Intravenous Infusion Of Normal Saline Research Articles

Propyl acetate protects intestinal barrier during parenteral nutrition in mice and Caco-2 cells.

Gut microbiota dysbiosis induces intestinal barrier damage during parenteral nutrition (PN). However, the underlying mechanisms remain unclear. This study aimed to investigate gut microbiota dysbiosis, luminal short-chain fatty acids, and autophagy in a mouse model and how these short-chain fatty acids regulate autophagy. Eight-week-old male specific-pathogen-free mice were randomly divided into a Chow group (standard diet and intravenous normal saline infusion) and a PN group (continuous infusion of PN nutrient solution) for 7 days. Caco-2 cells were also treated with intestinal rinse solutions from Chow and PN mouse models. Compared with the Chow group, the PN group exhibited increased Proteobacteria and decreased Firmicutes, correlating with decreased propyl acetate. In the PN group, intestinal tissue exhibited elevated adenosine monophosphate-activated protein kinase (AMPK) phosphorylation, LC3II protein levels, and Atg3 and Atg7 messenger RNA levels. P62 protein levels were decreased, indicating an increase of autophagy flux in the PN group. In the Caco-2 cell model, cells treated with PN solution plus propyl acetate exhibited increased Claudin-1 and occluding along with decreased interleukin-6 and tumor necrosis factor α compared with those treated with PN solution alone. Propyl acetate addition inhibited the AMPK-mammalian target of rapamycin (mTOR) pathway, mitigating the excessive autophagy induced by the PN intestinal rinse solution in Caco-2 cells. PN led to a significant reduction in propyl acetate levels in the intestine, excessive activation of autophagy, and barrier dysfunction. Propyl acetate inhibited excessive autophagy via the AMPK/mTOR signaling pathway and protected the intestinal barrier during PN.

Evaluation of effects of intravenous infusion of dexmedetomidine or lignocaine on stress response and postoperative pain in patients undergoing craniotomy for intracranial tumors: A randomized controlled exploratory study.

Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4-8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

A PROSPECTIVE COMPARATIVE STUDY TO ASSESS THE EFFECT OF TRANEXAMIC ACID IN PATIENTS UNDERGOING CEPHALOMEDULLARY NAILING FOR HIP FRACTURES

Background: The main objective of the present study was to assess the effect of TXAin patients undergoing cephalomedullary nailing xation of hip fractures in comparison with patients not receiving TXA. Methods: This is a prospective comparative study done with eligible in-patients (n=71) with hip fractures, planned for cephalomedullary nailing in Department of Orthopaedics and Traumatology, Meenakshi Mission Hospital and Research Centre, Tertiary Health Care Centre, Madurai, Tamilnadu. All eligible patients were divided into two groups viz. Group T and Group S. For Group T (TXA Group), intravenous infusion of TXA at the dose level of 15 mg/kg was given at the time of inducing anaesthesia i.e., 15 minutes before skin incision in surgery. For Group S (Saline Group) intravenous infusion of normal saline at the dose level of 15 mg/kg was given at the time of inducing anaesthesia i.e., 15 minutes before skin incision in surgery. Group T and Group S were compared and evaluated for blood loss and requirement of whole blood transfusion. Results: Majority of the study subjects i.e., 80% had Intertrochanteric femur fracture and majority of the study subjects i.e., 68.60% underwent closed reduction and internal xation with long Proximal Femoral Nail (PFN). Furthermore, our study ndings delineated that study subjects who received TXA had 79.8 mL lesser peri- operative blood loss as compared to control subjects and this difference was statistically signicant (p = 0.002) between the groups. In addition, number of study subjects who required blood transfusion was higher (44.44%) among Group S as compared to Group T (20.00%) and this difference was also statistically signicant (p<0.05) between the groups. Conclusion: Tranexamic acid play a signicant role in reducing postoperative blood loss and blood transfusion when used intravenously in patients undergoing cephalomedullary nailing xation of hip fractures.

