Fluid optimization with hydroxyethyl starch 130/0.4 compared with modified fluid gelatin guided by esoph- ageal doppler during major abdominal surgeries

Perioperative fluid therapy has a direct bearing on patient outcome and accordingly should be tailored individually. Thus the efficacy of HES 130/0.4 was fied fluid gelatin for volume expansion during major abdominal surgery guided by transesophageal Doppler [TED]. Fifty adult patients ASA physical status I-II undergoing major abdominal surgery were anesthetized with standard technique. In addition to basal fluid requirement, patients were randomly allocated into two equal groups [25 patients ; each] to receive 200 cc of either 6% HES 130/0.4 [HES group] or 3% modified fluid gel [GEL group] as intraoperative colloid replacement guided by TED. Heart ratenmean arterial blood pressure, central venous pressure, and Doppler derived measurements were recorded at the following timings: Tl; after induction, T2; after skin incision, T3; two hours after that and T4; at the end of surgery. Fluid administration and transfusion requirements were recorded. Laboratory tests for hemostasis, hepatic and renal functions weie continued till the fifth postoperative day. Both groups were comparable regarding Doppler derived data and fluid balance. Platelet count showed a significant drop [p<0.05] in group GEL in all postoperative days compared with baseline and with the group HES. Prothrombin time and INR showed a significant increase while prothrombin concentration showed a significant drop, throughout 5 postoperative days in group HES while in the 3 postoperative days in group GEL [p<0.05] but comparable between groups. Both groups showed postoperative drop in creatinine level and postoperative rise of liver function tests. HES 130/0.4 and modified gelatin have comparable fluid optimization effect guided by TED in major abdominalsurgeries. HES 130/0.4 has a more favorable effect on platelet counts than modified gelatin

In vivo effects of different anesthetic agents on apoptosis / 대한마취과학회지

BACKGROUND: This study was designed to measure in vivo effects of propofol, isoflurane and sevoflurane on apoptosis by measuring caspase-3 and tumor necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) blood level as apoptotic markers. METHODS: After obtaining ethical committee approval and informed written consents, sixty adult patients ASA I scheduled for open cholecystectomy participated in this study. They were randomally allocated into one of three equal groups to receive propofol infusion, low-flow isoflurane or sevoflurane for maintenance of anesthesia. Venous blood samples were collected preoperatively, immediately postoperative and after 24 hours to measure hemoglobin, hematocrit, creatinine, liver enzymes, serum TRAIL and caspase-3 levels. RESULTS: There was no significant difference in hematological markers and serum creatinine. Liver enzymes showed significant postoperative rise (P < 0.05). In Propofol group, TRAIL and caspase-3 levels were significantly elevated immediately postoperative then decreased significantly after 24-hours (P < 0.05). In Isoflurane group, immediate postoperative level of TRAIL was significantly higher than 24 hours reading and significantly lower than its level in Propofol group at the same timing meanwhile caspase-3 levels were comparable at different timings. In Sevoflurane group, TRAIL and caspase-3 levels increased significantly in both postoperative samples than preoperative level and than those of Isoflurane and Propofol groups after 24 hours concerning TRAIL (P & 0.05). CONCLUSIONS: This study concluded that isoflurane is superior and sevoflurane is the least effective among the three anesthetics in protection against apoptosis. This study neither proved nor excluded propofol-induced apoptosis. Further studies are required during lengthy procedure and in compromised patients.