Effect of Intra-Operative Intravenous Crystalloid Infusion on Post-Operative Nausea and Vomiting after Diagnostic Gynaecological Laparoscopy- Comparison of 30 mL/Kg & 15 mL/Kg.

Laparoscopic procedures have the advantages of minimal incision, early recovery, lesser post-operative pain and early ambulation. However, they are associated with an increased incidence of post-operative nausea and vomiting (PONV), which is all the more frequent in gynaecological laparoscopic surgeries. In our study, we have evaluated the effectiveness of intra-operative intravenous crystalloid infusion on post-operative nausea and vomiting after diagnostic gynaecological laparoscopy.METHODSInformed consent was obtained and patients were randomly divided into two groups. Group 1 received 30 mL/Kg intravenous crystalloid infusion intra operatively and group 2 received 15 mL/Kg intravenous crystalloid infusion. Incidence of nausea, incidence of emesis (retching or vomiting), the amount of rescue antiemetic used, and the haemodynamic parameters were noted in the postoperative period for 12 hours for both the groups.RESULTSIncidence of PONV was much more in group 2 in 0, 1, 2, 3, 4, 6 hours post operatively and rescue antiemetic use was much more in group 2 in total 12 hours post-operative period. There was no statistically significant difference in hemodynamic parameters between Group 1 and Group 2.CONCLUSIONSIntra-operative administration of 30 mL/Kg of crystalloid infusion significantly reduces the incidence of PONV and rescue antiemetic use compared to 15 mL/Kg crystalloid infusion in diagnostic gynaecological laparoscopy. So, it can be used as a non-pharmacological method for prophylaxis of PONV.

Rotational thromboelastometry assessment of ballanced crystalloid, hydroxyethyl starch and gelatin effects on coagulation: a randomized trial / Tromboelastometria rotacional na avaliação dos efeitos de cristaloides balanceados, hidroxietilamido e gelatina na coagulação: estudo randômico

Abstract Background and objectives Modern crystalloid and colloid solutions are balanced solutions which are increasingly used in perioperative period. However, studies investigating their negative effect on whole blood coagulation are missing, and vivid debate is going on about which solution has the minimal coagulopathy effect. The aim of our study was to assess the effect of modern fluid solutions on whole blood coagulation using rotational thromboelastometry. Methods Blood samples were obtained from 30 patients during knee arthroscopy before and after administration of 500 mL of crystalloid, Hydroxyethyl Starch and gelatin according to the randomization. Rotational thromboelastometry (Extem, Intem and Fibtem tests) was used to assess negative effect of fluid solutions on whole blood coagulation. Results In Extem test, the initiation phase of fibrin clot formation represented by CT parameter was not influenced by any fluid solution (p > 0.05). The speed of clot formation represented by CFT and α angle was impaired by Hydroxyethyl Starch and gelatin but not by crystalloids (p < 0.05). The strength of formatted coagulum represented by MCF parameter was impaired both in Extem and Fibtem test by HES and in Fibtem also by crystalloids (p < 0.05). Intem test was not negatively influenced by any crystalloid or colloid solution in any parameter (p > 0.05). Conclusion Extem test appears to be sensitive to coagulopathy effect of modern colloids and crystalloids. Hydroxyethyl starch has the most obvious negative effect on clot formation followed by gelatin and finally by crystalloids. Intem test seems to be insensitive to adverse effect of modern colloids and crystalloids.

