There is not one accepted definition of hypotension in the scientific literature. The incidence of hypotension varies depending on the chosen definition. Even minor changes of the definition cause major differences in the frequency of hypotension. This makes it difficult to compare studies on interventions to treat/prevent hypotension and probably hampers progress in this area of research.

Our analysis could clearly demonstrate a decreased risk of fetal acidosis associated with phenylephrine use. In addition with our findings for BE, this suggests a favorable effect of phenylephrine on fetal outcome parameters. The mechanism of pH depression is not related to pCO(2) .

Hypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of RCTs using the Consolidated Standards of Reporting Trials (CONSORT) statement since low quality can lend false credibility to a study and overestimate the effect of an intervention. We performed a systematic literature search in PubMed to identify relevant RCTs in a pre-CONSORT period (1990–1994) and a post-CONSORT period (2004–2008). A comparative evaluation was done between the two periods, and the trials were assessed for compliance with each of the 22 CONSORT items. A total of 37 RCTs was identified. The CONSORT score increased significantly (p < 0.05) from 66.7% (±12.5%) in the pre-CONSORT period to 87.4% (±6.9%) in the post-CONSORT period. A statistically significant improvement was found for eight items, including randomization, blinding and intention-to-treat analysis. The CONSORT score in the post-CONSORT era was fairly good, also in comparison to other medical fields. In the post-CONSORT era, reporting of important items improved, in particular in the domains that are crucial to avoid bias and to improve internal validity. Use of CONSORT should be encouraged in order to keep or even improve the reporting quality.

Pompe disease is a very rare disorder of glycogen metabolism. Due to a deficiency of the enzyme glucosidase glycogen accumulates inside the lysosomes. The clinical picture varies widely as a consequence of varying participation of skeletal and heart muscle. In adults respiratory insufficiency can occur which must be taken into consideration during anesthesiology procedures for affected patients. This case report describes a 60-year-old patient scheduled for punch biopsy of the prostate.

Topics: Pharmacology, Anesthetic ComplicationsT he choice of vasopressor to treat hypotension due to spinal anesthesia for cesarean section is controversial. For a number of years, the use of a low-dose phenylephrine infusion has been recommended to improve hemodynamic stability. However, evidence to support this recommendation is poor. pH and base excess (BE) are important outcome parameters of the newborn; and 1 systematic review has reported a significantly increased risk of lower pH and BE if ephedrine is used to treat hypotension. However, the clinical significance of this difference is unknown as the pHs reported were within the normal range regardless of whether ephedrine or phenylephrine was used. This meta-analysis was conducted to compare fetal and maternal effects of ephedrine and phenylephrine for spinal anesthesia-induced hypotension.A systematic literature search was conducted for trials comparing ephedrine and phenylephrine for hypotension treatment and the quality of the trials was scored with randomized controlled trials being weighted more in the analysis. The number of events and the total number of subjects in the ephedrine or phenylephrine groups were recorded in addition to instances of maternal hypotension, hypertension, and bradycardia, and instances of fetal acidosis defined as a pH < 7.2. Continuous parameters that were recorded were BE and arterial pCO 2 . The randomeffects model was applied in the analysis of the variables. The pooled risk ratio (RR) and 95% confidence interval (95% CI) and the weighted mean difference (WMD) of the pooled continuous data were calculated. The ephedrine group was chosen as the control group.From 133 articles, 20 were considered for further analysis and included 1069 subjects. The RR of fetal acidosis was 5.29 (95% CI, 1.62-17.25) for ephedrine compared with phenylephrine (P = 0.006). The WMD in pooled BE data was also statistically significantly lower in the ephedrine group (WMD, À1.17; 95% CI, À 2.01 to À0.33; P = 0.006). No significant difference between the 2 agents was found for umbilical artery pCO 2 (WMD, 1.60; 95% CI, À 0.41 to 3.62; P = 0.12). For the studies that reported Apgar values of <7, only 1 neonate in the ephedrine group of 1 study had an Apgar value of <7 after 5 minutes. The 1 study that reported Apgar values at 10 minutes after birth found no statistically significant differences between the ephedrine and phenylephrine groups. The risk of bradycardia was significantly lower in the women in the ephedrine group compared with those in the phenylephrine arm (RR, 0.17; 95% CI, 0.07-0.43). No significant difference was found in the risk of hypotension when the vasopressor was given prophylactically (RR, 1.13; 95% CI, 0.68-1.86; P = 0.64) or in pooled data for the vasopressors for either treatment or prevention (RR, 1.03; 95% CI, 0.72-1.48; P = 0.87). The 2 vasopressors did not differ in the risk of hypertension (RR, 1.18; 95% CI, 0.86-1.63; P = 0.30).These results support the favorable effects of phenylephrine over ephedrine for managing hy...

SummaryA case of retrograde ileo-ileal intussusception in a boy of 16 years is reported. There was no apparent predisposing cause. The patient was treated by resection-anastomosis of the ileum and recovered uneventfully.KEY WORDS: intussusception, intestine (small). Case reportA 16-year-old boy was admitted in August 1982 with abdominal pain of 2 days' duration. The pain had started around the umbilicus and shifted to the right iliac fossa. The patient had four bouts of vomiting and absolute constipation. He had suffered from a similar attack about 8 years before and was treated conservatively elsewhere.The patient was afebrile. The abdomen was moderately distended, with marked localized distension of the lower abdomen. Bowel sounds were absent. X-ray showed distended loops of bowel with a single large fluid level in the lower abdomen. Routine blood and urine examinations were normal.At laparotomy, the proximal intestine was found to be hypertrophied and distended. The caecum and ascending colon were mobile on a long mesocolon. A retrograde ileo-ileal intussusception was present about 15 cm proximal to the ileo-caecal junction. The distal bowel was collapsed. The intussusception could not be reduced and the loop of ileum containing the intussusception was resected and an end-toend anastomosis performed.On opening the resected part, it was found that the intussuscipiens was formed by a stomach-like sac of thickened and dilated proximal loop, the distal loop entering it in a retrograde fashion. The tip of the intussusceptum was gangrenous, with marked inflammation all around. No other pathology or abnormality was detected. The postoperative recovery was uneventful. DiscussionRetrograde intussusception is extremely rareGross (1953) recorded an incidence of 0-2% in a total of 702 cases of intussusception-despite the frequency with which one sees at autopsy retrograde 'agonal' intussusceptions of the small bowel (Shepherd, 1968).One of the earliest reports of retrograde intussusception was by Fitzwilliams (1908), with six cases of the retrograde type in a series of 1,000. Deterling, O'Malley and Knox (1953) reported six cases of the retrograde variety, five of which were apparently associated with the presence or withdrawal of a Miller-Abbott tube. An interesting case was reported by Campbell, Devereux and Forrest (1982) where a retrograde intussusception was concealed inside an antegrade intussusception, the latter being secondary to the pseudo-tumour formed by the former.The present case was interesting inasmuch as it was a case of retrograde ileo-ileal intussusception, most probably acute-on-chronic, without any predisposing cause.

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