Preoperative Infusion Research Articles

Eficácia da dexametasona na profilaxia de náuseas e vômitos no pós-operatório de colecistectomia laparoscópica

ObjectiveTo verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy. MethodsThis was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included. ResultsThe results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT]=7), vomiting (NNT=7), and need for smaller doses of rescue antiemetics (NNT=6). ConclusionThe preoperative infusion of 8mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy.

Effect of hydration improvement to prevent contrast induced nephropathy

Objective To discuss the effect of hydration improvement to prevent contrast induced nephropathy (CIN).Methods 160 patients with CIN of high risks who had received coronary arteriongraphy were chosen and Richard Doll was used to divide them into the control group and the improvement group,each with 80 cases.The control group had 0.9％ NaCl for 24 h with the speed of 1.5ml/kg · h,while the improvement group had 0.9％ NaCl for 24 h and their fluid volume and speed was adjusted according to patients'urine volume,recessive loss,blood pressure,heart rate and peripheral venous pressure to maintain dynamic equilibrium of blood volume.Effect in two groups was compared.Results There was no statistically significant difference of preoperative infusion volume and postoperative drinking volume in 24 hours between two groups (P ＞0.05).Postoperative 24 h infusion volume and urine volume were (2 314.21 ±295.03) and (1 918.25 ± 297.58) in the control group,(2 781.69 ± 254.72) and (2 245.50 ± 278.31) in the improvement group,and the differences were statistically significant (t =10.727,7.184,respectively; P ＜ 0.01).There was no statistically significant difference of preoperative NT-ProBNP between two groups (P ＞ 0.05).Postoperative NT-ProBNP was (2882.16 ±2 724.24)ng/ml in the control group and (1 507.16 ± 1 473.84) ng/ml in the improvement group,and the difference was statistically significant (Z =1.975,P ＜ 0.05).Incidence rate of CIN was 12.5％ in the control group and 2.5％ in the improvement group,and the difference was statistically significant (x2 =5.766,P =0.016).Scr in the blood 24,48 and 72 hours after surgery was higher in CIN patients than that in non-CIN patients.NGAL in urine was higher after the surgery than before,and reached its peak during 24-48 hours,24 hours ahead of Scr increase.There was no statistically significant difference of acute lung edema,urinary retention and hospitalization time between two groups (P ＞ 0.05).Neither groups had cases of hemodialysis or death.Conclusions Hydration improvement can prevent CIN as well as protect patients' heart function. Key words: Contrast induced nephropathy Hydration solution; Heart function protection

Progression of preoperative regional arterial infusion chemotherapy in advanced gastric cancer

The outcome of surgery alone for advanced gastric cancer is unsatisfactory. Local recurrence rate and distant metastasis rate are still high in postoperative patients. In recent years, people have paid more attention to neo- adjuvant chemotherapy, because it can reduce tumor loading, degrade the staging, increase the surgery excision rate and improve the long-term survival. Preoperative regional arterial infusion chemotherapy can directly act on the tumor endothelial cells with higher local drug concentration, but with fewer systemic side effects. So it may offer an effective treatment for advanced gastric cancer. The indications, complications, therapeutic evaluation, timing of surgery, chemotherapy regimens and pathomorphological changes and so on of the preoperative regional arterial infusion chemotherapy are summarized in this review.

Efficacy of dexamethasone in the prophylaxis of nausea and vomiting during the postoperative period of laparoscopic cholecystectomy

ObjectiveTo verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy. MethodsThis was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included. ResultsThe results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT] = 7), vomiting (NNT = 7), and need for smaller doses of rescue antiemetics (NNT = 6). ConclusionThe preoperative infusion of 8mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy.