Comparative evaluation of blood parameters in patients undergoing cephalomedullary nailing for hip fractures

Background: With the rapid increase in the aged population, hip fractures increase rapidly in elderly people and cause a significant social and economic problem. Dynamic hip screw with barrel plate and cephalomedullary nails are the usual methods of internal fixation in these fractures. The former method is associated with significant exposure and dissection for application of the plate. Hip fractures are commonly associated with a relatively large amount of blood loss from the initial injury in addition to blood loss resulting from surgery. Aim: The current study was conducted with the main purpose to evaluate the concentration of hemoglobin (Hb) and packed cell volume (PCV) in patients undergoing cephalomedullary nailing fixation of hip fractures receiving tranexamic acid (TXA) in comparison with not receiving TXA. Methods: This is a prospective comparative study done with eligible in-patients (n=71) with hip fractures, planned for cephalomedullary nailing in Department of Orthopaedics and Traumatology, Meenakshi Mission Hospital and Research Centre, Tertiary Health Care Centre, Madurai, Tamilnadu. All eligible patients were divided into two groups viz. Group T and Group S. For Group T (TXA Group), intravenous infusion of TXA at the dose level of 15 mg/kg was given at the time of inducing anaesthesia i.e., 15 minutes before skin incision in surgery. For Group S (Saline Group) intravenous infusion of normal saline at the dose level of 15 mg/kg was given at the time of inducing anaesthesia i.e., 15 minutes before skin incision in surgery. The concentration of hemoglobin (Hb) packed cell volume (PCV) was estimated using standardized methods in Group T and Group S and were compared. Results: Patients who received TXA had significantly (p

Effects of subanesthetic dose of esketamine on opioid consumption after thoracoscopic surgery

Objective: To investigate the effect of continuous intravenous infusion of subanesthetic dose of esketamine intraoperatively on postoperative opioid consumption in patients undergoing thoracoscopic surgery. Methods: A total of 71 patients with elective thoracoscopic lung surgery in the First Affiliated Hospital of Zhengzhou University from December 2020 to December 2021 were selected. Patients who were classified as grade Ⅰ or Ⅱ by the American Society of Anesthesiologists (ASA) and aged 18-70 years were included, including 32 males and 39 females, with a body mass index (BMI) of 18.5-30.0 kg/m2. The patients were randomly divided into three groups: (1) Control group (group C, n=24): continuous intravenous infusion of normal saline at the same rate during surgery; (2) Subanesthetic dose of esketamine 0.125 mg·kg-1·h-1 group (group ES1, n=23): continuous intravenous infusion of esketamine at a rate of 0.125 mg·kg-1·h-1 during surgery; (3) Subanesthetic dose of esketamine 0.250 mg·kg-1·h-1 group (group ES2, n=24): continuous intravenous infusion of esketamine at a rate of 0.250 mg·kg-1·h-1 during surgery. The main outcome measures were the total consumptions of hydromorphone of 3 groups within 24 and 48 hours after surgery. The secondary outcome measures were the extubation time, length of postanesthesia care unit (PACU) stay, the time of first feeding, and the incidences of adverse effects within 24 h after surgery in 3 groups. Results: The 24 h postoperative consumption of hydromorphone in group C, ES1 and ES2 was (5.4±1.0) mg, (4.5±1.5) mg and (4.0±0.8) mg, respectively. Likewise, the 48 h postoperative consumption of hydromorphone was (9.7±2.2) mg, (9.0±3.0) mg and (7.7±1.8) mg, respectively. Compared with group C, the 24 h postoperative hydromorphone consumptions were significantly reduced in group ES1 and ES2 (both P<0.05). The extubation time, length of PACU stay and the time of first feeding after surgery in group C were (23±10) min,(70±12) min,(17±3) h,in group ES1 were (22±4) min,(69±11) min,(14±5) h,in group ES2 were (16±8) min,(58±12) min,(14±3) h, respectively. Compared with group C and group ES1, both of the extubation time and length of PACU stay were shortened in group ES2 (both P<0.05). Compared with group C, the first postoperative feeding time of group ES1 and ES2 was shortened (both P<0.05). There were no differences in the incidences of adverse effects at postoperative 24 h among 3 groups (all P>0.05). Conclusion: Continuously intravenous infusion of subanesthetic esketamine at a rate of 0.250 mg·kg-1·h-1 can significantly reduce the postoperative opioid consumption and improve the patient's outcomes.

