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Prediction of acute volume loss in spontaneously breathing subjects
Abstracts hematoxylin-eosin–stained liver samples was significantly lower in the pretreated groups. The rate of necrosis was significantly lower in the short-term group than that in the control group. In the longterm group, tissue integrity was more preserved, whereas high rate of necroapoptosis could be seen in the control samples. More apoptotic than necrotic cell death was observed in the pretreated than in the control groups, and the serum ALT and AST levels were significantly lower (P = .045 for short-term and P = .038 for longterm pretreatment). Conclusion: Glutamine pretreatment is beneficial in supporting hepatic microcirculation and can prevent hepatocellular necrosis in liver reperfusion injury. Further investigations are needed before the clinical use of glutamine in this indication, but its preoperative administration could reduce the risk of postoperative liver failure after major liver resections and could help to preserve tissue integrity and function. doi:10.1016/j.jcrc.2008.12.003
Studies on the evaporation of volatile anesthetics during intracerebral surgery B.T. Tankó , T. Büdi , C. Pető , B. Fülesdi , C. Molnár Department of Anesthesiology and Intensive Care, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary Introduction: The aim of this study was to investigate whether sevofluran evaporation from brain tissue during intracerebral surgery poses an additional risk of environmental exposure of the staff to volatile anesthetics, with focus on operating surgeon being in the closest proximity of the craniotomic window. Methods: During narcosis of 35 patients undergoing intracerebral surgery, sample collection was undertaken at 3 detection sites—in the surgeon's and the anesthesiologist's breathing zone and the farend corner of the operation room—between the opening and the closure of the dura mater. Sevofluran captured by absorbers was quantified by gas chromatography. Results: Of the 3 detectors, those placed in the anesthesiologist's breathing zone (1.40 ± 0.37 ppm) showed significantly higher sevofluran concentrations compared with detectors placed in the surgeon's breathing zone (2.36 ± 0.39 ppm) or the far-end corner of the operation room (2.51 ± 0.72 ppm). The amount of released sevofluran in the absorbers did not show significant correlation with either the duration of the operation or the size of the craniotomic window. The only significant correlation was between sevofluran values measured in the surgeon's breathing zone and the corner of the operation room (r = 0.41, P = .015). Conclusions: The surgeon's sevofluran exposure during intracerebral surgery does not seem to be enhanced by evaporation from the craniotomic window and is comparable with that measurable in the operation room. The significantly higher exposure of the anesthesiologist remains the main finding of the study and needs further studies to explore its main source.
147 Introduction: Continuous measurement of central venous saturation (ScvO2) can help the evaluation of the balance between oxygen supply and demand [1]. The aim of our prospective, randomized, controlled, clinical trial was to investigate the effect of central venous pressure (CVP) and ScvO2 guided intraoperative fluid management on the postoperative inflammatory response and intraoperative fluid demand. Methods: After local ethics committee approval and written informed consent, 39 patients who underwent major abdominal surgery were enrolled to the study. Patients were randomized into CVP (n = 20) and ScvO2 (n = 19) groups. Besides routine monitoring of vital signs such as heart rate, invasive blood pressure, and CVP, ScvO2 was also continuously measured (CeVOX, PULSION Medical Systems, Germany) in the ScvO2 group. CVP was kept 8 to 12 mmHg in the CVP group and ScvO2 ≥70% in the ScvO2 group with bolus colloid infusions during surgery. If the mean arterial pressure fell to less than 60 mmHg, a bolus of ephedrine was administered. Vital parameters were recorded in every hour during the operation then on the first and the second postoperative day. Laboratory samples were taken right before and after surgery and on the first and the second postoperative day. For statistical analysis, Mann-Whitney test and independent-samples t test (SPSS for Windows version 11.5; SPSS, Chicago, Ill) was used. Results: There was no significant difference between the 2 groups in the intraoperative fluid requirement, the dose of ephedrine, and in the postoperative inflammatory marker levels. The patients in ScvO2 group needed less colloid than in the CVP group, but the difference was not significant (median [IQR]): 500 (250-1000) vs 1000 (5001000) mL; P = .165. The mean ScvO2 in the whole sample under the operation was 81.7% ± 7.8%. Conclusion: The preliminary results of this study, such as the tendency in less fluid requirement in the ScvO2 group, justify the completion of the trial to come to firm conclusions. The observed high ScvO2 (∼80%), which is in accord with previously reported data [2], suggest that “normal” or “target” values for anaesthetized patients during major abdominal surgery should be redefined. doi:10.1016/j.jcrc.2008.12.005
References [1] Hameed SM, et al. Oxygen delivery. Crit Care Med 2003;31:S122. [2] Pearse R, et al. Changes in central venous saturation after major surgery, and association with outcome. Crit Care 2005;9:694.