Resumo Justificativa e objetivos Os cristaloides e coloides modernos são soluções balanceadas e cada vez mais utilizadas no período perioperatório. No entanto, não há estudos que avaliem seu efeito negativo na coagulação do sangue total e o intenso debate sobre a solução que cause um efeito mínimo na coagulopatia permanece. O objetivo de nosso estudo foi avaliar o efeito das soluções líquidas modernas na coagulação do sangue total com o uso da tromboelastometria rotacional. Métodos De acordo com a randomização, amostras de sangue foram colhidas de 30 pacientes durante a artroscopia de joelho, antes e após a administração de 500 mL de cristaloides, hidroxietilamido e gelatina. A tromboelastometria rotacional (testes Extem, Intem e Fibtem) foi utilizada para avaliar o efeito negativo das soluções líquidas na coagulação do sangue total. Resultados No teste Extem, a fase de iniciação da formação de coágulos de fibrina representada pelo parâmetro CT não foi influenciada por qualquer solução líquida (p > 0,05). A velocidade da formação de coágulos representada pelo CFT e pelo ângulo α foi prejudicada pelo hidroxietilamido e pela gelatina, mas não pelos cristaloides (p < 0,05). A força do coágulo formatado representado pelo parâmetro MCF foi prejudicada tanto no teste Extem quanto no teste Fibtem pelo HES e no teste Fibtem também pelos cristaloides (p < 0,05). O teste Intem não foi influenciado negativamente por nenhuma solução cristaloide ou coloide em nenhum parâmetro (p > 0,05). Conclusão O teste Extem parece ser sensível ao efeito de coagulopatia dos coloides e cristaloides modernos. O hidroxietilamido apresentou o efeito negativo mais óbvio na formação do coágulo, seguido pela gelatina e finalmente pelos cristaloides. O teste Intem parece ser insensível ao efeito adverso dos coloides e cristaloides modernos.

The effects of crystalloid warming on maternal body temperature and fetal outcomes: a randomized controlled trial / Os efeitos do aquecimento de cristaloides sobre a temperatura corporal materna e nas condições fetais: ensaio clínico randômico

Abstract Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.

Resumo Justificativa e objetivos: A hipotermia ocorre em cerca de 60% dos pacientes sob anestesia e geralmente não é tratada adequadamente durante procedimentos cirúrgicos de curta duração. A hipotermia está associada a desfechos clínicos adversos. O presente estudo teve como objetivo avaliar os efeitos do aquecimento de cristaloides nas condições maternas e fetais em pacientes submetidas à cesariana eletiva com raquianestesia. Métodos: Neste estudo prospectivo, randômico e controlado, 60 parturientes agendadas para cesárea eletiva com raquianestesia foram distribuídas aleatoriamente para receber cristaloides à temperatura ambiente ou aquecidos a 37 °C. A raquianestesia foi realizada no interespaço L3-L4 com 10 mg de bupivacaína hiperbárica sem adição de opioides. Temperatura central, tremores e parâmetros hemodinâmicos foram medidos a cada minuto até o décimo minuto e em intervalos de 5 min até o fim da operação. O desfecho primário foi a temperatura central materna ao final da cesárea. Resultados: Não houve diferença nas mensurações basais da temperatura timpânica, mas a diferença foi significativa no fim da operação (p = 0,004). A temperatura central foi de 36,8 ± 0,5 °C na fase basal e diminuiu para 36,3 ± 0,5 °C no grupo com aquecimento isotérmico de cristaloides e a temperatura basal timpânica foi de 36,9 ± 0,4 °C e diminuiu para 35,8 ± 0,7 °C no grupo sem aquecimento das soluções no fim da operação. Tremores foram observados em 43,3% no grupo controle. Alterações nos parâmetros hemodinâmicos e dados demográficos não foram significantes entre os grupos. Conclusões: O aquecimento isotérmico de cristaloides previne a redução da temperatura central durante a cesariana com raquianestesia em parturientes a termo. Os escores de Apgar para os fetos no primeiro e quinto minutos são maiores com o aquecimento isotérmico.

Saline for adverse effects caused by septic shock fluid resuscitation and the exploration of new resuscita￣tion fluid / 中国小儿急救医学

Sepsis is a life￣threatening organ dysfunction caused by deleterious host response due to infection. Septic shock is a type of sepsis that has a high mortality rate worldwide each year. At present, 0. 9% saline is still the first choice for resuscitation fluid in septic shock in the world,but hyperchloremia and acute kidney injury caused by 0. 9% saline resuscitation are receiving more and more attention. This review elaborates on the mechanism of hyperchloremia and acute kidney injury caused by saline,and explores a new type of liquid (balanced crystalloids) instead of 0. 9% saline for fluid resuscitation,thereby reducing compli￣cations caused by fluid resuscitation.

