group II at any other time. There was no significant difference in MABP between both groups at 0, 3 times, whereas the MABP of group I was significantly lower than that of group II regarding the rest of time. There was no significant difference between the two groups as regard oxygen saturation at any time. VRS of postoperative pain was significantly higher in group II than that of group I with significant reduction in pethidine requirements in group I patients. During the operation group II patients developed a significant increase in stress hormones levels. In the control group there was a significant percentage reduction in PEFR, FVC and FEV[1] at all times postoperatively. It could be concluded that single injection PVB used during major breast surgery provided higher quality of analgesia with less incidence of postoperative pulmonary complications with early ambulation and haemodynamic stability