Parenteral fish oil as a pharmacological agent to modulate post-operative immune response: A randomized, double-blind, and controlled clinical trial in patients with gastrointestinal cancer

Fish oil-based lipid emulsions (FOLEs) have shown post-operative immunological and clinical benefits in parenteral nutrition. To assess post-operative immune response after short-term pre-operative parenteral infusion of isolated FOLE in gastrointestinal cancer patients. The patients (n = 63) received pre-operative peripheral infusion (0.2 g fat/kg body weight/d) of FOLE (Omegaven(®)) or control lipid emulsion (MCT/LCT; Lipovenos MCT(®)) for 3 days. Post-operative concentrations of inflammatory mediators, leukocyte functions, surface molecules, infections, and length of intensive care unit (ICU) and hospital stay were measured. FOLE patients had a significant increase of IL-10 levels on day 3, decrease of IL-6 and IL-10 levels on day 6, lower decrease in leukocyte oxidative burst, maintenance of monocyte percentage expressing HLA-DR and CD32, and increase of CD32 neutrophil expression compared to MCT/LCT patients. No changes were observed in the frequency of post-operative infections or length of ICU and hospital stay. Short-term pre-operative infusion of FO alone improves the post-operative immune response of gastrointestinal cancer patients without significantly changing post-operative infections or length of ICU and hospital stay. ID:NCT01218841.

Preoperative Irradiation and Donor Splenocyte Infusion Induce Tolerance in Lung, but not Heart Allografts in a Minipig Model - Role of Passenger Leukocytes

Preoperative Irradiation and Donor Splenocyte Infusion Induce Tolerance in Lung, but not Heart Allografts in a Minipig Model - Role of Passenger Leukocytes

622 Preoperative Irradiation and Donor Splenocyte Infusion Induce Tolerance in Lung, but Not Heart Allografts in a Minipig Model – Role of Passenger Leukocytes

622 Preoperative Irradiation and Donor Splenocyte Infusion Induce Tolerance in Lung, but Not Heart Allografts in a Minipig Model – Role of Passenger Leukocytes

Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave

A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%). O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.

Human Leukocyte Death After a Preoperative Infusion of Medium/Long‐Chain Triglyceride and Fish Oil Parenteral Emulsions

Parenteral lipid emulsions (LEs) can influence leukocyte functions. The authors investigated the effect of 2 LEs on leukocyte death in surgical patients with gastrointestinal cancer. Twenty-five patients from a randomized, double-blind clinical trial (ID: NCT01218841) were randomly included to evaluate leukocyte death after 3 days of preoperative infusion (0.2 g fat/kg/d) of an LE composed equally of medium/long-chain triglycerides and soybean oil (MCTs/LCTs) or pure fish oil (FO). Blood samples were collected before (t0) and after LE infusion (t1) and on the third postoperative day (t2). After LE infusion (t1 vs t0), MCTs/LCTs did not influence cell death; FO slightly increased the proportion of necrotic lymphocytes (5%). At the postoperative period (t2 vs t0), MCTs/LCTs tripled the proportion of apoptotic lymphocytes; FO maintained the slightly increased proportion of necrotic lymphocytes (7%) and reduced the percentage of apoptotic lymphocytes by 74%. In the postoperative period, MCT/LCT emulsion increased the proportion of apoptotic neutrophils, and FO emulsion did not change any parameter of apoptosis in the neutrophil population. There were no differences in lymphocyte or neutrophil death when MCT/LCT and FO treatments were compared during either preoperative or postoperative periods. MCT/LCTs altered the expression of 12 of 108 genes related to cell death, with both pro- and antiapoptotic effects; FO modulated the expression of 7 genes, demonstrating an antiapoptotic effect. In patients with gastrointestinal cancer, preoperative MCT/LCT infusion was associated with postoperative lymphocyte and neutrophil apoptosis. FO has a protective effect on postoperative lymphocyte apoptosis.

外耳道癌手術症例と術前超選択的動注化学療法の導入

近年，超選択的動注化学療法が各種の頭頸部癌に対して良好な成績を挙げており，外耳道癌に対しても有効例が散見されるようになってきた。当科では数年前から進行外耳道癌の術前治療として超選択的動注化学療法を導入しており，過去7年間の外耳道癌6例のうち3例に適応された。適応例の3例中2例で顎関節包付近の外科的断端が陰性となり，術前に顎関節窩への浸潤が疑われていたにもかかわらず，下顎骨関節突起を温存することが可能であった。これらの治療中に重篤な合併症はなく，術後2年現在で非胆癌生存である。本法は，外耳道進行癌の切除率と患者のQOL向上が期待できる一治療選択肢として有用である可能性が高い。

The impact of combined preoperative and postoperative regional intra-arterial infusion chemotherapy on the survival of low rectal cancer

