Clinical evaluation of the flotrac/Vigileo system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study.

BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

Clinical evaluation of the flotrac/vigileo™ system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study

BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia.

BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (alpha-agonist) prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesia(1). The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5% hyperbaric bupivacaine (CLON/HYPER Group; n = 11) or 2.5 mg of 0.5% isobaric bupivacaine (CLON/ISO Group; n = 11) associated with 2.5 microg of sufentanil and 30 microg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation) was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3) or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for repeated measurements were used in the statistical analysis and a p < 0.05 was considered significant. RESULTS: Anthropometric data, duration of analgesia (70.9 +/- 32.9 vs. 85.4 +/- 39.5), heart rate, and the incidence of pruritus, sedation, nausea, and vomiting were similar in both groups. Mean arterial pressure was significantly lower in the CLON/ISO Group than in the CLON/HYPER Group at 15, 30, and 45 minutes (p < 0.05). CONCLUSIONS: Under the conditions of the present study, the association of a small dose of clonidine (30 microg) with sufentanil caused a higher incidence of hypotension when the isobaric solution of the local anesthetic was used. For all other side effects, both hyperbaric and isobaric solutions showed similar behavior.

Efeito da adição de clonidina subaracnóidea à solução anestésica de sufentanil e bupivacaína hiperbárica ou hipobárica para analgesia de parto / Efecto de la adición de clonidina subaracnoidea a la solución anestésica de sufentanil y bupivacaína hiperbárica o hipobárica para la analgesia de parto / Effects of the addition of subarachnoid clonidine to the anesthetic solution of sufentanil and hyperbaric or hypobaric bupivacaine for labor analgesia

JUSTIFICATIVA E OBJETIVOS: Adição de clonidina subaracnóidea (±-agonista) prolonga a ação analgésica da combinação sufentanil e bupivacaína isobárica em analgesia combinada para o trabalho de parto Õ. O objetivo deste estudo foi comparar a qualidade de analgesia e a prevalência de efeitos colaterais após a adição de clonidina subaracnóidea à solução anestésica em gestantes durante trabalho de parto. MÉTODO: Após aprovação da Comissão de Ética, 22 gestantes em trabalho de parto receberam aleatoriamente no espaço subaracnóideo 2,5 mg de bupivacaína hiperbárica 0,5 por cento (grupo CLON/HIPER; n = 11) ou 2,5 mg de bupivacaína isobárica 0,5 por cento (grupo CLON/ISO; n = 11) em associação ao sufentanil 2,5 µg e à clonidina 30 µg. A dor avaliada pela Escala Analógica Visual, a freqüência cardíaca e a pressão arterial média foram estudadas a cada 5 minutos nos primeiros 15 minutos e, a seguir, a cada 15 minutos até o nascimento. Foi avaliada a prevalência de efeitos colaterais (náusea, vômito, prurido e sedação). O estudo foi encerrado no momento em que foi necessária complementação analgésica peridural (dor > 3 cm) ou ao nascimento. A análise estatística foi realizada pelos testes t de Student, Qui-quadrado, Fisher e ANOVA de duas vias para medidas repetidas, considerando como significativo p < 0,05. RESULTADOS: Os grupos CLON/HIPER e CLON/ISO foram semelhantes com relação a dados antropométricos, duração da analgesia (70,9 ± 32,9 vs. 85,4 ± 39,5), freqüência cardíaca, ocorrência de prurido, sedação, náusea e vômitos. No grupo CLON/ISO houve diminuição significativa da pressão arterial média com relação ao grupo CLON/HIPER nos momentos 15, 30 e 45 minutos (p < 0,05). CONCLUSÕES: Nas condições estudadas, a adição de clonidina em baixa dose (30 »g), associada ao sufentanil, determinou maior ocorrência de hipotensão quando administrada com soluções isobáricas de anestésico local. Com relação aos demais efeitos colaterais, as soluções hiperbáricas...