Uso de la matriz hemostática Floseal® en el control de la hemorragia obstétrica: estudio de seguimiento y costos asociados con el tratamiento / Use of Floseal® hemostatic matrix in the management of obstetric hemorrhage: A follow-up and costs related to treatment

Resumen OBJETIVO Evaluar cómo se atendieron las pacientes con hemorragia obstétrica, qué recursos se utilizaron y los costos directos relacionados con el tratamiento de pacientes con placenta previa, con o sin placenta acreta, en quienes se indicó Floseal® como parte de las medidas de control e inhibición de la hemorragia en comparación con quienes solo recibieron los cuidados convencionales. MATERIALES Y MÉTODOS Estudio retrospectivo, observacional y comparativo de los expedientes clínicos de pacientes adultas con más de 20 semanas de gestación y placenta previa tratadas entre septiembre y noviembre del 2012 en la Unidad Médica de Alta Especialidad 23 en Monterrey, México. Los resultados clínicos y costos se compararon con pruebas paramétricas y no paramétricas. RESULTADOS Se analizaron 29 expedientes (15: Floseal® coadyuvante, 14: solo con tratamiento convencional). El grupo tratado con Floseal® tuvo menos reintervenciones (0 vs 57.1%, p 0.0010), días de estancia hospitalaria [2(2-4) vs 6(4-11), p 0.0048] y cuidados intensivos (2.4 ± 1.5 vs 4.5 ± 2.1, p 0.0048). El costo promedio por remuestreo fue de 109,172.00 pesos mexicanos (IC95%: 80,153.10-139,073.71 pesos) para Floseal® vs 224,289.00 pesos mexicanos (IC95%: 181,881.48-269,061.23 pesos) para el tratamiento convencional a expensas de un número de piezas mayor de Tisseel®, crioprecipitados, cristaloides y retiro quirúrgico de compresas. CONCLUSIONES El uso coadyuvante de Floseal® se asoció con menor número de reintervenciones, días de estancia hospitalaria y atención en cuidados intensivos. Se registraron menores costos promedio y total asociados con la atención. Para corroborar estos resultados en población mexicana se requieren análisis de largo seguimiento y con muestras más grandes.

Abstract OBJECTIVE To evaluate the clinical outcomes and direct costs related to treatment of placenta previa with Floseal® hemostatic matrix as part of the treatment of obstetric hemorrhage in comparison with conventional management only. METHODS Clinical records of patients with hemorrhagic hemorrhage, with more than 20 weeks of pregnancy and placenta previa were reviewed, all patients were adults and treated within September and November of 2012 in the "Unidad Médica de Alta Especialidad 23" of the Mexican Institute of Social Security, Monterrey, México. Costs where estimated using the Diario Oficial de la Federación 2013) and a resampling was performed. Clinical and costs outcomes where compared with parametric and non-parametric tests. RESULTS 29 clinical records (15: Adjuvant Floseal®, 14: conventional treatment only). Floseal® group resulted in less re-interventions (0% vs 57.1%, p 0.0010), days of hospital stay [2(2-4) vs 6(4-11), p 0.0048] and days in the intensive care unit (2.4 ± 1.5 vs 4.5 ± 2.1, p 0.0048). Average cost by resampling was $109,172.00 [CI95% (80,153.10-139,073.71 mexican pesos)] for Floseal® vs 224,289.00 mexican pesos [IC95% (181,881.48-269,061.23)] for conventional treatment at the expense greater number of pieces of Tisseel®, cryoprecipitate, crystalloids and surgical removal of compresses. CONCLUSIONS The adjuvant use of Floseal® was associated with fewer re-interventions, days of hospital stay and intensive care. Lower average and total costs associated with treatment were also estimated. Future long-term analyzes and larger sample sizes are necessary to corroborate these results in the Mexican population.