Comparative evaluation of two different doses of intravenous dexmedetomidine infusion for sedation in patients undergoing lower abdominal general surgical procedures under spinal anesthesia

BACKGROUND: Spinal anesthesia is the most popular regional anesthesia technique for lower abdominal surgeries. The failure of many spinal anesthesia techniques is more due to inadequate sedation and anxiolysis than technically faulty blocks. This study was designed to determine the appropriate dose of intravenous dexmedetomidine maintainance infusion to provide adequate sedation for spinal anesthesia. METHODS: A prospective, randomized, controlled double-blind study was carried out on 75 patients aged 18-60 years with ASA I and ASA II physical status who were scheduled for elective lower abdominal surgery under spinal anesthesia. Before the spinal anesthesia, all study participants were given an initial loading dose of 0.5 µg/kg dexmedetomidine infusion. Participants were randomly divided into three groups for maintenance drug infusion, Group A (to receive dexmedetomidine infusion at 0.2 µg/kg/hr), Group B (to receive dexmedetomidine infusion at 0.4 µg/kg/hr) and Group C to receive an intravenous infusion of normal saline during surgery. The Ramsay Sedation Scale (RSS) score, duration of analgesia, hemodynamic variables and occurrence of adverse events were monitored in all patients. RESULTS: Dexmedetomidine group had increased RSS score in intraoperative period and upto first 30 minutes in postoperative period compared to control group . Time to request for first analgesic was prolonged and incidence of shivering and PONV in postoperative period was less in group B than group A. The hemodynamic parameters, Respiratory parameters were not statistically significant among group A and group B. CONCLUSION: We conclude that intravenous administration of dexmedetomidine0.5 µg/kg loading dose followed by 0.4 µg/kg/hr as maintenance infusion is the optimum dose to produce sedation during spinal anesthesia with an additional advantage of increased duration of analgesia and reduced postoperative sideeffects .

Left Ventricular End-Diastolic Pressure and B-Type Natriuretic Peptide Levels Guidance of Low-Dose Furosemide Treatment to Prevent Contrast-Induced Nephropathy in Patients with Percutaneous Coronary Intervention: A Randomized Controlled Trial

Objective. We aimed to explore the preventive effect of low-dose furosemide administration guided by left ventricular end-diastolic pressure (LVEDP) and B-type natriuretic peptide (BNP) based on adequate hydration on contrast-induced nephropathy (CIN) in patients with percutaneous coronary intervention (PCI). Methods. This parallel randomized clinical trial was conducted at a tertiary hospital in China. A total of 1053 consecutive patients (71.98% men) who underwent PCI at our hospital were enrolled. Pre-PCI plasma BNP levels were recorded. Patients enrolled received a continuous intravenous infusion of normal saline starting 4 h before PCI until 24 h after surgery. LVEDP was measured immediately after surgery. Patients in the control group received intravenous furosemide injection (20 mg). Patients in the experimental group received furosemide if they showed LVEDP ≥15 mmHg, a post-PCI BNP level ≥100 pg/mL, and/or a post-PCI BNP value &gt; 150% of the pre-PCI value. The primary and secondary outcome measures were serum creatinine levels, glomerular filtration rate, and creatinine clearance rate measured before and after PCI. CIN incidence was compared between the two groups. Logistic regression analysis was used to study the risk factors for CIN. Results. CIN incidence was significantly higher in the control group than in the experimental group ( P &lt; 0.05 ). Logistic regression analysis showed that elevated LVEDP and BNP levels were risk factors. As LVEDP increased, the CIN incidence also increased (odds ratio (OR) 1.038, 95% confidence interval (CI) 1.006–1.070). The OR of BNP was 1.001 (95% CI 1.000–1.002). Conclusions. Low-dose furosemide administration guided by LVEDP or BNP is superior to direct low-dose administration on the basis of adequate hydration during PCI. This trial is registered with ChiCTR-IOR-14005250

Graves’ Disease Presenting as Adrenal Crisis in a Patient With Congenital Adrenal Hyperplasia