直肠癌术后复发和转移制约着根治性切除后患者5年生存率的提高.术前区域动脉灌注化疗可提高进展期直肠癌的根治性切除率[1],术后区域动脉灌注化疗可抑制直肠癌根治性切除后盆腔局部复发和肝转移[2].笔者通过对术前辅助肠系膜下动脉及肝动脉灌注化疗、术后辅助双侧髂内动脉及肝动脉灌注化疗加常规静脉化疗的pT3-4N0-2M0期中低位直肠癌患者临床资料的回顾性分析,探讨手术前后联合区域动脉灌注化疗对直肠癌患者复发和远期生存的影响。

Effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patients with advanced gastric cancer

To evaluate the effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patient with gastric cancer. Between January 2009 and January 2011, 139 patients with curable stage T2N2 or T3N2 gastric cancer were randomly assigned to group 1(69 cases, neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy before gastrectomy and D2 lymphadenectomy) and group 2(70 cases,gastrectomy and D2 lymphadenectomy alone). The morbidity of postoperative pneumonia in the two groups were recorded respectively. The two groups were similar with respect to various clinical or pathological characteristics. All the patients underwent gastrectomy and D2 lymphadenectomy successfully. Eight patients in group 1 suffered from the postoperative pneumonia, accounting for 11.6%. Nine patients in group 2 suffered from the postoperative pneumonia, accounting for 12.9%. There was no significant difference between the two groups about the incidence of postoperative pneumonia. Surgery following neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy is safe with similar morbidity of postoperative pneumonia to immediate surgery in patients with locally-advanced resectable gastric carcinoma.

Effect of 6% hydroxyethyl starch 200/0.5 infusion before operation on postoperative immune function

Objective To investigate the effect of 6 % hydroxyethyl starch (HES) 200/0.5 infusion before operation on postoperative immne function in patients. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 21-58 yr weighing 47-79 kg were randomly divided into 2 groups ( n = 20 each): 6% HES 200/0.5 group (group H) and compound sodium acetate group (group A). 6% HES 200/0.5 10 ml/kg or compound sodium acetate solution was infused intravenously over 15 min before anesthesia induction. Anesthesia was induced with iv injection of propofol, fentanyl and vecuronium and maintained with target-controlled infusion of propofol and infusion of remifentanil. Venous blood samples were collected before operation and at 1 h, 1 day and 3 days after operation to detect the serum concentrations of IL-6, IL-8, TNF-α, IL-2, IL-10, IgG, IgA andIgM. Results Serum concentrations of IL-6, IL-8, TNF-α, II-2 and IL-10 were significantly higher after operation in the two groups, and serum concentrations of IgA and IgG were significantly lower after operation in group A than those before operation ( P ＜ 0.05 or 0.01 ). Serum concentrations of IL-6, IL-8 and TNF-α were significantly lower, while serum concentrations of IL-2, IL-10, IgA and IgG were significantly higher after operation in group H than in group A ( P ＜0.05). Conclusion Preoperative infusion with 6% HES 200/0.5 can improve the immune function after operation in patients. Key words: Hetastarch; Cytokines; Immunoglobulins; Immunity

Experience of four UK comprehensive care centres using FEIBA® for surgeries in patients with inhibitors

Increasing evidence indicates that factor VIII (FVIII) inhibitor bypassing agents (FEIBA® and NovoSeven®) can provide effective peri-operative haemostasis in haemophilia patients with high-responding inhibitors. We report the collected experience of all major and minor surgeries, conducted between December 1998 and September 2008, at four UK haemophilia Comprehensive Care Centres with FEIBA® as the first-line bypassing agent in patients with inhibitors. A total of 26 surgical procedures were performed in 18 patients of ages 34-83 years including five patients with acquired FVIII inhibitors. A single pre-operative infusion of FEIBA was followed by 6-12 h interval dosing for major surgeries at the discretion of the physician to approximate a maximum of 200 U kg(-1) day(-1), with tapering when postoperative haemostasis and wound healing permitted. Haemostatic outcomes were retrospectively reviewed against European consensus thresholds for blood loss and duration of treatment compared with expectations for equivalent procedures in non-inhibitor patients. Peri-operative haemostatic outcome with FEIBA was rated excellent or good in 78% of 18 major surgeries in 12 patients, including 11 major orthopaedic procedures. Haemostatic outcome was rated excellent in all seven procedures in five patients with acquired FVIII inhibitors and in all eight minor surgical procedures in six patients. FEIBA was well tolerated with no intra-operative haemostatic complications. A single, transient postoperative thrombotic adverse event occurred in a patient with cerebrovascular disease. This case series adds significantly to existing evidence that FEIBA can provide adequate, well-tolerated, peri-operative haemostatic cover for a wide variety of major and minor surgical procedures.