Effects of different goal-directed fluid therapy strategies on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy / 中国医师进修杂志

Objective To compare the different goal-directed fluid therapy(GDFT)strategies on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy. Methods Ninety patients undergoing hepatectomy with ASA physical status Ⅱor Ⅲ were divided into three groups based on fluid treatment by random number table method:control group(conventional fluid therapy), observation group Ⅰ(GDFT filled with colloi) and observation group Ⅱ(GDFT filled with crystalloids),with 30 cases in each group.The ScvO2,Lac and Glu were tested at 5 min before anesthesia induction(T1),5 min before hepatectomy(T2),5 min after hepatectomy(T3)and the end of operation(T4). The duration of operation,fluid requirement,urinary output, bleeding volume and the use of vasoactive agent were recorded. The exhaust time, ambulation time and postoperative hospital stay were recorded. Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with that in control group,the amount of crystalloids[(1408.5 ± 348.4) ml vs. (1 819.4 ± 315.1) ml],the amount of colloids [(468.6 ± 193.4) ml vs. (1 009.7 ± 440.9) ml],the total volume[(1 867.3 ± 370.4)ml vs.(2 821.3 ± 264.6)ml]were all lower,first flatus time[(51.8 ± 8.5)h vs.(63.6 ± 9.2) h], ambulation time [(3.4 ± 0.7) d vs. (4.3 ± 0.7) d] and postoperative hospital stay [(7.8 ± 1.7)d vs.(10.5 ± 2.9)d]were all shorter,ScvO2at T3,T4was higher,Lac at T2-T4were lower,Glu at T3,T4was lower, and ALT and AST on the third day and the fifth day after surgery were lower in observation groupⅠ(P<0.05).Compared with those in observation groupⅠ,the amount of crystalloids [(2 014.7 ± 388.2)ml vs.(1 408.5 ± 348.4)ml]was increased,and the incidences of postoperative nausea and vomiting[33.3%(10/30)vs.10.0%(3/30)]were significantly higher than those in observation groupⅡ(P<0.05). Conclusions GDFT using colloids in hepatectomy probably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay. It has a much lower incidence of postoperative nausea and vomiting, compared with crystalloids.

Effects of goal-directed fluid therapy filled with crystalliods or colliods on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy / 临床麻醉学杂志

Objective To compare the difference between crystalloids and colloids under goal-directed fluid therapy (GDFT) in elective hepatectomy.Methods Seventy patients undergoing hepatectomy, 42 males and 28 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ, were included and randomly divided into three groups base on fluid treatment: conventional fluid therapy (group C, n=24), goal-directed fluid therapy filled with colloids (group G1, n=23) and goal-directed fluid therapy filled with crystalloids (group G2, n=23).Group C received conventional fluid therapy mainly based on MAP while group G1 and group G2 received goal-directed fluid therapy based on MAP, stroke volume variation (SVV) and cardiac index (CI), and the Flotrac/Vigileo system was used to obtain SVV and CI in group G1 and group G2.250 ml colloids were administered if SVV>13% in group G1 while 250 ml crystalloids were administered in group G2.If CI<2.5 L·min-1·m-2, dobutamine 2.0-10.0 μg·kg-1·min-1 was given until CI≥2.5 L·min-1·m-2.The ScvO2, Lac and Glu were tested at 5 min before anesthesia induction (T1), 5 min before hepatectomy (T2), 5 min after hepatectomy (T3) and the end of operation (T4).The duration of operation, fluid requirement, urinary output, bleeding volume, and the use of vasoactive agent were recorded.The exhaust time, ambulation time and postoperative hospital stay were recorded.Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with group C, the total volume was lower, flatus time, ambulation time and postoperative hospital stay were shorter, ScvO2 at T3 and T4 were higher, Lac at T2-T4 were lower, Glu at T3 and T4 were lower, ALT and AST on the third day and the fifth day after surgery were lower in group G1 (P<0.05).Compared with group G1, the amount of crystalloids was increased, the incidences of postoperative nausea and vomiting were significantly higher in group G2 (P<0.05).There was no significant difference in flatus time, ambulation time and postoperative hospital stay between group G1 and group G2.Conclusion GDFT in hepatectomy propably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay.GDFT using colloids bolus contribute to a much lower incidence of postoperative nausea and vomiting.There is no significant difference in tissue perfusion and postoperative recovery between colloids and crystalloids.