Background: Adrenal crisis (AC) is a life-threatening condition that occurs either as the initial presentation of adrenal insufficiency or in patients who are known to have hypoadrenalism, when a precipitating acute stressor outweighs the mineralocorticoid and glucocorticoid supply. It is known that exposure to high levels of thyroid hormones in the presence of hypoadrenalism may precipitate AC.Graves’ disease (GD), as a precipitant of AC in patients with congenital adrenal hyperplasia (CAH), has been rarely described in the literature. Clinical Case: A 15-year-old male with classic CAH diagnosed since birth when he had vomiting and darkly pigmented skin. He was on regular follow-up with his endocrinologist in his home country. For an unclear reason, he was on hydrocortisone 40 mg daily in divided doses. The patient presented to the emergency department with nausea, vomiting, loose stool, dizziness, and fatigue for 5 days. On examination, he was conscious and oriented but looked tired. He had a temperature of 36.8°C, blood pressure (supine) 132/78 mmHg (standing blood pressure could not be taken because the patient was dizzy), pulse rate 130/minute, and respiratory rate 17/minute. Otherwise, the physical exam was unremarkable. Initial laboratory investigations showed sodium 114 (136–145 mmol/L), potassium 6.0 (3.5–5.1 mmol/l), chloride 83 (102–104 mmol/L) and Bicarbonate 14 (22–29 mmol/L). Serum creatinine, complete blood count, C-reactive protein (CRP) and procalcitonin levels were within normal. He was treated for AC with stress doses of hydrocortisone intravenously, and normal saline intravenous infusion. He showed a gradual improvement of his symptoms with normalization of the electrolytes. Thus, he was switched to oral hydrocortisone replacement 15 mg am and 10 mg in the afternoon. Nevertheless, his pulse rate was 105 -110 / min. Therefore, thyroid function test (TFT) was done and revealed TSH 0.3 (0.5–4.3 mIU/L) and FT4 30.6 (12.9–20.6 pmol/L). Thyroid uptake scan showed a mildly enlarged thyroid gland with homogeneous and slightly increased radiotracer uptake suggestive of GD. Thus, propranolol and carbimazole were prescribed in addition to hydrocortisone. Then, the patient was discharged after proper education about precipitating factors of AC. Later on, the patient appeared for his clinic appointment, he was clinically well with normal vital signs, serum electrolytes, and TFT. Propranolol was stopped, carbimazole dose was adjusted, and he was maintained on hydrocortisone. Conclusion: Unrecognized Graves’ disease was the precipitating factor of the adrenal crisis in this patient with CAH. Despite the rarity of the association, a high index of clinical suspicion for unusual acute stressors is very important for proper management of AC and to prevent future recurrence.

Hemodynamic Changes in the Carotid Artery after Infusion of Normal Saline Using Computational Fluid Dynamics.

Purpose: To study the effect of the infusion of normal saline on hemodynamic changes in healthy volunteers using computational fluid dynamics (CFD) simulation. Methods: Eight healthy subjects participated and 16 carotid arteries were used for the CFD analysis. A one-liter intravenous infusion of normal saline was applied to the participants to observe the hemodynamic variations. Blood viscosity was measured before and after the injection of normal saline to apply the blood properties on the CFD modeling. Blood viscosity, shear rate, and wall shear stress were visually and quantitatively shown for the comparison between before and after the infusion of normal saline. Statistical analyses were performed to confirm the difference between the before and after groups. Results: After the infusion of normal saline, decreased blood viscosity was observed in the whole carotid artery. At the internal carotid artery, the recirculation zone with low intensity was found after the injection of normal saline. Increased shear rate and reduced wall shear stress was observed at the carotid bifurcation and internal carotid artery. The hemodynamic differences between before and after groups were statistically significant. Conclusions: The infusion of normal saline affected not only the overall changes of blood flow in the carotid artery but also the decrease of blood viscosity.