BACKGROUND AND OBJECTIVES: The addition of subarachnoid clonidine (α-agonist) prolongs the analgesia produced by the combination of sufentanil and isobaric bupivacaine in combined labor analgesiaÕ. The objective of this study was to compare the quality of analgesia and the prevalence of side effects after the addition of subarachnoid clonidine to the anesthetic solution in labor analgesia. METHODS: After approval by the Ethics Commission, 22 pregnant women in labor were randomly assigned to the subarachnoid administration of either 2.5 mg of 0.5 percent hyperbaric bupivacaine (CLON/HYPER Group; n = 11) or 2.5 mg of 0.5 percent isobaric bupivacaine (CLON/ISO Group; n = 11) associated with 2.5 µg of sufentanil and 30 µg of clonidine. Pain, evaluated by the Visual Analogue Scale, heart rate, and mean arterial pressure were assessed every 5 minutes during the first 15 minutes, and then every 15 minutes afterwards until delivery. The prevalence of side effects (nausea, vomiting, pruritus, and sedation) was evaluated. The study was terminated whenever the patient needed supplemental epidural analgesia (pain > 3) or upon delivery of the fetus. The Student t test, Chi-square test, Fisher exact test, and two-way ANOVA for repeated measurements were used in the statistical analysis and a p < 0.05 was considered significant. RESULTS: Anthropometric data, duration of analgesia (70.9 ± 32.9 vs. 85.4 ± 39.5), heart rate, and the incidence of pruritus, sedation, nausea, and vomiting were similar in both groups. Mean arterial pressure was significantly lower in the CLON/ISO Group than in the CLON/HYPER Group at 15, 30, and 45 minutes (p < 0.05). CONCLUSIONS: Under the conditions of the present study, the association of a small dose of clonidine (30 µg) with sufentanil caused a higher incidence of hypotension when the isobaric solution of the local anesthetic was used. For all other side effects, both hyperbaric and isobaric solutions...

JUSTIFICATIVA Y OBJETIVOS: La adición de la clonidina subaracnoidea (±-agonista), prolonga la acción analgésica de la combinación sufentanil y bupivacaína isobárica en analgesia combinada para el trabajo de parto Õ. El objetivo de este estudio fue comparar la calidad de analgesia y la prevalencia de los efectos colaterales, después de la adición de clonidina subaracnoidea a la solución anestésica en gestantes durante el parto. MÉTODO: Después de la aprobación de la Comisión de Ética, 22 gestantes en trabajo de parto recibieron aleatoriamente en el espacio subaracnoideo 2,5 mg de bupivacaína hiperbárica 0,5 por ciento (grupo CLON/HIPER; n = 11) o 2,5 mg de bupivacaína isobárica 0,5 por ciento (grupo CLON/ISO; n = 11) en asociación con el sufentanil 2,5 µg y la clonidina 30 µg. El dolor evaluado por la Escala Analógica Visual, la frecuencia cardíaca y la presión arterial promedio, fueron estudiados a cada 5 minutos en los primeros 15 minutos y a continuación, a cada 15 minutos hasta el nacimiento. Fue evaluada la prevalencia de efectos colaterales (náusea, vómito, prurito y sedación). El estudio fue terminado en el momento en que se hizo necesaria la complementación analgésica epidural (dolor > 3 cm) o al nacimiento. El análisis estadístico fue realizado a través de los tests t de Student, Chi-cuadrado, Fisher y ANOVA de dos vías para medidas repetidas, considerando como significativo p < 0,05. RESULTADOS: Los grupos CLON/HIPER y CLON/ISO fueron similares con relación a los datos antropométricos, duración de la analgesia (70,9 ± 32,9 vs. 85,4 ± 39,5), frecuencia cardíaca, incidencia de prurito, sedación, náusea y vómitos. En el grupo CLON/ISO hubo una disminución significativa de la presión arterial promedio con relación al grupo CLON/HIPER en los momentos 15, 30, y 45 minutos (p < 0,05). CONCLUSIONES: En las condiciones estudiadas, la adición de clonidina en baja dosis (30 »g), asociada al sufentanil, determinó una mayor incidencia de...

Nitric oxide sera levels as an inflammatory marker in asthma.

BACKGROUND: Nitric oxide is an important regulator of various biological activities in human physiology, and it has been studied in the physiopathology of asthma, especially in exhaled air. OBJECTIVE: We studied the presence of NO in sera of patients with distinct degrees of asthma severity in order to determine a parameter of diagnosis and control of efficacious treatment. METHODS: We determined the presence of NO based upon the Griess reaction in the sera of 124 donors--34 controls and 90 asthmatic subjects. RESULTS: Asthmatic patients presented higher levels of nitric oxide in peripheral blood (56.54 +/- 33.37) compared to the control group (3.06 +/- 4.48). A statistically significant difference (p < 0.0001) between the nitric oxide sera levels from the two groups was demonstrated. CONCLUSION: This study demonstrates that nitric oxide sera levels can be used as an additional inflammatory marker in asthma, especially as an auxiliary diagnostic method in children where NO exhaled air analysis is difficult.