Albumin vs.Crystalloids in Fluid Resuscitation for Adults with Severe Spesis and Septic Shock:a Meta-analysis / 医药导报

Objective To systematically evaluate the effects of albumin compared with crystalloids on fluid resuscitation for adults with severe sepsis and septic shock.Methods The six databases as follows:Cochrane Library,Pubmed,Embase,CNKI,VIP and Wanfang,were retrieved by computer,from their inception to November,2015.Randomized controlled trials(RCT) in the treatment of adult patients with severe sepsis and septic shock were included for quality assessment and Meta-analysis was performed by using RevMan5.3 software.Results A total of 4 RCTs involving 3 862 participants were included.No differences were found between albumin and crystalloids resuscitation with respect to 28-day mortality[RR=0.95,95%CI(0.86,1.05),P=0.33],90-day mortality[RR=0.95,95%CI(0.86,1.05),P=0.33],duration of stay in ICU,duration of hospital stay,duration of mechanical ventilation and renal replacement therapy.Conclusion In that meta-analysis,the effects of fluid resuscitation with albumin or crystalloids were not significantly different in adults with severe sepsis and septic shock.

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions / Coloides versus cristaloides em fluidoterapia guiada por objetivos, revisão sistemática e metanálise. Demasiadamente cedo ou demasiadamente tarde para obter conclusões / Coloides versus cristaloides en fluidoterapia guiada por objetivos, revisión sistemática y metaanálisis. Demasiado pronto o demasiado tarde para obtener conclusiones

Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality.

Foram feitos múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), muitos deles com o uso de coloides para aprimoramento da pré-carga. Após a decisão da Agência Europeia de Medicamentos, existe ainda controvérsia sobre seu uso, seus benefícios e sua possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas.

Se han realizado múltiples ensayos clínicos en fluidoterapia guiada por objetivos (FGO), muchos de ellos con el uso de coloides para la optimización de la precarga. Tras la decisión de la Agencia Europea del Medicamento, existe cierta controversia en cuanto a su utilización, beneficios y su posible contribución al fallo renal. El objetivo de esta revisión sistemática y metaanálisis es comparar el uso de coloides de última generación, derivados del maíz, con cristaloides en FGO para determinar las complicaciones y la mortalidad asociadas.

Recent findings on the use of hydroxyethyl starch

There has long been a controversy on the use of colloids. Many developments have now been made in the theological aspects. The new glycocalyx model and other related studies have shown that the volume expansion effect of colloids is not so superior to crystalloids in many situations. Moreover, the results from several multicenter studies on septic shock patients indicated that hydroxyethyl starch did not improve clinical outcome, but instead, increased the number of serious complications such as death and renal failure. Accordingly, this long debate has been concluded, at least about the use of hydroxyethyl starch colloid on patients with septic shock. Although there is still a lack of studies on perioperative patients, care is also needed when using colloids in their treatment.