Emergency hysterectomy for a ruptured intramural ectopic pregnancy: A case report

Intramural ectopic pregnancy is usually complicated by uterine rupture requiring emergency laparotomy and appropriate intervention. The diagnosis poses a serious challenge and the type of surgical intervention required depends on the hemodynamic status and the extent of damage to the uterus. A 38-year-old gravida 3, Para 2, abortion 0, who had an emergency hysterectomy due to a ruptured intramural pregnancy with massive hemoperitoneum. Pre-operative ultrasound was suggestive of the diagnosis which was confirmed by operative findings and histopathology report on the specimens. Intravenous infusion of normal saline, blood transfusion and emergency hysterectomy is essential for prevention of maternal mortality in intramural pregnancy complicated by uterine rupture.

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

BackgroundIntravenous lidocaine and dexmedetomidine treatments have been proposed as methods for inhibiting cough. We compared the efficacy of intravenous lidocaine and dexmedetomidine treatments on inhibiting cough during the tracheal extubation period after thyroid surgery.MethodsOne hundred eighty patients undergoing thyroid surgeries were randomly allocated to the LIDO group (received lidocaine 1.5 mg/kg loading, 1.5 mg/kg/h infusion), the DEX group (received dexmedetomidine 0.5 μg/kg loading, 0.4 μg/kg/h infusion) and the CON group (received saline), with 60 cases in each group. The primary outcomes of cough were recorded. Secondary outcomes included hemodynamic variables, awareness time, volume of drainage, the postoperative visual analogue scale and adverse effects were recorded.ResultsThe incidence of cough were significantly lower in the LIDO group (28.3%) and the DEX group (31.7%) than that in the CON group (66.7%) (P = 0.000). Additionally, both moderate and severe cough were significantly lower in the LIDO group (13.3%) and the DEX group (13.4%) than these in the CON group (43.4%) (P < 0.05). Compared with the two treatment groups, both mean arterial blood pressure and heart rate were significantly increased in the CON group during tracheal extubation (P < 0.05). Compared with the CON group, the volume of drainage was significantly reduced in the two treatment groups within 48 h after surgery (P < 0.05). compared with the CON group, the postoperative visual analogue scale was significantly lower in groups LIDO and DEX after surgery(P < 0.05). Compared with the LIDO group and the CON group, the time to awareness was longer in the DEX group (P < 0.05). In the DEX group, bradycardia was noted in 35 patients, while no bradycardia was noted in LIDO group and CON group.ConclusionCompared with intravenous infusions of normal saline, both lidocaine and dexmedetomidine had equal effectiveness in attenuating cough and hemodynamic changes during the tracheal extubation period after thyroid surgery, and both of these treatments were able to reduce the volume of postoperative bleeding and provide better analgesic effect after surgery. But intravenous infusions of dexmedetomidine resulted in bradycardia and delayed the time to awareness when compared with lidocaine and normal saline.Trial registrationChiCTR1800017482. (Prospective registered). Initial registration date was 01/08/2018.

Intraoperative mannitol during robotic-assisted-laparoscopic partial nephrectomy.

Mannitol is routinely used during partial nephrectomies due to its renoprotective properties. With minimally invasive techniques, the need for mannitol has been questioned. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has been shown to decrease warm ischemia time, which may potentially minimize the benefit of mannitol. To date, no prospective, randomized, controlled trials have investigated the use of mannitol in only robotic procedures. We hypothesize that the intraoperative mannitol use during RALPN provides no statistically significant benefit for post-operative renal function outcomes. We conducted a randomized, controlled, double-blinded, single surgeon, prospective study to assess renal function after RALPN. Patients were randomized into a control group with intravenous normal saline infusion prior to clamping of the vessels or to an experimental group with an infusion of mannitol. Estimated glomerular filtration rate (eGFR) were obtained prior to the surgery as well as post operatively at 24h, 1week, and 30days. Preoperative eGFR showed no statistical differences between the groups and evaluation of median percent change in eGFR after surgery did not indicate a statistical difference between the groups after RALPN. After prospective analysis of the change in post-operative renal function of randomized groups who received 12g of mannitol following RALPN, we determined that infusion of mannitol does not provide significant improvement of maintenance of renal functions after RALPN. Based on our results, we recommend discontinuing routine use of mannitol during RALPN.