Neuroma Removal for Neuropathic Pain

Injury to peripheral nerves associated with trauma, amputation, or surgery may lead to the formation of neuromas that can produce severe pain refractory to pharmacotherapy. Ectopic impulse activity arising in blindly ending axons within the neuroma, which contain abnormal accumulations of sodium channels, is thought to be a major contributor to this pain. The effect of surgical excision has remained controversial. Here we report a prospective study on the effect of neuroma removal on pain. A series of 6 patients with chronic neuropathic pain owing to neuromas after nerve injury were studied before and 3 months after neuroma excision. Quantitative sensory testing included measurement of areas of brush-evoked allodynia, pinprick hyperalgesia, and mechanical and thermal thresholds. The hypothesis that the analgesic response to a preoperative, intravenous infusion of the sodium channel blocker lidocaine can predict outcome of surgery was also tested. Surgery only relieved spontaneous pain in 2 out of the 6 patients. One of those patients had a prior poor response to neuroma removal. In one patient the pain worsened. Response to surgical removal of neuromas was not predicted by the response to preoperative infusion of intravenous lidocaine. Our findings suggest that, as a therapeutic maneuver, surgical excision of neuromas should be reserved for only those patients with intractable pain, who have failed to respond to other therapies. However, prior poor response to neuroma removal does not preclude relief of pain after a new excision.

Prophylactic Fibrinogen Infusion in Cardiac Surgery Patients: Effects on Biomarkers of Coagulation, Fibrinolysis, and Platelet Function

We have recently reported that prophylactic fibrinogen infusion reduces bleeding after coronary artery bypass grafting (CABG) surgery. Because fibrinogen for the first time was administered to patients without hereditary fibrinogen deficiency or ongoing bleeding, a detailed analysis of the effects of fibrinogen concentrate on biomarkers of coagulation, fibrinolysis, and platelet function was performed. Twenty CABG patients with preoperative plasma fibrinogen levels <3.8 g/L were included in a prospective study. Patients were randomized to preoperative infusion of 2 g fibrinogen concentrate (fibrinogen group) or no infusion (control group). Activated partial thromboplastin time (aPTT), prothrombin time, activated clotting time, and plasma concentrations of fibrinogen, antithrombin, thrombin-antithrombin complex, prothrombin fragment 1.2, and D-dimer, thromboelastometry, platelet count, and platelet aggregometry were analyzed before and 15 minutes after infusion, and 2 and 24 hours after surgery. Fifteen minutes after infusion of fibrinogen concentrate, fibrinogen plasma levels increased by 0.6 ± 0.2 g/L (P < .001 between groups), and induced minimal changes in aPTT and plasma levels of antithrombin, while remaining variables remained unchanged. After surgery, fibrinogen levels no longer differed between groups. D-dimer was significantly higher after surgery in the fibrinogen group (P = .03), while none of the other markers were statistically different between groups. Infusion of 2 g fibrinogen to cardiac surgery patients, without hereditary or acquired fibrinogen deficiency or ongoing bleeding, results in no or minimal changes in biomarkers reflecting coagulation and platelet function. An increased release of fibrin degradation products was detected after surgery in fibrinogen-treated patients.

