Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Abstract Background and objectives The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability. Methods This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10 mL.kg-1 of ideal body weight was administered intravenously 30 min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid. Results The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p= 0.001, p= 0.016, p= 0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p= 0.016, p= 0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p= 0.003, p= 0.018, p= 0.019, respectively). Conclusion Consequently, preloading can be favorable approach to preserve hemodynamic stability.

A Comparative Study on Therapeutic modalities in the Management of Spinal Anesthesia-Induced Hypotension in Parturient in Cesarean Delivery

Objective: was to compare the two therapeutic modalities, fluid preloading and ephedrine, in the management of spinal anesthesia-induced hypotension in patients undergoing elective cesarean delivery. Methodology: Following ethical approval from Mayo hospital ethical committee and informed consent from patients study was started in Department of Anaesthesia. Duration of study was one year from November 2016 to October 2017. A total of 90 patients were enrolled through non probability consecutive sampling and randomly divided into two equal groups 45 patients in each. Group F for fluid preload patients and group E for ephedrine receiving patients. Required data was collected on preformed performa. Data information was entered in SPSS version 24 and analyzed for variables. Continuous variables were presented as mean and SD and categorical data was presented as numbers and percentages (%). Independent t-test was applied to see significance of results. P value equal or less than 0.05 was considered as significance. Results: Overall, 90 women were included in this study. The study consisted of two equal groups, 50% in each, i.e. F group and E group respectively. Mean trend of systolic blood pressure was shown in table 2. Higher means were observed in E group than in F group. The difference was statistically significant with regards to groups (P < 0.05). The mean trend of heart rate was shown in table 3. Higher means heart rates were observed in the E group as compare to the F group. The differences were statistically significant with regards to groups (P < 0.05). Conclusion: Results of our study revealed that use of ephedrine is superior to that of fluid preloading in managing hypotension after spinal anesthesia in cesarean section deliveries.

The elimination method of preloading force for soft tissue based on the linear loading region / 生物医学工程学杂志

Aiming at the problem of the influence of preloading force on its mechanical response in soft tissue compression experiments, an elimination method of preloading force based on linear loading region is proposed. Unconfined compression experiments under a variety of different preloading forces are performed. The influence of the preloading force on the parameters of constitutive model is analyzed. In the preload phase, the mechanical response of the soft tissue is taken as a linear model. The preloading force is eliminated by taking the preloading phase into account throughout the response process. According to five different preloading forces of the unconfined compression experiments, the elimination method is validated with two different constitutive models of soft tissue, and the error between the models obtained by the preloading force elimination method and the traditional method with the experimental results is compared. The results show that the error obtained by preloading force elimination method is significantly smaller than the traditional method. The preloading force elimination method can eliminate the influence of preloading force on mechanical response to a certain extent, and constitutive model parameters which are closer to the true properties of soft tissue can be obtained.

Influence of the timing of administration of crystalloid on maternal hypotension during low dose spinal anesthesia for elective cesarean delivery: Preload versus coload

Background: Spinal induced maternal hypotension is a common problem during cesarean delivery. Timing of infusion of crystalloid may be important because of its short stay in intravascular space. Aim: This study was conducted to compare effectiveness of preloading and co-loading with crystalloid in prevention of spinal anesthesia induced maternal hypotension during caesarean section. Material and Methods: In total 62 parturients were randomized to two groups. Preload group (Group P) received 15 ml/kg of Ringer Lactate solution over 20 min before giving low dose (2 ml, 0.5% hyperbaric Bupivacaine) spinal anesthesia and coload group (Group C) were given same volume of Ringer Lactate solution as fast as possible after CSF tapping and Bupivacaine injected. Non-invasive BP measurements were recorded. The incidence of hypotension and dose of inj. Mephentermine were checked. Blood pressure, heart rate, nausea and neonatal outcome were assessed. Results: The incidence of hypotension, blood pressure drop and dose of Mephentermine was lower in the coload group compared to the preload group (significant p<0.05). The incidence of nausea was also lower in the coload group. No significant differences in neonatal outcome. Arpit Singhal, Ashima Gupta, S.P. Chittora. Influence of the timing of administration of crystalloid on maternal hypotension during low dose spinal anesthesia for elective cesarean delivery: Preload versus coload. IAIM, 2019; 6(5): 16-21. Page 17 Conclusion: In case of using crystalloids (ringer lactate) for cesarean delivery, coload is more effective than preload for the prevention of maternal hypotension after spinal anesthesia for caesarean delivery.

Comparative study of preloading with ringer lactate v/s 6% hexa starch solutions to prevent hypotension following spinal anaesthesia in elective surgery.