Observation of the effect of oxymatrine combined with interferon alpha-2b in the treatment of patients with chronic hepatitis B

Objective To investigate the clinical value of oxymatrine combined with interferon alpha-2b in the treatment of chronic hepatitis B. Methods From January 2014 to January 2017, Ninety patients with chronic hepatitis B in the Third People's Hospital of Linfen were divided into observation group and control group according to the random number table method, with 45 cases in each group.The control group was treated with recombinant human interferon alpha-2b, intramuscular injection of 5 million IU, 1 time/d, and on the basis of the control group, the observation group was treated with oxymatrine injection 500 mg+ 0.9% sodium chloride injection 250mL, intravenous infusion of normal saline, 1 time/d, the treatment cycle was 6 months.The changes of liver function, HBV-DNA negative rate and liver fibrosis indicators were compared between the two groups before and after treatment. Results After treatment, the liver function indicators of the observation group and the control group[ALT(45.2±8.3)IU/L, (68.4±9.5)IU/L; AST(42.6±7.2)IU/L, (63.7±9.3)IU/L]were significantly decreased, which of the observation group were significantly lower than those of the control group, the differences were statistically significant (t=11.678, 10.186, all P<0.05). The negative rate of HBV-DNA in the observation group(82.2%) was significantly higher than that in the control group(60.0%), the difference was statistically significant(χ2=5.409, P<0.05). After treatment, the levels of Ⅳ-C[(57.7±10.6)ng/L, (132.2±47.6)ng/L], LN[(103.1±33.1)ng/L, (162.5±57.9)ng/L]and HA[(158.7±59.2)ng/L, (263.4±97.9)ng/L]of the observation group and the control group were significantly decreased, which of the observation group were significantly lower than those of the control group, the differences were statistically significant (t=9.899, 5.971, 5.856, all P<0.05). Conclusion Oxymatrine injection combined with interferon alpha-2b in the treatment of chronic hepatitis B can significantly improve liver function, improve the negative rate of virus and liver fibrosis. Key words: Hepatitis B; Interferon Alfa-2b; Oxymatrine

Effect of Intravenous Dexmedetomidine Infusion on Interleukin-6 (IL-6) and Plasma Cortisol in Open Heart Surgery

Aim of the work: to evaluate the effect of intravenous dexmedetomidine infusion on patientsundergoing open heart surgery regarding stress response markers as plasma interleukin-6 andplasma cortisol.Patents and Methods: Fifty consecutive patients aged 18-70years, scheduled for elective openheart surgery using CPB technique were enrolled in this study at the Cardiothoracic Surgery Unit,Luxor international hospital, from July 2018 to May 2019. Patients randomly assigned using closedenvelope technique into two equal groups according to the drug infused intraoperatively: 1st group (25 patients):- Dexmedetomidine group (Group D); received loading dose of intravenousdexmedetomidine infusion of 1 μg/kg IV dissolved in 20ml normal saline over 10 minutes followedby maintenance dose of 0.5 μg/kg/hr. till the end of surgery where 0.5 μg /kg/h was calculated foreach patient and dissolved in 12.5 ml normal saline 2nd group ( 25 patients):- placebo group (Group P); receive 20ml intravenous infusion of normal saline 0.9 % over 10 minutes followed bycontinuous infusion of 12.5 ml of normal saline till the end of surgery.Results: Our study revealed that HR and MAP wasn’t significantly different between the twogroups at the baseline, but significantly lowered in Dex. group after induction, during CPB, postCPB, and postoperative.Dexometomedine suppress the intraoperative and postoperative rise of IL-6which was significantly higher in placebo group relative to Dex. group. Also dexometomedine haseffect on stress hormone as serum cortisol and serum glucose decease in Dex. group relative toplacebo group. None of studied cases revealed bradycardia or hypotention and there are nosignificant difference between groups regarding side effect drowsiness, nausea and vomitingConclusion: This study demonstrated that the continuous administration of dexmedetomidineduring open heart surgery with CPB suppressed intraoperative and post-operative cytokinesecretion, and improved post-operative inflammatory response indices in the present study. Also itstabilize blood pressure and heart rate and blunt cardiovascular response to CPB. These resultscould be attributed to the anti-inflammatory effects of dexmedetomidine.

