We investigated the influence of the pressure generated by low lumbar extradural injection of bupivacaine on the development of block in a randomized double-blind study. Thirty patients (aged 17-66 yr) received one of two volumes of 0.75% bupivacaine. Group I (n = 15) received 10 ml (75 mg) and group II (n = 15) 15 ml (112.5 mg). Injection of the larger volume resulted in a greater pressure at the end of injection, but within 1 min this decayed to the same plateau pressure that was produced by the smaller volume. Mean maximum cephalad spread of block was the same in each group (group I, T9.5; group II, T8.4) and there was no correlation between individual level of block and maximum or plateau extradural pressure, or with patient characteristics.
The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. A secondary increase in GST concentration, at 24 h, was seen in a small number of individuals who received halothane or enflurane. Abnormal GST concentrations were found in 50% of patients following halothane anaesthesia, 20% following enflurane and 11% after isoflurane. The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.
Objective: Static monitors for assessing the fluid status during major surgeries and in critically ill patients have been gradually replaced by more accurate dynamic monitors in modern-day anaesthesia practice. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are the two commonly used dynamic indices for assessing fluid responsiveness. Methods: In this prospective observational study, 50 patients undergoing major surgeries were monitored for PPV and SPV: after the induction of anaesthesia and after the administration of 500 mL of isotonic crystalloid bolus. Following the fluid bolus, patients with a cardiac output increase of more than 15% were classified as responders and those with an increase of less than 15% were classified as non-responders. Results: There were no significant differences in the heart rate (HR), mean arterial pressure (MAP), PPV, SVV, central venous pressure (CVP) and cardiac index (CI) between responders and non-responders. Before fluid bolus, the stroke volume was significantly lower in responders (p=0.030). After fluid bolus, MAP was significantly higher in responders but there were no significant changes in HR, CVP, CI, PPV and SVV. In both responders and non-responders, PPV strongly correlated with SVV before and after fluid bolus. Conclusion: Both PPV and SVV are useful to predict cardiac response to fluid loading. In both responders and non-responders, PPV has a greater association with fluid responsiveness than SVV. Keywords: Fluid management, pulse pressure variation, systolic pressure variation, fluid responsiveness Amaç: Günümüzde anestezi pratiğinde, büyük ameliyatlarda ve ağır hastalarda sıvı durumunun değerlendirilmesi için kullanılan statik izlem yöntemlerinin yerini, daha doğru sonuçlar veren dinamik izlemler almıştır. Nabız basıncı değişimi (PPV) ve sistolik basınç deği-şimi (SPV) sıvı yanıtını değerlendirmek amacıyla yaygın bir şekilde kullanılan dinamik indekslerdir. Yöntemler: Bu prospektif gözlemsel çalışmada, major cerrahi geçire-cek 50 hastada anestezi indüksiyonundan ve 500 mL izotonik verildikten sonra PPV ve SPV monitörize edildi. Bolus sıvı uygulamasını takiben, %15'ten fazla kardiyak debisi artışı olan hastalar yanıt verenler olarak, %15'ten daha az artışı olanlar ise yanıt vermeyenler olarak sınıflandırıldılar. Bulgular: Yanıt verenler ve vermeyenler arasında kalp atım hızı (HR), ortalama arter basıncı (MAP), PPV, SVV, santral venöz basınç (CVP) ve kardiyak indeks (CI) açısından anlamlı bir fark bulunmadı. Bolus sıvı uygulaması öncesinde, atım hacmi yanıt verenlerde anlamlı derecede daha düşüktü (p=0,030). Bolus sıvı uygulaması sonrasında, MAP yanıt verenlerde anlamlı ölçüde daha yüksek bulundu, ancak HR, CVP, CI, PPV ve SVV açısın-dan anlamlı fark gözlenmedi. Bolus sıvı uygulaması öncesinde ve sonrasında, hem yanıt veren hem de yanıt vermeyen hastalarda, PPV değeri ile SVV değeri arasında güçlü bir ilişki saptandı. Sonuç: PPV ve SVV sıvı yüklenmesine verilen kardiyak yanıtı tahmin etmede yararlıdır. Hem yanıt veren hem de vermeyen hastalarda ...
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