Background: Hemodynamic variations are commonly encountered following subarchnoid block and can attribute to significant mortality and morbidity. To counteract the hypotension, fluid adminstration before spinal anaesthesia is recommended (preloading). Crystalloids and colloids are recommended as preloading fluids but both have their own merits and demerits. Objective: This comparative study was done to compare the effectiveness of ringer lactate versus 6% hydroxyl ethyl starch for preventing spinal anesthesia induced hypotension. Material and Methods: In this prospective study, we compare the effectiveness of ringer lactate versus 6% hydroxy ethyl starch at 10ml/kg over a period of 20 minutes before spinal anaesthesia in preventing hypotension. After administration of spinal anaestheisa mean arterial pressure were recorded at 1, 5, 10, 15, 30, 45, 60, 90 minutes and 3 hours after spinal anaesthesia. Number of patient, recieving injection Mephentermine sulphate for persistent hypotension was also recorded. Results: We found that hydroxy ethyl starch is more effective than ringer lactate solution as a preloading fluid in prevention of hypotension following spinal anaesthesia. Conclusion: Hydroxy ethyl starch is superior to ringer lactate in preventing hypotension in patients undergoing elective lower abdominal surgeries under spinal anaesthesia but the incidence of hypotension is not completely eliminated.

Fit analysis of CAD-CAM custom abutment using micro-CT / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate screw joint stability and sagittal fit between internal connection implant fixtures of two different manufacturers and customized abutments. MATERIALS AND METHODS: Internal connection implant systems from two different manufacturers (Biomet 3i system, Astra Tech system) were selected for this study (n=24 for each implant system, total n=48). For 3i implant system, half of the implants were connected with Ti ready-made abutments and the other half implants were connected with Ti CAD-CAM custom ones of domestic-make (Myplant, Raphabio Co., Seoul, Korea) and were classified into Group 1 and Group 2 respectively. Astra implants were divided into Group 3 and Group 4 in the same way. Micro-CT sagittal imaging was performed for fit analysis of interfaces and preloading reverse torque values (RTV) were measured. RESULTS: In the contact length of fixture-abutment interface, there were no significant differences not only between Group 1 and Group 2 but also between Group 3 and Group 4 (Mann-Whitney test, P>.05). However, Group 2 and Group 4 showed higher contact length significantly than Group 1 and Group 3 in abutmentscrew interface as well as fixture-screw one (Mann-Whitney test, P<.05). In addition, RTV was lower in CAD-CAM custom abutments compared to ready-made ones (Student t-test, P<.05). CONCLUSION: It is considered that domestically manufactured CAD-CAM custom abutments have similar fit at the fixture abutment interface and it could be used clinically. However, RTV of CAD-CAM custom abutments should be improved for the increase of clinical application.

A Comparative Study of Crystalloid and Colloids as Preloading in Spinal Anaesthesia for Prevention of Hypotension.

Objectives : To compare the efficacy of crystalloids and colloids as preloading infusion to prevent hypotension, requirement of vasopressors and requirement of total fluid given during surgery to maintain stable hemodynamic. Methodology : A total of 60 patients scheduled for elective lower abdominal, lower limb and gynaecological procedures were selected to participate in this prospective, randomized, double-blind study. Patients were randomly allocated into two groups for preloading. Group A received 15 ml/kg Ringer lactate for preloading and group B 5m1/kg gelatin for preloading. Vital parameters (PR, SBP, DBP, and MAP) were recorded. Incidence of hypotension in both groups was noted and requirement of mephentine to treat hypotension and total intravenous fluid required intraoperatively was also recorded. Results : After spinal anesthesia SBP in the crystalloid group decreases to minimum 101.77±14.18 after 15 minutes and rises again at the end of surgery. In colloid group systolic blood pressure decreases to minimum106.00±12.15 after 20 minutes and then increases at the end. P value 0.010, 0.015, 0.029, 0.046 during 8 20 min. suggest significant fall in SBP in crystalloid group. 40% pt. required mephentine to treat hypotension compared to 16.7% in colloid. Intraoperatively requirement of IV fluid in crystalloid group was 1662.33±179.30 and in colloid group was 1260.67±158.22. Conclusion : There was significant hypotension with crystalloid group intraoperatively in spite of preloading and also intraoperatively fluid requirement was high. The incidence of nausea, vomiting, rigors and postoperative hypotension was comparable in both groups.