Evidencia actual sobre el uso de soluciones coloides versus cristaloides durante la reanimación del paciente con shock / Current evidence onthe use of solutions colloids versus crystalloids during the reanimation patient-with shock

La administración de fluidos intravenosos, es uno de los pilares de la reanimación del paciente en shock y su beneficio es mayor cuanto antes se inicie. Los fluidos más utilizados para tal objeto son las soluciones cristaloides (solución salina y Ringer Lactato) y los coloides (albumina, gel, dextrán y almidones). Estudios fisiológicos y clínicos han demostrado que los coloides y los cristaloides tienen diferentes efectos y perfiles de seguridad. Por otra parte, ambos tipos de fluidos administrados en exceso o a destiempo pueden tener efectos perjudiciales. Estudios clínicos recientes parecen coincidir que, en general, los coloides no ofrecen mayor beneficio clínico que los cristaloides y se asocian a mayor tasa de eventos adversos. Por tanto, el presente artículo pretende describir las ventajas y limitaciones de los tipos de soluciones que se utilizan para la reanimación de los pacientes críticos en base a literatura más reciente.

The administration of intravenous fluids, is a mainstay of patient resuscitation in shock and your benefit is greater the earlier it starts. The fluids commonly used for this purpose are crystalloid solutions (saline and Ringer Lactate) and colloids (albumin, gel, dextran and starch). Physiological and clinical studies have shown that colloids and crystalloids have different effects and safety profiles. Moreover, both ty-pes of fluids administered in excess or untimely can have detrimental effects. Recent clinical studies seem to agree that, in general, colloids offer no greater clinical benefit than crystalloids and are associated with increased rate of adverse events. Therefore, this article aims to describe the advantages and limitations of the types of solutions used for resuscitation of critically ill patients based on recent literature.

Progress in perioperative liquid therapy / 国际外科学杂志

Liquid therapy is a vital method of perioperative treatment.Choosing correct kinds of transfusion and reasonable therapy strategies can significantly reduce the perioperative complications and shorten days in hospital and improve the critical patients prognosis.The historical development of perioperative liquid therapy is a forward process,which is about crystalloids vs.cilloid,dry vs.wet,and other controversial problems continuing to be summarized,explored and discussed.In this process,there are some specific perioperative treatment strategies with the physician having a deeper cognitive,such as goal-directed therapy,early goal directed therapy and fast track surgery which have significant clinical curative effect.This article summarizes the advance of perioperative liquid therapy.

Reposição volêmica perioperatória / Perioperative volemic repositioning

Justificativa e objetivos: a reposição volêmica perioperatória tem sido alvo de inúmeros trabalhos, focando-se no debate entre o uso de criataloides ou coloides, bem como reposição restritiva ou liberal. Como ainda não existe consenso nesse assunto que interessa a todos os anestesiologistas, foi escrito este artigo objetivando esclarecer asprincipais vantagens e desvantagens de cada tipo de fluido utilizado na reposição volêmica perioperatória. Conteúdo: são apresentados sucintamente os diferentes tipos de fluidos utilizados para repor o volume, as possíveis vantagens e desvantagens de cada um, bem como seus efeitos adversos. Conclusões: a reposição volêmica deve integrar o conhecimento dos fluidos utilizados, com o volume total administrado e os procedimentos específicos, pois diferentes procedimentos têm diferentes fisiopatologias de distribuição dos fluidos.

Justification and purposes: The perioperative volemic reposition has been the focus of several studies which discuss the use of crystalloids or colloids, as well as the restrictive or unrestrictive repositioning. As there has been no consensus on this issue which is of interest to all anesthesiologists, this paper has been written with the purpose of explaining the main advantages and disadvantages of each type of fluid used in the perioperativevolemic repositioning. Content: Different types of fluids used to reposition the volume, possible advantages and disadvantages of each one as well as their adverse effects are briefly shown in this article. Conclusions: In order to better understand the volemic repositioning it is important to know about the fluids used, the total volume administered and the specific procedures, as different procedures have different pathophysiologies of fluid distribution.