doi:10.1016/j.jcrc.2008.12.004
Prediction of acute volume loss in spontaneously breathing subjects A. Csillik a, D. Paprika a, Z. Gingl b, É. Zöllei a, L. Rudas a a Department of Anaesthesia and Intensive Care, University of Szeged, Szeged, Hungary b Department of Experimental Physics, University of Szeged, Szeged, Hungary
Goal-directed intraoperative fluid management: central venous pressure vs central venous saturation K. Tanczos , A. Mikor, T. Leiner, I. Toth , Z. Molnar Department of Anaesthesiology and Intensive Care, University of Pecs, Pecs, Hungary
Introduction: Breathing-related hemodynamic changes can predict volume deficit in mechanically ventilated subjects. We tested if any of the heart rate, systolic arterial pressure (SAP), and stroke volume (SV) variability indices would predict acute volume loss in spontaneously breathing individuals. We have evaluated the possibility that slow patterned breathing could increase the discriminative power of these parameters.
148
Abstracts
Methods: Measurements were taken at a local blood bank before and after 350 to 400 mL blood donation. Five 5-minute recordings were taken during both conditions while breathing spontaneously and at 5/min patterned breathing rate. Fifty-eight subjects participated in the study (43 male; age, 40 ± 13 years). Their ECG (R-R intervals) and blood pressure were continuously recorded. Heart rate, SAP, and their variability were calculated in all 4 study conditions. Short-term systolic pressure variation (StSPV), defined as systolic maximum-minimum difference averaged over 3 breathing cycles, was also calculated. SV variability was calculated by pulse contour analysis. Results: Mean RR interval decreased significantly after blood donation only while spontaneous breathing. Hypovolemia did not alter SAP and pulse pressure (PP). Systolic variability, as reflected by SD of SAP, increased in acute hypovolemia irrespective of the breathing pattern. StSPV assessed during patterned breathing increased similarly. However, we found no specific cutoff value that could predict acute blood loss. Stroke volume decreased significantly after volume loss; however, SD of SV remained unchanged. R-R interval mean SAP
SB1 SB2 PB1 PB2
SB1 SB2 PB1 PB2
SAP SD PP
PP SD
ms
mm Hg mm Hg
mm Hg mm Hg
949 827 ⁎⁎ 833 823
152 155 152 151
7 8⁎ 9 10 ⁎⁎
64 65 65 64
StSPV
SV
SV SD
mm Hg
mL
mL
19 22 ⁎⁎ 12 13 ⁎⁎
66 59 ⁎ 68 59 ⁎
4.9 4.7 6 5.6
4.7 5.5 ⁎⁎ 5.7 6.2
SB1 indicates spontaneous breathing before blood donation; SB2, spontaneous breathing after blood donation; PB1, 5/min patterned breathing before blood donation; PB2, 5/min patterned breathing after blood donation. ⁎ P b .002. ⁎⁎ P b .01.
Conclusion: Although most of the studied hemodynamic parameters changed significantly after blood donation, their discriminative value for practical clinical use in minor hypovolemia is poor. Discriminative power of these variables did not increase with 5/min breathing. doi:10.1016/j.jcrc.2008.12.006
Studies on the evaporation of volatile anesthetics during intracerebral surgery B.T. Tankó , T. Büdi , C. Pető , B. Fülesdi , C. Molnár Department of Anesthesiology and Intensive Care, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary Introduction: The aim of this study was to investigate whether sevofluran evaporation from brain tissue during intracerebral surgery poses an additional risk of environmental exposure of the staff to volatile anesthetics, with focus on operating surgeon being in the closest proximity of the craniotomic window. Methods: During narcosis of 35 patients undergoing intracerebral surgery, sample collection was undertaken at 3 detection sites—in the surgeon's and the anesthesiologist's breathing zone and the farend corner of the operation room—between the opening and the closure of the dura mater. Sevofluran captured by absorbers was quantified by gas chromatography. Results: Of the 3 detectors, those placed in the anesthesiologist's breathing zone (1.40 ± 0.37 ppm) showed significantly higher sevofluran concentrations compared with detectors placed in the surgeon's breathing zone (2.36 ± 0.39 ppm) or the far-end corner of the operation room (2.51 ± 0.72 ppm). The amount of released sevofluran in the absorbers did not show significant correlation with either the duration of the operation or the size of the craniotomic window. The only significant correlation was between sevofluran values measured in the surgeon's breathing zone and the corner of the operation room (r = 0.41, P = .015). Conclusions: The surgeon's sevofluran exposure during intracerebral surgery does not seem to be enhanced by evaporation from the craniotomic window and is comparable with that measurable in the operation room. The significantly higher exposure of the anesthesiologist remains the main finding of the study and needs further studies to explore its main source.
