ABSTRACT
BACKGROUND: In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample. METHODS: We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases. RESULTS: Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes. CONCLUSION: The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.
Subject(s)
Androstanols/pharmacology , Anesthesia, General/methods , Anesthesia, Obstetrical/methods , Apgar Score , Succinylcholine/pharmacology , Adult , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , RocuroniumABSTRACT
BACKGROUND: Parenteral nutrition is now a standard part of supportive treatment in pediatric departments. We describe four cases in which parenteral nutrition was extremely difficult due to coincidence with inborn errors of metabolism. The first two cases was fatty acid beta-oxidation disorders associated with necrotizing enterocolitis and congenital heart disease. Thus, limitations of intravenous lipid intake made it difficult to maintain a good nutritional status. The third case was phenylketonuria associated with a facial region tumour (rhabdomyosarcoma), in which parenteral nutrition was complicated because of a high phenylalanine content in the amino acid formulas for parenteral nutrition. The fourth patient was a child with late-diagnosed tyrosinemia type 1, complicated with encephalopathy - during intensive care treatment the patient needed nutritional support, including parenteral nutrition - we observed amino acid formula problems similar to those in the phenylketonuria patient. Parenteral nutrition in children with inborn errors of metabolism is a rare, but very important therapeutic problem. Total parenteral nutrition formulas are not prepared for this group of diseases.
Subject(s)
Metabolism, Inborn Errors/therapy , Parenteral Nutrition/methods , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
BACKGROUND: Phenylketonuria (PKU) is an inborn error of amino acid metabolism in which high phenylalanine (Phe) concentrations in the central nervous system adversely affect its development and functioning. In PKU high oxidative stress and inefficiency of free radical scavenging may lead to systemic chronic inflammation. We hypothesised that in PKU gut mucosa is chronically inflamed and that this leads to release of calprotectin from neutrophils and monocytes. AIM: The aim of this study was to compare intestinal mucosa inflammation status, as measured using fecal calprotectin, in patients with PKU irrespective of compliance, and healthy controls. PATIENTS AND METHODS: Forty-four patients with classical PKU were included in the study (21 male, 23 female; aged 0-41 years; mean ± SEM: 16.5 ± 1.7 years). Forty-eight healthy subjects (HS) aged 9-68 years (29.4 ± 2.6 years) comprised the control group, of whom 21 were male and 27 female. Among PKU patients 25 had normal Phe blood concentrations and in 19 they were elevated. In all subjects calprotectin stool concentrations were assessed (PhiCal ELISA, Calpro, Lysaker, Norway). RESULTS: Normal FC (fecal calprotectin) concentrations were found in 43 (97.7%) PKU patients and 46 (95.8%) HS. No correlation between dietary control of Phe blood concentrations and FC levels in PKU patients was found. CONCLUSIONS: No detectable intestinal inflammation occurs in phenylketonuria. Lack of dietary control and elevated Phe levels do not seem to be risk factors for inflammation of the mucosa of the gut.
Subject(s)
Enteritis/etiology , Intestinal Mucosa/pathology , Phenylketonurias/complications , Adolescent , Adult , Aged , Child , Child, Preschool , Feces/chemistry , Female , Humans , Infant , Infant, Newborn , Leukocyte L1 Antigen Complex/analysis , Male , Middle Aged , Risk FactorsABSTRACT
AIM OF THE STUDY: To evaluate the influence of warmed infusions on the mothers and newborns well-being after C-section. DESIGN: Prospective randomized study. SETTING: Dept. of Anaesthesiology, Resuscitation and Intensive Care Medicine, Dept. of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc. METHODS: Prospective randomized study including 29 pregnant women between 38th and 42nd week of pregnancy, that were indicated to elective caesarian section (SC) and from all of which the fetal distress was excluded. The women were randomized into four groups according to the temperature of applied infusion solution - colloids and afterwards crystalloids (pre-heated and non pre-heated), and according to the type of anaesthesia (general or SAB). These values were monitored in perioperative period: body temperature, differences of hemoglobin and hematocrit levels, tremor and pain level after the operation. In newborns the acid-base balance parameters and Apgar score were monitored. RESULTS: The study is still going on, however up to now some of the results suggest that usage of pre-heated infusion solutions is effective both for mother and child in increasing of their comfort in the perioperative period. In the group of actively heated mothers we have noticed: lower perioperative blood loss - differences in haemoglobin levels were 8 g/l compared to 15 g/l in the group of non heated mothers. The umbilical cord blood of the newborns whose mothers were not actively heated and were operated in subarachnoid anaesthesia had the lowest pO2 (0.9 kPa). The lowest level of umbilical cord blood lactate was noticed in the group of newborns whose mothers underwent the surgery under general anaesthesia and were actively heated. CONCLUSION: Up to now results suggest that the heating of mothers during the SC lowers the loss of body temperature, blood loss, and perception of pain by the mother. In combination with general anaesthesia it increases pO2 and lowers the levels of lactate in umbilical arteria in the newborns.