Revisión sistemática sobre la eficacia de los fluidos coloides y cristaloides en la reposición inicial del volumen intravascular en el tratamiento del dengue hemorrágico con shock / Systematic review: efficacy of colloids versus crystalloids for initial fluid resuscitation in dengue haemorrhagic shock

OBJETIVO: comparar la efectividad de las soluciones coloides versus las cristaloides en el tratamiento inicial del shock por dengue hemorrágico. MÉTODO: La búsqueda bibliográfica fue realizada en las bases Medline, Lilacs, Biblioteca Cochrane y en texto libre con el motor Google. Solamente tres de los 14 estudios identificados y potencialmente elegibles cumplían con los criterios de selección preestablecidos. En total, incluyeron 792 pacientes menores de 15 años de edad con shock por dengue hemorrágico. La mortalidad en las primeras 24 horas, la recurrencia del shock y el tiempo insumido para la recuperación de la presión de pulso, fueron considerados los resultados principales para la evaluación. RESULTADOS: Sólo un estudio refiere una muerte sobre 512 pacientes. La recurrencia del shock ocurrió en el 23,7 por ciento de aquellos inicialmente tratados con coloides y en el 25,5 por ciento de los tratados con cristaloides (RR 0,93; IC95 por ciento 0,63 a 1,38). El tiempo de la recuperación del pulso fue medido en un solo estudio, mostrando un beneficio marginal para los tratados con coloides (RR 0,40;IC95 por ciento 0,16 a 0,99). Las reacciones alérgicas severas fueron más frecuentes en los tratados con coloides (RR 5,43; IC95 por ciento 0,33 a89,13). El precio de las soluciones coloides disponibles en plaza fue hasta 90 veces mayor que el de las soluciones cristaloides. CONCLUSIONES: En la presente revisión sistemática no se identificaron razones clínicamente relevantes y sustentadas por evidencia que aconsejen recomendar el uso de soluciones coloides en el tratamiento inicial del shock por dengue hemorrágico.

OBJECTIVE: The aim of this systematic review was to compare the effectiveness of colloids and crystalloids solutions as initial treatment of dengue hemorrhagic shock. METHOD: A comprehensive bibliographic search was carried out through Medline, Lilacs, Cochrane Library andusing search motor Google. Only three out of the 14 studies initially identified fulfilled the inclusion criteria. In total, they included 792 patients less than 15 years old with dengue hemorrhagic shock. Mortality during first 24 hours, shock recurrence and time to recovery of hemodynamic variables were used as main outcomes to assess effectiveness among solutions. RESULTS: Only one patient death out of 512 during the first 24 hours was reported by a single study. Shock recurrence occurred in 23.7 percent of those initially treated with colloids and in 25.5 percent in those treated with crystalloids (RR0.93, CI95 percent 0.63 to 1.38). Pulse pressure recovery after 1 hour was measured in only one study, showing a marginal benefit from colloids solutions (RR 0.40; CI95 percent 0.16 to 0.99).Severe allergic reactions were more frequent in colloids group (RR 5.43; CI95 percent 0.33 to 89.13). Otherwise, colloids solutions price is up to 90 times higher than crystalloids. CONCLUSIONS: This review did not identify any clinically relevant and evidence supported reason to prescribe colloids solutions instead crystalloids solutions in the initial treatment of dengue hemorrhagic shock.

Hemogasometria em cães com desidratação experimental tratados com soluções eletrolíticas comerciais administradas por via intravenosa / Blood gas analysis in dogs with experimental dehidration treated with commercial electrolytes solutions by intravenous route

No presente estudo, foram comparados os efeitos da administração intravenosa de três soluções eletrolíticas comerciais sobre o equilíbrio ácido-base em cães desidratados experimentalmente por restrição hídrica e poliúria. Os animais foram aleatoriamente distribuídos em três grupos e tratados com três diferentes soluções eletrolíticas comerciais durante 12 horas: Ringer com lactato de sódio (RL), Ringer simples (RS) e Glicofisiológico (GF). Entre os tratamentos testados, a fluidoterapia intravenosa com solução de Ringer com lactato de sódio (RL) foi o tratamento que apresentou efeito alcalinizante, sinalizado por pequeno aumento nos valores do pH(a), cHCO3(aP), ctCO2(aP) e cBase(a), podendo ser utilizada no tratamento de animais com acidose metabólica de intensidade discreta a moderada. As soluções Ringer simples (RS) e glicofisiológica (GF) determinaram discreta diminuição na concentração de base titulável do sangue arterial (cBase), demonstrando efeito acidificante, o que as tornam uma opção para tratar cães com alcalose metabólica.