A comparative study on the fit and screw joint stability of ready-made abutment and CAD-CAM custom-made abutment / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate the fit and screw joint stability between Ready-made abutment and CAD-CAM custom-made abutment. MATERIALS AND METHODS: Osstem implant system was used. Ready-made abutment (Transfer abutment, Osstem Implant Co. Ltd, Busan, Korea), CAD-CAM custom-made abutment (CustomFit abutment, Osstem Implant Co. Ltd, Busan, Korea) and domestically manufactured CAD-CAM custom-made abutment (Myplant, Raphabio Co., Seoul, Korea) were fabricated five each and screws were provided by each company. Fixture and abutments were tightening with 30Ncm according to the manufacturer's instruction and then preloding reverse torque values were measured 3 times repeatedly. Kruskal-Wallis test was used for statistical analysis of the preloading reverse torque values (alpha=.05). After specimens were embedded into epoxy resin, wet cutting and polishing was performed and FE-SEM imaging was performed, on the contact interface. RESULTS: The pre-loading reverse torque values were 26.0 +/- 0.30 Ncm (ready-made abutment; Transfer abutment) and 26.3 +/- 0.32 Ncm (CAD-CAM custom-made abutment; CustomFit abutment) and 24.7 +/- 0.67 Ncm (CAD-CAM custom-made abutment; Myplant). The domestically manufactured CAD-CAM custom-made abutment (Myplant abutment) presented lower pre-loading reverse torque value with statistically significant difference than that of the ready-made abutment (Transfer abutment) and CAD-CAM custom-made abutment (CustomFit abutment) manufactured from the same company (P=.027) and showed marginal gap in the fixture-abutment interface. CONCLUSION: Within the limitation of the present in-vitro study, in domestically manufactured CAD-CAM custom-made abutment (Myplant abutment) showed lower screw joint stability and fitness between fixture and abutment.

Comparative study of intrathecal hyperbaric Bupivacaine with Clonidine, Fentanyl and Midazolam for quality of anaesthesia and duration of post operative pain relief in patients undergoing elective caesarean section.

Pain free postoperative period and early ambulation are the need of the day for mothers caring for their neonates.The use of adjuvants in spinal analgesia has gained popularity in recent times. This prospective randomized study was carried out among 120 patients scheduled for elective caesarian section. They were divided into 4 groups. Group A (Control) received Injection Bupivacaine (Hyperbaric) along with 0.9% Normal saline, Group B, C and D received Clonidine 75 µg, Fentanyl 25 µg and Midazolam 2.5 mg along with injection Bupivacaine (H) respectively. The results of the present study showed that intrathecal Clonidine, Fentanyl and Midazolam can be used safely in parturient, provided strict protocol for preloading is followed by vigilant operative and post-operative monitoring by a trained person. Requirement of postoperative analgesics was found to be significantly reduced in all the study groups when compared with the control group. The highest duration of pain relief was found with Clonidine. Adverse effects were minimal and could be easily managed; no adverse foetal effect was noted with the use of any drug in this study.

The Effects of Volume Preloading on Spinal Anesthesia for Elective Caesarean Section

BACKGROUND: We have compared the protective effect of 1,000 ml preload on prevention of hypotension with 200 ml preload of crystalloid solution, administered during the 10 min before spinal anesthesia in 30 healthy women undergoing elective caesarean section. METHODS: Systolic blood pressure (SAP) and heart rate (HR) were measured as index of hypotension due to vasodilaton. Ephedrine IV bolus was treated as a decrease in systolic blood pressure to less than 70% of baseline value or to less than 90 mmHg. Apgar score, umbilical artery and vein blood gas analysis were also checked as parameters of fetal well-being. RESULTS: There was no difference in changes in maternal HR, SAP during spinal anesthesia between the two groups. There was no significant difference in ephedrine requirements between the two groups. There was no effect on the clinical condition of the newborn in each group, as assessed by Apgar scores and umbilical cord blood gas analysis. CONCLUSIONS: These results suggest that volume preloading is not essential to prevent spinal-induced hypotension at caesarean section.

Effect of volume preloading to prevent hypotension associated with epidural block combined general anesthesia / 中国基层医药

Objective To compare the effects of volume preloading with crystalloid and colloid fluid to prevent hypotension associated with thoracic epidural block combined general anesthesia.Methods Ninety ASA Ⅰ～Ⅱ grade patients,scheduled for elective upper abdominal surgery,were randomly allocated to three groups(30 patients in each group).A,B and C group respectively received 1000ml lactated Ringer's solution,500ml and 1000ml polygeline injection for volume preloading in 40min before general anesthesia induction.During volume preloading,epidural catheter was placed at T_ 8～9 and blocked with mixed solution of 1.6% lidocaine and 0.2% dicaine.Results Systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower in group A and B than those in group C after epidural block,general anesthesia induction and intubation(P