Neopterin is elevated in infections, autoimmune diseases and post-transplant. Recently neopterin elevation was linked to stress response and malignancy. To determine early changes of serum neopterin ...caused by surgical stress and to investigate their association with other inflammatory markers and with malignancy, we measured neopterin, C-reactive protein (CRP) and procalcitonin (PCT) levels at four predefined time-points within 24 hours in 27 patients admitted for liver resection. Our results show that neopterin increased during operation and the increase was not related to preoperative neopterin levels. On the first day after surgery neopterin level was not significantly different from postoperative levels. In patients with malignant disease neopterin concentration before operation was higher than in patients with non-malignant disease, however, the increase in neopterin concentration during operation was not different between both patient groups. During surgery CRP and PCT did not increase significantly. On the first postoperative day CRP and PCT were elevated and their levels correlated with neopterin (Pearson's correlation coefficient r=0.51 and r=0.76, respectively). We conclude that neopterin elevation during liver resection contributes major part to the increased levels observed on the first postoperative day. Perioperative neopterin release can/may be related to stress response and hypoxia produced during operation. Using this marker, hypoxic reperfusion damage could be detected earlier and more accurately.
Sugammadex reverses neuromuscular block (NMB) through binding aminosteroid neuromuscular blocking agents. Although sugammadex appears to be highly selective, it can interact with other drugs, like ...corticosteroids. A prospective single-blinded randomized clinical trial was designed to explore the significance of interactions between dexamethasone and sugammadex.
Sixty-five patients who were anesthetized for elective abdominal or urological surgery were included. NMB was assessed using train-of-four stimulation (TOF), with rocuronium used to maintain the desired NMB depth. NMB reversal at the end of anaesthesia was achieved using sugammadex. According to their received antiemetics, the patients were randomized to either the granisetron or dexamethasone group. Blood samples were taken before and after NMB reversal, for plasma dexamethasone and rocuronium determination. Primary endpoint was time from sugammadex administration to NMB reversal. Secondary endpoints included the ratios of the dexamethasone and rocuronium concentrations after NMB reversal versus before sugammadex administration.
There were no differences for time to NMB reversal between the control (mean 121 ± 61 s) and the dexamethasone group (mean 125 ± 57 s; P = 0.760). Time to NMB reversal to a TOF ratio ≥0.9 was significantly longer in patients with lower TOF prior to sugammadex administration (Beta = -0.268; P = 0.038). The ratio between the rocuronium concentrations after NMB reversal versus before sugammadex administration was significantly affected by sugammadex dose (Beta = -0.375; P = 0.004), as was rocuronium dose per hour of operation (Beta = -0.366; p = 0.007), while it was not affected by NMB depth before administration of sugammadex (Beta = -0.089; p = 0.483) and dexamethasone (Beta = -0.186; p = 0.131). There was significant drop in plasma dexamethasone after sugammadex administration and NMB reversal (p < 0.001).
Administration of dexamethasone to anesthetized patients did not delay NMB reversal by sugammadex.
The trial was retrospectively registered with The Australian New Zealand Clinical Trials Registry (ANZCTR) on February 28th 2012 (enrollment of the first patient on February 2nd 2012) and was given a trial ID number ACTRN12612000245897 and universal trial number U1111-1128-5104.
Introduction: The maintainaning of optimal perioperative uid and electrolyte balance in the perioparative period (before, during and aer surgery) is crucial for anaesthesia and intensive therapy. ...Fluid treatment interferes with the metabolism and functioning of all organ systems, therefore it is important that the patient gets the right type and quantity of uid at the right time. Perioperative uid therapy should be guided by the patients condition and the type of surgical procedure. In uid therapy, one should take into consideration the need for uid maintenance (basal metabolism needs), preoperative uid loss correction (e.c. duration of preoperative starving, especially in children), and aim for good tissue perfusion with an adequate uid load. The nal goal of uid replacement is to maintain uid and electrolyte balance, intravascular volume and consequently cardiovascular stability (adequate cardiac output), organ perfusion and tissue oxygenation. Before, during and aer surgery, balanced uids should be used in order to minimise disturbances of the electrolyte balance. In our article, the literature on perioperative uid replacement is reviewed. The results of the latest research have provoked a lot of criticism and disagreement about colloids. Only guidelines about crystalloid application are presented. Conclusions: The latest guidelines for perioperative uid therapy emphasise the application of balanced intravenous uids that minimise electrolyte and acid base balance disturbances. It is important to individualise the amount of intravenous uid to avoid hyper- or hypovolemia. The correct choice of the type of solution is equally important as any other medication that inuences the patients outcome.
