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

Controlled mechanical ventilation with lmasureme[TM] Versus I-Gel[TM] in anesthetized adult patients

The efficacy, safety and ease of insertion of LMA[TM] Supreme and the i-gel™ in adult cases undergoing elective surgical procedures requiring general anesthesia with controlled mechanical ventilation. This study included 60 ASA physical status I-II adult patients of both sexes scheduled for elective surgical procedures under general anesthesia. Patients were randomly allocated into one of two groups; LMA-S[TM] GI [n=30] and i-gel[TM] Gil [n=30]. A size 4 LMA Supreme[TM] and a size 4 i-gel[TM] were used with standard monitoring. Number of insertion attempts, ease of insertion, presence of gastric insufflation, laryn-geal leak, leak pressure, ease of gastric tube insertion, ventilatory parameters, complications as well as hemodynamic variables was recorded. The results showed no clinically significant changes of heart rate, MAP, Sp0[2] or P[ET] CO[2] in GI and GIL The i-gel[TM] showed higher frequency of ease of insertion[p=0.048] and gastric tube [p< 0.001]. First attempt of insertion was successful in 60% of LMA-S[TM] GI and 73.3% of the i-gel[TM]Gil [p=0.460] without failures in both groups. Leak pressure was significantly higher in the i-gel[TM] [25.5 +/- 4.8 cm H[2]O] compared to the LMA-S[TM] [21.1 +/- 7.6 cm H[2]O] [p=0.010] while both peak and plateau pressures were significantly lower in i-gel[TM] GI [19.35 +/- 2.25 cm H[2]O and 17.75 +/- 2.07 cm H[2]O] compared to LMA-S[TM] Gil [30.05 +/- 3.82 cm H[2]O and 28.80 +/- 3.99cm H[2]O][p<0.001] respectively. There was no significant difference between both groups in the frequency of complications encountered during insertion or recovery