Effect of oxytocin infusion on reducing the blood loss during abdominal myomectomy: a double-blind randomised controlled trial.

OBJECTIVE: To assess the effectiveness and safety of oxytocin to reduce blood loss during abdominal myomectomy. DESIGN: Double-blind randomised controlled trial. SETTING: Obstetrics and Gynecologic University Medical Centre. POPULATION: Eighty healthy women candidates for abdominal myomectomy. METHODS: Women were randomly assigned to two groups. In the study group (n = 40) oxytocin 30 IU in 500 ml normal saline; and in the placebo group (n = 40) pure normal saline was administered during myomectomy. The main outcome measures were peri-operative blood loss and rates of blood transfusion. MAIN OUTCOME MEASURE: Estimated intra-operative blood loss. RESULTS: Estimated intra-operative blood loss in the study group (189.5 ± 16.72 ml) was significantly lower than the placebo group (692.25 ± 89.93 ml) (95% CI 672.54-711.96; P < 0.0001).The need for blood transfusion was significantly lower in the study group. Blood transfusions were required for three (7.5%) women in the study group and 10 (25%) women in the placebo group (95% CI 15.5-34.5; P < 0.001). CONCLUSIONS: Intra-operative oxytocin infusion appears to be safe and effective in decreasing blood loss during abdominal myomectomy. TWEETABLE ABSTRACT: Intra-operative oxytocin is effective in decreasing blood loss during abdominal myomectomy.

Anesthesia in adult cardiac surgery without maintenance of muscle relaxants: a randomized clinical trial.

There may be no need for muscle paralysis during cardiac surgery when adequate anesthesia is provided. We studied intra- and post-operative conditions during cardiac surgery without maintenance muscle relaxant therapy. Eighty adult patients who were candidates for elective coronary artery bypass graft surgery were randomly allocated into two groups. In the noMR or study group (noMR group; n = 40) only an intubation dose of cisatracurium (0.15 mg kg(-1)) was administrated, as opposed to the control group (MR group; n = 40), who had a continuous infusion added to the intubation dose. The anesthesia level was maintained at a Bispectral score of 40-50 using a propofol infusion. A remifentanil infusion was titrated to control patient hemodynamic response. During surgery, any minor (fine body or respiratory muscle movements) or major (coarse body movements or bucking/caught) movements were recorded. Postoperatively, analgesia was provided by remifentanil. The surgical condition was classified into three states: good (no movement), acceptable (minor movements), or poor (major movements). Anesthesia, surgery and postoperative characteristics were compared between the two groups. Statistical analysis was performed in only 78 patients (noMR = 38, MR = 40). The demographic and preoperative characteristics of the two groups were comparable. Intra-operative propofol consumption was the same, but significantly more remifentanil was used in the noMR group (p = 0.001). Post-operative characteristics and complication rates did not differ between the two groups. There were no movements in the MR group patients, while in the noMR group one patient had major movement and three had minor movements. We concluded that omitting maintenance muscle relaxants in adult cardiac surgery or eliminating residual muscle paralysis at the end of the surgery without improving early outcome can increase patient intra-operative movement risk.

The influence of microtubule associated proteins on the production of polymorphic products from tubulin and microtubules.

Crude preparations of microtubule-associated proteins (MAPs), as well as purified MAP 2, influence the structure of products assembled from purified tubulin at low pH values. At pH 6.2, only 12% of the assembled products were microtubules (MTs) when assembly was conducted in 10% DMSO; 88% were large sheets of protofilaments. In the absence of DMSO, 28% of the structures were MTs. As the content of MAPs in the assembly reaction was increased, the proportion of MTs increased to 87% at a MAP/tubulin (w/w) ratio of 0.67 in the presence of DMSO and to 98% at a MAP/tubulin (w/w) ratio of 0.33 in the absence of DMSO. Purified MAP 2 was as effective as crude MAP preparations in promoting MT formation at pH 6.2. MTs formed from purified tubulin and MAP 2 were transformed into spirals of protofilaments upon the addition of Vinblastine (VLB). Spirals were also formed when VLB was added to a mixture of tubulin and MAP 2 at 4 degrees C. It thus appears that MAP 2 is a causative factor in initiating spiral formation in the presence of VLB.