Inverse correlation between left ventricular end-diastolic pressure and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

There is a rising incidence of contrast-induced nephropathy (CIN), which is defined as either a 25% relative increase or an absolute increase of 0.5mg/dL (44.2µmol/L) in the serum creatinine (Scr) level at 48-72h after administration of iodinated contrast media (CM). We investigated the relationship between left ventricular end-diastolic pressure (LVEDP) and CIN in patients undergoing percutaneous coronary intervention (PCI). A total of 431 consecutive patients with coronary artery disease undergoing PCI were divided into four groups based on LVEDP quartile cut-off points. Enrolled patients were given continuous intravenous infusion of normal saline starting 4h before PCI and lasting 24h. At the end of hydration administration, 20mg furosemide was slowly injected intravenously. Serum creatinine (Scr), creatinine clearance rate (Ccr), and glomerular filtration rate (GFR) were detected before and after PCI. There were significant differences in the incidences of CIN in the four groups: 10.25% in the Q1 group, 5.55% in the Q2 group, 5.31% in the Q3 group, and 1.06% in the Q4 group (P < 0.05). With increasing LVEDP, the incidence of CIN decreased significantly (OR 0.581, 95% CI 0.367-0.920). Received operating characteristic curve analysis of the predictive value of LVEDP for CIN produced area under the curve values was 0.641, with a sensitivity of 74.1% and specificity of 48%. The optimal LVEDP cut-off for the occurrence of CIN was 14.5mmHg. LVEDP correlated inversely with CIN in patients undergoing PCI.

Effect of Normal Saline Infusion versus Dextrose 5% Infusion on the Duration of Labor in Nulliparous Women : Randomized Controlled Trial

Background: During labor, it is common for women to have no or little nutrient intake, inspite of the fact that the demand of energy increases as a result of skeletal and smooth muscle contraction. Aim of the Work: This study aims to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion in acceleration of active phase of labor in nulliparous women. Patients and Methods: Thisprospective randomized controlled trial was conducted on nulligravida patients recruited from those attending labor ward of Ain Shams University, Maternity hospital who are, singleton gestation, 36 weeks or more. Results: Total duration of first and second stages of laborwas significantly shorter among Dextrose 5% group than among Normal saline group. Conclusion: Dextrose 5% solution administration is associated with shortened duration of labor because it provides the required energy for pregnant mothers during the labor procedure through the detraction of harmful metabolites produced together with ATP production and results in acceleration of the labor process. Recommendations: Dextrose 5% administration during labor is associated with shortened duration of labor. Further studies with larger sample sizes, more outcomes and different dextrose concentration is required to determine the exact effect of dextrose.

Tranexamic Acid Reduces Occult Blood Loss, Blood Transfusion, and Improves Recovery of Knee Function after Total Knee Arthroplasty: A Comparative Study.

This study intends to explore the effects of tranexamic acid (TA) on occult blood loss, blood transfusion, and recovery of knee function in patients undergoing total knee arthroplasty (TKA). From October 2013 to April 2015, 224 patients undergoing TKA were enrolled in this study. These patients were randomly assigned into the control group (intravenous infusion of normal saline), 10 mg/kg TA group (intravenous infusion of 10 mg/kg TA) and 15 mg/kg TA group (intravenous infusion of 15 mg/kg TA). Compared with the control group, the 10 and 15 mg/kg TA groups were lower in postoperative blood loss, occult blood loss, blood transfusion rate, and volume. In comparison to the control group, hemoglobin levels were lower and the number of red blood cells was higher at 7 days after surgery in the 10 and 15 mg/kg TA groups. Higher fibrinogen levels and lower prothrombin time (PT), activated partial thromboplastin time, D-dimer levels, thrombin time, lower the visual analog scale/score, and circumference diameter of knee joint were observed in the 10 and 15 mg/kg TA groups compared with the control group at 7 and 14 days after surgery. At 1 and 3 months after surgery, the knee joint range of motion scores, Hospital for Special Surgery scores, and Knee Society Score were increased in 10 and 15 mg/kg TA groups in comparison to the control group. TA could reduce occult blood loss and blood transfusion rate and improve recovery of knee function in patients undergoing TKA.

