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

Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old

All patients undergoing major abdominal procedures have some degree of gastric atony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide. antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin [250 mg], altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients [20 each] were allocated randomly to receive orally, either erythromycin 250 mg [E250] or erythromycin 500 mg [E500], or 10 mg metoclopramide [M], or 4mg ondansetron [Z], an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250mg elicited a significantly lower residual gastric volume [P<0.001] and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z [100, 10 and 10 %] compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin [250 mg], given1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron

non opioid fast track anesthetic regimen for colonic resection

Fast-tracking implies a preoperative patient care paradigm that reduces time to recovery and discharge. The current study adopted fast-track anesthetic techniques, comparing outcome of a multimodal non-opioid and another opioid regimen, on recovery profiles after colonic surgery, with standard anesthetic practice. Seventy five ASA II colectomy patients were randomly assigned to one of three groups. Control group for conventional general anesthetic technique and two fast-track anesthesia groups using combined light general anesthesia and epidural techniques. Epidural maintenance was by infusion cocktail of bupivacaine-fentanyl in opioid-based group, while in non-opioid group by bupivacaine-ketamine which were both continued postoperatively for pain in lower doses and concentrations. Postoperative analgesia in control group was achieved by morphine. Supplemental ketorolac and acetaminophen were added only to non-opioid group. Early and intermediate recovery profiles were compared among the three groups together with recorded side effects. All patients in fast-track groups had significant shorter times to: awakening, extubation, orientation, both PACU arrival and discharge, hospital stay with a significant lower mean VAS for pain at rest, and rescue analgesia, compared to control group. Control group had a significant higher rate of postoperative nausea and vomiting, drowsiness and pruritis. Non-opioid fast-track regimen had a significant shorter PACU and hospital stay with lower side-effects rate than opioid one. Fast-track anesthesia enhanced recovery profile. Non-opioid regimen was superior to opioid-based, having a better recovery profile and a lower rate of side-effects

Hepatocellular integrity during sevoflurane anesthesia with induced hypotension

The effect of sevoflurane anesthesia with or without induced hypotension on hepatocellular integrity was studied. Forty adult consented patients scheduled for various urological procedures were allocated randomly to either NTG group [nitroglycerin-induced hypotension] or a control group of twenty patients each. Anesthesia was induced and maintained by fentanyl, sevoflurane and vecuronium in both groups. In NTG group, nitro-glycerin infusion was adjusted to maintain mean arterial pressure [MAP] of 50-65 mm Hg. Specific and sensitive hepatic biomarkers; alpha [alpha] and pi [pi] glutathione S-transferases [GST] and hyaluronic acid [HA], also traditional liver enzymes; aspartate [AST] and alanine [ALT] aminotransferases were measured at: TO [pre-induction], T1, T2, T3 [15, 30 and 60 minutes after MAP stabilization respectively] and T4 [24 hours after anesthesia end]. Plasma alpha-GST significantly increased at T3 in control group [p < 0.05] and in NTG group [p < 0.01] compared to T0 in same group. In NTG group, hyaluronic acid con-centrations was significantly increased at T1, T2 [p < 0.05] and T3 [p < 0.01] from T0. Compared to control group, alpha- GST and HA concentrations showed significant increases in NTG group at T3 with p < 0.05 then returned back to normal range at T4. But, pi-GST, AST and ALT showed no significant changes throughout the study in both groups

Does isoflurane anesthesia alter immuno-modulatory response in schistosomal Patients?. Assessment of serum pro- and anti-inflammatory cytokine balance

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immuno-suppressive effects, can influence long term disease progression, morbidity, and mortality. Literature on postoperative immune response in schistosomiasis patients is scarce. The aim of this study was to assess the impact of isoflurane anesthesia on pro- and anti-inflammatory cytokine balance in schistosomal patients undergoing minor procedures. The study was conducted on 24 patients [ASA class I-II] scheduled for elective urologic endoscopic procedures. Patients were divided into two groups 12 patients each: control group [n=l2] and patient group [n=l2]. Anaesthesia was induced by a bolus dose of sufentanil 0.2 micro g.kg -1, thiopentone sodium 5mg.kg -1, vecuronium 0.1 mg.kg -1 and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 micro g.kg -1 when indicated. Venous blood samples were obtained from each patient: before induction, fifteen minutes, one hr after induction and 24 hrs after surgery. Plasma levels of IL-1 beta, TNF-alpha, IL-8, IFN-lambda, IL-1ra and TNF-BP1, as well as stress hormones [cortisol and prolactin] were measured. As for pro- and anti-inflammatory cytokine balance, the overall end- result was a rise at 24 hr postoperatively, in the level of TNF-alpha [a key pro-inflammatory cytokine] and IFN-lambda, as well as both anti-inflammatory cytokines [IL-Ira and sTNF-R1]. The anti-inflammatory response was more conspicuous in the patients than controls