Inferior Vena Cava Collapsibility Index: A Precise, Noninvasive Tool for Evaluation of Edema in Children with Nephrotic Syndrome

This study aimed to evaluate available volume status assessment tools in nephrotic syndrome (NS). Sixty children with INS were subdivided into hypovolemic and nonhypovolemic groups based on fractional excretion of sodium (FeNa%); all were studied for inferior vena cava collapsibility index (IVCCI), plasma atrial natriuretic peptide (ANP), and body composition monitor (BCM). Forty-four patients had nonhypovolemic and 16 had hypovolemic states. ANP did not difer between both groups. IVCCI was higher in hypovolemic group (p<0.001) with sensitivity 87.5% and specifcity 81.8% for hypovolemia detection, while BCM overhydration (BCM-OH) values were higher in nonhypovolemic group (p=0.04) with sensitivity=68.2% and specifcity=75% for detection of hypervolemia. FeNa% showed negative correlation with IVCCI (r= ?0.578, p<0.001) and positive correlation with BCM-OH (r=0.33, p=0.018), while FeNa% showed nonsignifcant correlation to ANP concentration. IVCCI is a reliable tool for evaluating volume status in NS and is superior to BCM.

Effects of different doses of colloid on systemic hemodynamics during general anesthesia induction / 上海第二医科大学学报

Objective To explore the relationship between administration of different doses of colloid before general anesthesia induction and general anesthesia-induced hypotension. Methods Fifty patients for selective gastrointestinal operations were randomly divided into 5 groups according to the volume of colloid administered 30 min before general anesthesia induction: 0 mL/kg group (control group), 4 mL/kg group, 8 mL/kg group, 12 mL/kg group and 15 mL/kg group. To replace the deficit of hypovolemia before operation, crystalloid was given to each patient. Anesthesia was induced with propofol 25 min after infusion. Hemodynamic parameters were compared before and after anesthesia induction among groups. Results The changes in diastolic blood pressure and mean arterial blood pressure were related to colloid supplementation volume (r=-0.657, P<0.01). There were significant differences between control group and 8 mL/kg group, 12 mL/kg group and 15 mL/kg group (P<0.05), while there was no significant difference among 8 mL/kg group, 12 mL/kg group and 15 mL/kg group. Conclusion Administration of colloid before general anesthesia induction attenuates the severity of general anesthesia-induced hypotension, especially when the dose of colloid is over 8 mL/kg.

The Effects of Intravascular Volume Expansion on the Stability of Hemodynamic Responses in Patients undergoing Carotid Endarterectomy / 대한마취과학회지

BACKGROUND: During carotid endarterectomy, hemodynamic stability is very important to reduce the incidence of cerebral stroke and myocardial infarction. Therefore, we studied the effects of intravascular volume expansion using colloid solution on hemodynamic stability. METHODS: We studied 22 patients undergoing elective surgery under general anesthesia. Preanesthetic mean arterial blood pressure (MABP) and heart rate (HR) were checked, and the intraoperative target range was taken +/- 20% of these values. Following standardized anesthetic technique including intravenous induction with thiopental sodium and vecuronium, standard intraoperative monitoring and direct arterial blood pressure monitoring were instituted. Patients were randomly assigned to a Hartmann's solution group (group H, n = 11) or a pentastarch group (group P, n = 11). Distinct intraoperative episodes beyond the predetermined target range, and the number of episodes requiring interventional therapy were recorded. RESULTS: The pentastarch group had a significantly lower incidence of episodes requiring interventional drug therapy during the pre-reperfusion period. No difference was found between out of target incidents in MABP and HR. CONCLUSIONS: During carotid endarterectomy, the infusion of pentastarch solution reduced drug therapy requirement for hemodynamic stability during pre-reperfusion period only.

Induced Hypertension Therapy for Postoperative Cerebral Ischemia in Aneurysm Surgery

The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.

Induced Hypertension Therapy for Postoperative Cerebral Ischemia in Aneurysm Surgery

The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.