Pressurized Intravenous Fluid Administration in the Professional Football Player: A Unique Setting for Venous Air Embolism.

Venous air embolism (VAE) is a potentially life-threatening event that is most commonly associated with certain surgical procedures, although this theoretical complication of pressurized rapid infusion of intravenous (IV) fluids has been described. This series of cases describes 4 athletes who presented with continuous coughing and other chest complaints after peripheral IV infusion of normal saline through manual pressurized infusion. Symptoms resolved within 20 minutes, and these incidences did not interfere with resuming athletic competition with no recurrence of symptoms or complications. These cases are most consistent with varying degrees of VAE and reveal the risk of VAE associated with pressurized peripheral IV fluid administration along with the unique clinical presentation of more modest forms of VAE in an awake patient. Becoming more knowledgeable about IV infusion technique and understanding potential pitfalls can be helpful in reducing future incidences of VAE.

Ascorbic acid attenuates the pressor response to voluntary apnea in postmenopausal women

We recently demonstrated that postmenopausal women have an augmented blood pressure response to voluntary apnea compared to premenopausal women. Both obstructive sleep apnea (OSA) and healthy aging are associated with increased oxidative stress, which may impair cardiovascular function. Restoring physiological responses could have clinical relevance since transient surges in blood pressure are thought to be an important stimulus for end-organ damage in aging and disease. We tested the hypothesis that acute antioxidant infusion improves physiological responses to voluntary apnea in healthy postmenopausal women (n = 8, 64 ± 2 year). We measured beat-by-beat mean arterial pressure (MAP), heart rate (HR), and brachial artery blood flow velocity (BBFV, Doppler ultrasound) following intravenous infusion of normal saline and ascorbic acid (∼3500 mg). Subjects performed maximal voluntary end-expiratory apneas and changes (Δ) from baseline were compared between infusions. The breath hold duration and oxygen saturation nadir were similar between saline (29 ± 6 sec, 94 ± 1%) and ascorbic acid (29 ± 5 sec, 94 ± 1%). Ascorbic acid attenuated the pressor response to voluntary apnea (ΔMAP: 6 ± 2 mmHg) as compared to saline (ΔMAP: 12 ± 2 mmHg, P = 0.034) and also attenuated forearm vasoconstriction (ΔBBFV: 4 ± 9 vs. −12 ± 7%, P = 0.049) but did not affect ΔHR. We conclude that ascorbic acid lowers the blood pressure response to voluntary apnea in postmenopausal women by inhibiting vasoconstriction in the limb vasculature. Whether ascorbic acid has similar effects in OSA patients remains to be prospectively tested.

Acute high blood glucose level attenuates histamine-stimulated acid secretion in male Wistar rats

Studies have shown that the hyperglycemic state induced by intravenous glucagon or glucose infusion may lead to inhibition of gastric acid secretion through the inhibition of gastric vagus activity. Histamine is a well-known mammalian acid secretagogue and it stimulates acid secretion through H2 receptors. Therefore, the aim of this study was to determine what effect an acute hyperglycemic or hypoglycemic state would have on histamine-stimulated acid secretion. Male Wistar rats weighing between 200 and 250 g were divided into three groups that received an intravenous infusion of normal saline (control group), glucose (hyperglycemic group), or insulin (hypoglycemic group) followed by injection of histamine to stimulate acid secretion. The oesophageal and duodenal ends of the rats' stomach were cannulated with polythene tubing and the stomach was perfused at room temperature using a Langendoff perfusion apparatus. The effluent was collected in aliquots over 10 min per sample and its pH was measured. There was a significant (p<0.05) decrease in acid secretion following histamine injection in the hyperglycemic rats, while histamine injection led to an increase (p<0.05) in acid secretion in the hypoglycemic rats. These results show that hyperglycemic state would result in attenuated histamine-stimulated gastric acid secretion, while hypoglycemic state would lead to increased histamine-stimulated gastric acid secretion.