147 Introduction: Continuous measurement of central venous saturation (ScvO2) can help the evaluation of the balance between oxygen supply and demand [1]. The aim of our prospective, randomized, controlled, clinical trial was to investigate the effect of central venous pressure (CVP) and ScvO2 guided intraoperative fluid management on the postoperative inflammatory response and intraoperative fluid demand. Methods: After local ethics committee approval and written informed consent, 39 patients who underwent major abdominal surgery were enrolled to the study. Patients were randomized into CVP (n = 20) and ScvO2 (n = 19) groups. Besides routine monitoring of vital signs such as heart rate, invasive blood pressure, and CVP, ScvO2 was also continuously measured (CeVOX, PULSION Medical Systems, Germany) in the ScvO2 group. CVP was kept 8 to 12 mmHg in the CVP group and ScvO2 ≥70% in the ScvO2 group with bolus colloid infusions during surgery. If the mean arterial pressure fell to less than 60 mmHg, a bolus of ephedrine was administered. Vital parameters were recorded in every hour during the operation then on the first and the second postoperative day. Laboratory samples were taken right before and after surgery and on the first and the second postoperative day. For statistical analysis, Mann-Whitney test and independent-samples t test (SPSS for Windows version 11.5; SPSS, Chicago, Ill) was used. Results: There was no significant difference between the 2 groups in the intraoperative fluid requirement, the dose of ephedrine, and in the postoperative inflammatory marker levels. The patients in ScvO2 group needed less colloid than in the CVP group, but the difference was not significant (median [IQR]): 500 (250-1000) vs 1000 (5001000) mL; P = .165. The mean ScvO2 in the whole sample under the operation was 81.7% ± 7.8%. Conclusion: The preliminary results of this study, such as the tendency in less fluid requirement in the ScvO2 group, justify the completion of the trial to come to firm conclusions. The observed high ScvO2 (∼80%), which is in accord with previously reported data [2], suggest that “normal” or “target” values for anaesthetized patients during major abdominal surgery should be redefined. doi:10.1016/j.jcrc.2008.12.005
References [1] Hameed SM, et al. Oxygen delivery. Crit Care Med 2003;31:S122. [2] Pearse R, et al. Changes in central venous saturation after major surgery, and association with outcome. Crit Care 2005;9:694.
doi:10.1016/j.jcrc.2008.12.004
Prediction of acute volume loss in spontaneously breathing subjects A. Csillik a, D. Paprika a, Z. Gingl b, É. Zöllei a, L. Rudas a a Department of Anaesthesia and Intensive Care, University of Szeged, Szeged, Hungary b Department of Experimental Physics, University of Szeged, Szeged, Hungary
Goal-directed intraoperative fluid management: central venous pressure vs central venous saturation K. Tanczos , A. Mikor, T. Leiner, I. Toth , Z. Molnar Department of Anaesthesiology and Intensive Care, University of Pecs, Pecs, Hungary
Introduction: Breathing-related hemodynamic changes can predict volume deficit in mechanically ventilated subjects. We tested if any of the heart rate, systolic arterial pressure (SAP), and stroke volume (SV) variability indices would predict acute volume loss in spontaneously breathing individuals. We have evaluated the possibility that slow patterned breathing could increase the discriminative power of these parameters.
148
Abstracts
Methods: Measurements were taken at a local blood bank before and after 350 to 400 mL blood donation. Five 5-minute recordings were taken during both conditions while breathing spontaneously and at 5/min patterned breathing rate. Fifty-eight subjects participated in the study (43 male; age, 40 ± 13 years). Their ECG (R-R intervals) and blood pressure were continuously recorded. Heart rate, SAP, and their variability were calculated in all 4 study conditions. Short-term systolic pressure variation (StSPV), defined as systolic maximum-minimum difference averaged over 3 breathing cycles, was also calculated. SV variability was calculated by pulse contour analysis. Results: Mean RR interval decreased significantly after blood donation only while spontaneous breathing. Hypovolemia did not alter SAP and pulse pressure (PP). Systolic variability, as reflected by SD of SAP, increased in acute hypovolemia irrespective of the breathing pattern. StSPV assessed during patterned breathing increased similarly. However, we found no specific cutoff value that could predict acute blood loss. Stroke volume decreased significantly after volume loss; however, SD of SV remained unchanged. R-R interval mean SAP
SB1 SB2 PB1 PB2
SB1 SB2 PB1 PB2
SAP SD PP
PP SD
ms
mm Hg mm Hg
mm Hg mm Hg
949 827 ⁎⁎ 833 823
152 155 152 151
7 8⁎ 9 10 ⁎⁎
64 65 65 64
StSPV
SV
SV SD
mm Hg
mL
mL
19 22 ⁎⁎ 12 13 ⁎⁎
66 59 ⁎ 68 59 ⁎
4.9 4.7 6 5.6
4.7 5.5 ⁎⁎ 5.7 6.2
SB1 indicates spontaneous breathing before blood donation; SB2, spontaneous breathing after blood donation; PB1, 5/min patterned breathing before blood donation; PB2, 5/min patterned breathing after blood donation. ⁎ P b .002. ⁎⁎ P b .01.
Conclusion: Although most of the studied hemodynamic parameters changed significantly after blood donation, their discriminative value for practical clinical use in minor hypovolemia is poor. Discriminative power of these variables did not increase with 5/min breathing. doi:10.1016/j.jcrc.2008.12.006