Three commercial intravenous electrolyte solutions were compared as for their effects on the blood acid-base status in dogs experimentally dehydrated by withholding water and inducing polyuria. Animals were randomly divided into three groups which were rehydrated with the following commercial electrolyte solutions during 12 hours: Lactate Ringerïs solution (RL), Ringerïs solution (RS) and a normal saline solution (0.9 percent sodium chloride) containing 5 percent dextrose (GF). The RLïs intravenous fluid therapy resulted in an alkalinizing effect demonstrated by a mild increase in arterial blood pH, ctCO2, bicarbonate (cHCO-3), and arterial blood base concentration (cBase) and, thus, can be used in animals exhibiting mild to moderate metabolic acidosis. In contrast, the RS and GF therapies led to a mild decrease in the concentration of arterial blood tritiable base (cBase) inducing an acidifying effect, which make them an option to treat dogs with metabolic alkalosis.

Comparison of the effects of lactated Ringer solution with and without hydroxyethyl starch fluid resuscitation on gut edema during severe splanchnic ischemia

The type of fluid used during resuscitation may have an important impact on tissue edema. We evaluated the impact of two different regimens of fluid resuscitation on hemodynamics and on lung and intestinal edema during splanchnic hypoperfusion in rabbits. The study included 16 female New Zealand rabbits (2.9 to 3.3 kg body weight, aged 8 to 12 months) with splanchnic ischemia induced by ligation of the superior mesenteric artery. The animals were randomized into two experimental groups: group I (N = 9) received 12 mL·kg-1·h-1 lactated Ringer solution and 20 mL/kg 6 percent hydroxyethyl starch solution; group II (N = 7) received 36 mL·kg-1·h-1 lactated Ringer solution and 20 mL/kg 0.9 percent saline. A segment from the ileum was isolated to be perfused. A tonometric catheter was placed in a second gut segment. Superior mesenteric artery (Q SMA) and aortic (Qaorta) flows were measured using ultrasonic flow probes. After 4 h of fluid resuscitation, tissue specimens were immediately removed for estimations of gut and lung edema. There were no differences in global and regional perfusion variables, lung wet-to-dry weight ratios and oxygenation indices between groups. Gut wet-to-dry weight ratio was significantly lower in the crystalloid/colloid-treated group (4.9 ± 1.5) than in the crystalloid-treated group (7.3 ± 2.4) (P < 0.05). In this model of intestinal ischemia, fluid resuscitation with crystalloids caused more gut edema than a combination of crystalloids and colloids.

Leydig Cell Tumor of the Ovary: Report of a case

Leydig cell tumor of the ovary is a very rare tumor which usually occurs in the postmenopausal age, and which is frequently associated with virilization. It has been classified as a lipid cell tumor due to the presence of intracytoplasmic lipids. However, since up to 25% of these tumors contain little or no lipid, the new term "steroid cell tumor" is proposed for this type of neoplasm. We report a case of Leydig cell tumor of the ovary in a 16 year old girl. The patient exhibited recently recognized hirsuitism and secondary amenorrhea. Physical examination revealed moderate obesity with moderate amounts of coarse hair over the whole body and a deepening of the voice. Testosterone and dehydroepiandrosterone sulfate levels were markedly elevated in the peripheral blood. Pelvic ultrasonography revealed a right ovarian tumor. The resected ovary showed a well demarcated, golden yellow to orange colored solid mass, measuring 7 cm on the cut surface. Microscopically, the tumor was composed of solid and diffuse sheets of tumor cells having abundant eosinophilic cytoplasm, and large round nuclei with frequent crystalloids of Reinke in the cytoplasm. To our knowledge this is the first case of Leydig cell tumor of the ovary in a young girl in the Korean literature.