L-Alanyl-Glutamine Preoperative Infusion in Patients with Critical Limb Ischemia Subjected to Distal Revascularization Reduces Tissue Damage and Protects from Oxidative Stress

Critical limb ischemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb. Our aim was to examine the effects of preoperative infusion of l-alanyl-glutamine (l-Ala-Gln) during the ischemic period and during the first 30 minutes following blood reflow in patients with CLI who are undergoing distal femoral artery bypass surgery. Thirty-two patients with CLI were alternately allocated to group 1 (saline) or group 2 (l-Ala-Gln). Saline (1000 mL) or L-Ala-Gln 250 mL plus 750 mL of saline were infused intravenously over a 3-hour period prior to surgery. Samples (muscle and blood) were collected at the beginning of the surgical procedure, at the end of ischemia, and at 15 and 30 minutes after reperfusion. l-Ala-Gln induced elevation in glutathione (GSH) muscle concentrations while promoting reduction in thiobarbituric acid reactive substance concentrations, demonstrating enhancement of antioxidant capacity and protection from lipid peroxidation. Decreases in LDH, lactate, and glucose blood concentrations in l-Ala-Gln-treated patients suggest increased glucose utilization by muscle and peripheral tissues. Reduction in creatine phosphokinase blood concentrations may reflect smaller muscle cell damage in l-Ala-Gln-treated patients. l-Ala-Gln pretreatment reduces muscle cell damage and enhances antioxidant capacity in patients with CLI.

The ameliorating effect of preoperative loading infusion with 4% succinylated gelatin solution on hemorheology of gastric cancer patients during perioperative period

Objective To investigate the effect of loading infusion with succinylated gelatin(GEL) solution before surgery on hemorheology of patients with gastric cancer during perioprative period. Methods Forty patients undergoing gastric cancer radical surgery were randomly divided into 2 groups (n=20): GEL solution group (GEL group) and Ringer's Lactated solution group(RL group). Twenty people received health examination were selected as normal control group. The two kinds of solution were respectively infused at a dose of 15 ml/kg over a period of 30 rain before surgery (loading infusion, LI). Blood samples were taken for determination of hemorheology variables before LI(T_0, baseline), the end of LI(T_1), 1 h after the end of Ll(T_2)and 1 h after the end of surgery (T_3). Results The blood viscosity, plasma viscosity, erythrocyte aggregation index (EAI)and fibrinogen were higher than those in normal control group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct decreased significantly as compared to the baseline values at T_0 in GEL group(P<0.05). The blood viscosity at low shear rate and EAI increased significantly as compared to the baseline values at T_0 in RL group (P<0.05). The blood viscosity, plasma viscosity, EAI, fibrinogen and Hct were lower than those in RL group at T_2 and T_3(P<0.05). Conclusion Blood of patients with gastric cancer presentes hyperviscosity state.GEL solution can ameliorate hemorheology variables and alleviate hyperviscosity state during perioperative period. Key words: Gelatin; Fluid therapy; Hemorheology; Gastric neoplasms

Clinical results and histological changes following preoperative interventional treatment of the aggressive subtype of endometrial cancer

Objective The aim of the study was to evaluate the clinical value of preoperative intra-arterial infusion chemotherapy and embolization in treating the aggressive subtype of endometrial carcinoma with hysterectomy.

Influence of preoperative acute hypervolaemic haemodilution on the dose-response relationship of rocuronium

Objective To study the influence of preoperative acute hypervolaemic haemodilution (AHHD) on the dose-response relationship of rocuronium.Methods Forty patients were randomly allocated to AHHD group or control group (n=20).Anesthesia was maintained with propofol and remifentsnyl using TCI,and rocuronium was randomly given with one of six doses(60 μg/kg).AHHD was conducted with preoperative infusion of 15 ml/kg 6% hydroxyethyl starch at a rate of 30 ml/min.Neuromuscular function was assessed using an accelograph with train-of-four stimulation at wrist.The dose-response relationship of rocuronium was determined with cumulative dose-response technique.Results Hb,Hct,TPP and ALB decreased markedly (P＜0.05) after AHHD.AHHD did not result in a significant shift in rocuronium dose-response curve.There was no significant difference in ED50,ED90,and ED95 between the AHHD group[(192.1±24.9) μg/kg,(309.9±42.7) μg/kg,(322.0±44.4) μg/kg,respectively]and the control group [(178.5±34.7) μg/kg,(209.1± 47.8)μg/kg,(304.1±49.5) μg/kg,respectively].Conclusion These results demonstrate that the potency of rocuronium is not affected by AHHD,and rocuronium may become an ideal choice of relaxant in occasion of applying AHHD. Key words: Haemodilution ; Rocuronium ; Dose-response relationship ;