Background: To date research has demonstrated that the use of general anaesthesia in combination with thoracic epidural anaesthesia (TEA) protects the patient against surgical stress. There is ...disagreement, however, concerning the effect of TEA on intestinal blood supply. In order to determine the influence of TEA on intestinal blood flow, partial O2 pressure (pO2) and pH were determined in the portal blood that drains blood from intestine, just before liver resection. These values were compared with those measured in the superior caval vein which drains blood from the upper part of the body, region not directly affected by TEA.Methods: Forty patients included in our prospective randomized study were divided into two groups, i.e. a group of 20 patients given TEA in combination with general anaesthesia, and a group of 20 patients receiving only general anaesthesia. They were premedicated with midazolam 1.5–3.0 mg i. v. Immediately after introduction of an epidural catheter at T11– T12, 15 ml of 0.25% local anaesthetic bupivacain or 15 ml of 0.9% NaCl was injected into the thoracic epidural space in the TEA group and in the control group, respectively. Anaesthesia was initiated by intravenous opioid analgesic fentanyl 0.1–0.2 mg, thiopentone 4.0 mg/kg body weight, and muscle relaxant vecuronium 0.1 mg/kg body weight. The patients were intubated and controlled ventilation was started with a 45 to 55 per cent oxygen-air mixture with addition of the volatile agent isoflurane 0.8–1.5 vol %. Muscle relaxation was maintained with vecuronium at a dose of 2–4 mg i. v. Central venous pressure was maintained at a low normal limit, i.e. 6 ± 2 mmHg. Just before liver resection, blood samples were obtained from the portal vein and superior caval vein. Intestinal blood supply was evaluated by measuring pO2 and pH in the portal vein, and the results were compared with the values obtained in the superior caval vein in each patient and in the two groups.Results: In both groups, pO2 levels in the portal vein were significantly higher than those in the superior caval vein (TEA group: 7.8 kPa in the portal vein vs. 6.0 kPa in the superior caval vein; p < 0.001; control group: 7.5 kPa in the portal vein vs. 6.1 kPa in the superior caval vein; p < 0.01). No significant differences were found between the groups (p > 0.05). In both groups, portal venous pH was significantly higher than pH determined in the superior caval vein (TEA group: 7.41 in the portal vein vs. 7.39 in the superior caval vein; p < 0.001; control group: 7.41 in the portal vein vs. 7.39 in the superior caval vein; p < 0.05), yet they were within the range of normal. There was no statistically significant difference between the groups (p > 0.05). In the TEA groups, a statistically significant negative correlation was found between the portal venous pH and pO2 levels (r = –4.7) (p < 0.05). No such correlation was observed for the control group (r = 0.058; p > 0.05).Conclusions: The observed negative correlation between pO2 and pH levels in the portal blood of TEA group suggests that the use of TEA in combination with general anaesthesia with a central venous pressure of 6 ± 2 mmHg affords a more constant intestinal blood flow pattern than general anaesthesia alone.
U radu prikazujemo primjenu rekombiniranog aktiviranog faktora VIIa (rFVIIa) u šestomjesečnog djeteta koje je pretrpjelo opsežno krvarenje s posljedičnim poremećajem zgrušavanja tijekom elektivne ...operacije karcinoma koroidnog spleta lateralne moždane komore. Primjena rFVIIa rezultirala je dobrom kontrolom zgrušavanja. Tijekom operacije i u poslijeoperacijskom tijeku nisu primijećene tromboembolijske komplikacije.
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