Can fluid preloading attenuate spinal induced hypotension in the elderly?

Physiologic is aimost associated with progressive loss of reserve in organ function. The objective of this study was to evaluate fluid preloading either by colloid, crystalloid or both on the incidence and frequency of spinal anesthesia induced hypotension in elderly patient. 60 patients scheduled for lower limb orthopedic surgery under spinal anaesthesia were randomly allocated to receive preload with either 6% hydroxyethyl starch 500 ml [Colloid group], 1000 ml lactated Ringer's [Crystalloid group], 500 mI lactated Ringer's plus 250 ml 6% hydroxyethylstarch [Combined group] or received no prehydration [No preload group]. ABP decreased significantly in the four groups after induction of spinal anaesthesia and it was significantly higher in the colloid goup than the other groups. The mean of ephedrine and incidence of hypotension was significantly lower in colloid group 3 of 15 [20%], compared with crystalloid 9 of 15 [60%], combined group 7 of 15 [46%] and no preload group 11 of 15 [73%]. intravascular administration in the four groups resulted in significant increase of CVP then decrease after spinal block. The use of colloid as a pre-emptive infusion is demonstrably effective to attenuate spinal anaesthesia induced hypotension in elderly patient as compared with crystalloid or no fluid preload. However, the incidence of hypotension was only reduced but not completely eliminated

Effect of addition of fentanyl to intra-articular ketorolac for pain management in patients undergoing arthroscopic knee surgery

Arthroscopic Knee surgery is now one of the most commonly performed surgical procedures as its major advantage is the minimal surgical trauma to the knee joint. It is not associated with severe postoperative pain but providing the patients with adequate analgesia may affect the recovery profile. The goal of this study was to evaluate the effect of addition of fentanyl to ketorolac intra-articularly on the haemodynamic parameters, postoperative analgesia, possible postoperative complications and optimum discharge criteria in patients undergoing arthroscopic knee surgery. The study was conducted on 40 adult patients of either sex admitted at Mansoura university hospital knee unit for elective knee arthroscopy. Patients were randomly allocated into two equal groups [20 patients each] according to intra-articulary injected solution: Ketorolac group [K] [10 mg ketorolac] and Ketorolac Fentanyl group [KF] [5 mg ketorolac + 50microg fentanyl] diluted in 20 ml 0.9% saline. All patients received general anaesthesia and all received the intra-articular study solution at the end of knee arthroscopy. Ten minutes before release of the tourniquet. Every patient was monitored intraoperativeiy and postoperatively for 24 hours with ECG non invasive blood pressure, and pulse oximetry. Duration of postoperative analgesia, Verbal Rating Pain Score, postoperative analgesic consumption and postoperative complications [sedation, respiratory depression, pruritus, nausea and vomiting] were recoded postoperatively for 24 hours. The patient's characteristics were comparable in the two groups regarding age, body weight, height and sex with no significant differences between the two groups. The duration of postoperative analgesia was significantly longer in KF group when compared with K group. Also the lotal consumption and the number of postoperative supplemental diciofenac doses were significantly decreased in KF group when compared with K group. Verbal Rating Scale Pain Score were significantly increased in K group at 12 hours when compared with the basal value, and significantly decreased in KF group when compared with K group at 12 hours. Haemodynamic parameters [mean arterial blood pressure and heart rate], oxygen saturation, sedation score and modified Al-dret score showed no significant differences either within each group or in between the two groups. No patient complained from nausea/ vomiting, pruritus or respiratory depression. No patient had a respiratory rate less than 10/minute. All patients in the two groups were discharged from hospital after the first 24 hours following surgery. Based on the previous results of our study, we can conclude that the addition of fentanyl to ketorolac intra-articularly significantly produces more prolonged duration of postoperative analgesia without any undesirable side effects in patients undergoing arthroscopic knee surgery

Renal functions and serum fluoride concentrations in chronic renal failure patients after sevoflurane or isoflurane anaesthesia

Sevoflurane is metabolised to hexa-fluoro-isopropanol and inorganic fluoride ions by human liver. The peak plasma fluoride level is higher after sevoflurane than after isoflurane. Although this has no effect on renal functions in normal patients and volunteers, it might be risky on those with chronic renal insufficiency. In this study, 60 patients with stable chronic renal insufficiency who required surgical intervention were randomly allocated into one of two groups each of 30 patients; sevoflurane and isoflurane groups. We compared the renal functions [serum creatinine, urea, osmolality, sodium and urine osmolality] and the serum inorganic fluoride levels afler sevoflurane to those after isoflurane anaesthesia. Peak serum inorganic fluoride concentrations were significantly higher after sevoflurane than after isoflurane anesthesia [26 +/- 3 Vs 14 +/- 2 um/L]. Laboratory measures or renal functions remained stable throughout the postoperative period in both groups. No patient suffered a permanent renal damage of preexisting renal insufficiency and non required postoperative dialysis. There is no evidence that the increased fluoride levels after sevoflurane worsened the preexisting renal impairment. We concluded that the increase in serum inorganic fluoride after sevoflurane to levels as seen in this study are of little risk to patients with chronic renal insufficiency. Further studies to evaluate the effect of compound A on the renal functions on those chronic renal impairment patients are required