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Introduction: A wide range of acid base fluctuations are seen during Cardiopulmonary bypass (CPB) and the development of metabolic acidosis is well recognized. We conducted a study tocompare the metabolic effects of Ringer lactate and Plasmalyte-A as CPB prime in causing bypass associated acidosis in valve replacement surgeries. Methods: We performed a prospective, randomized controlled study on a total of 80 adult patients undergoing CPB for valvular heart surgeries. The patients were randomized into two groups: Group I (Ringer Lactate) and Group II (Plasmalyte-A). Arterial blood samples were taken before initiating CPB, 30 minutes after starting CPB, then every half hourly till termination of CPB and after half an hour stay in the ICU post operatively to analyze primarily H+ ions, bicarbonates, lactate and strong ion difference. Results and Discussion: The results were analyzed in a quantitative manner. In Ringer Lactate group, during CPB, there was reduction in pH from 7.428 ± 0.029 at T1 to 7.335 ± 0.06 (P < 0.01) and 7.358 ± 0.06 (P < 0.01) at T2 and T3 respectively. Mean bicarbonates decreased in Ringer Lactate group during CPB from 24.28 ± 1.65 mEq/L at T1 to 20.98 ± 2.97 mEq/L at T2 (P < 0.01). In Plasmalyte-A group, mean pH, bicarbonate, strong ion difference (SID) were comparable at all time intervals (P > 0.05). In Ringer Lactate group, maximum surge in mean blood lactate levels was seen from 0.85 ± 0.35 mmol/l at T1 to 4.29 ± 1.78 mmol/L (P < 0.01) and 4.17 ± 1.28 mmol/L (P < 0.01) at T2 and T3, respectively. Such surge was not seen in Plasmalyte-A group. The mean SID decreased during the CPB in Ringer Lactate group from 41.102 mEq/L at T1 to 35.66 mEq/L (P = 0.033) at T2 implying metabolic acidosis. Numbered patients having hypotension and arrhythmias were also higher in Ringer Lactate group again indicating higher acidosis. Conclusion: The different composition of Plasmalyte-A and Ringer Lactate have different metabolic implications for patients undergoing cardiac surgery. Patients who received Plasmalyte-A as cardiopulmonary bypass prime developed less metabolic acidosis. Hence we conclude that Plasmalyte-A is the preferred cardiopulmonary bypass prime in adult patients undergoing valve replacement surgeries.

Background: Fluid replacement is one of the important issues in the management of burn cases. Objective: To compare the outcome between Ringer lactate and Hydroxyethyl starches (HESs) in cases with burn injuries. Methodology: Study design: Randomized controlled trial. Place and duration of study: Department of Plastic Surgery, Sheikh Zayed Hospital, Rahim Yar Khan, from June to December 2018. Study subjects selected were those who had a burn of any type (thermal, chemical, electric) and at least more than 10% of the surface area of the body. The cases were then divided into two equal groups. The fluid requirement was calculated according to the Parkland formula. After this, the cases in group A were given Ringers lactate solution 500 ml while those in group B were given 500 ml of 6% hydroxyethyl starches (HESs) and further fluid was administered in group A as ringer only and in group B as ringer and HES in a ration of 2:1. The cases were then followed to look for various outcomes in the form of urine output, serum creatinine, and mean hospital stay. Results: In this study, there were a total of 60 cases (30 in each group). The mean age in group A and B was 17.33±5.39 vs 19.11±4.79 years (p= 0.33). Mean hospital stay was 14.65±3.31 vs 13.49±2.78 days with p= 0.41. Mean urine output per day was 1645.81±143.47 vs 1705.31±165.83 ml with p= 0.43 and mean creatinine in group A and B was 1.79±0.38 vs 1.83±0.44 with p= 0.86. Conclusion: There was no significant difference in both the groups regarding urine output, creatinine, and mean hospital stay.

Background Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. Aim To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. Patients and methods A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. Results Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups. Conclusion The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.

Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

Background: Prevention of spinal induced hypotension was remained challenge to anaesthesiologist for years as it poses risk to mother as well as baby. Prehydration with various volumes of crystalloid or colloids was attempted in the past variable success rate. Recently the principle of preloading with fluids has been challenged by various studies. This prompted us to evaluate the effectiveness of crystalloid preloading compared to preloading for prevention of spinal hypotension. We evaluated vasopressor requirement and neonatal Outcome in the form of APGAR score as well. Material and method: ASA grade I parturients posted for elective cesarean section were randomly allocated in two study groups of 30 each to receive either preload or co-load with Ringers lactate solution. Blood pressure, heart rate, SpO2, vasopressor requirement and other outcomes recorded at regular interval. Results: Hypotension was observed significantly less in co-loading group (36%) than preloading group (60%). Mean vasopressor requirement was also significantly more in preload group. Heart rate change, nausea, vomiting and fetal outcome remained same across both the groups. Conclusion: Co-loading with crystalloids is more effective strategy than preloading in prevention of spinal induced hypotension. We can save valuable time given for preloading in case of emergency cesarean sections.

Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.

BACKGROUND Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP), which may lead to death. The purpose of this study was to evaluate the preventive effect of aggressive fluid therapy on the incidence of post-ERCP pancreatitis. METHODS In double-blind controlled condition, 240 patients were selected and divided into two groups. The treatment of the intervention group (n = 120) included a dose of 20 mL/kg of ringer lactate infusion within 90 minutes before ERCP and 3 mL/kg/h during ERCP followed by 3 mL/kg/h up to 8 hours. The treatment of the control group (n = 120) included a dose of 1.5 mL/kg of ringer lactate infusion during ERCP up to 8 hours later. Firstly, the patients were evaluated in terms of excessive fluid and serum amylase and pain level, and then they were re-evaluated 2, 8, and 24 hours after ERCP. RESULTS The mean age of the patients was 51.57 ± 13.5 years. Most of the patients were female (54.5%). Pancreatitis was developed in 26 patients including 5.83% of the patients in the intervention group and 15.83% of the patients in the control group (p = 0.013). Pancreatic pain was seen in 7.5% of the patients in the intervention group and in 27.5% of the control group (p < 0.005). Hyperamylasemia was seen in 20.83% of the patients in the intervention group and in 35% of the control group (p = 0.014). The mean days of hospital admission was 1.308 ± 0.807 in the intervention group and 1.425 ± 0.876 in the control group (p = 0.275). CONCLUSION Aggressive fluid therapy with ringer lactate solution before ERCP can effectively prevent postERCP pancreatitis, pancreatic pain, and hyperamylasemia.

Ringer lactate is the main fluid for resuscitation of acute burns. However it is not a complete fluid alone, as it does not take care of sugar and electrolyte balance adequately. This study has been carried out to compare the use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal Saline (DNS) as fluid replacement therapy in acute burn.To assess the biochemical parameters with the use of DNS as maintenance fluid in combination with Ringer lactate as resuscitation fluid in acute burns resuscitation.A prospective randomized control study has been carried out by enrolling 200 patients into 2 groups, treated in ICU and resuscitated by using Modification of Brooke's formula (2mL/kg/% TBSA for resuscitation plus 2500mL maintenance). Group A received RL for resuscitation and DNS as maintenance in 1st 72h of burns. Group B received RL only for 1st 72h. The effects of this on various blood parameters were studied.Mean value of sodium at 24h was 137.79±3.89 in group A and was 133.2±4.57 (p.0001) in group B. The sodium levels remained in range of 137-138 (p.0001) in group A with only 22% patients showing lower range of sodium levels, whereas, there was a falling trend (p.0001) of sodium levels in group B on subsequent days with 54.00% (p.0001) showing hyponatremia on 1st day which increased to 76% on 3rd day. Mean values of early morning random blood sugar (RBS) levels in group A remained between 165.5±65.51mg/dL-115.82±32.52mg/dL on all 3days but in group B there was a falling trend from 127.49±46.11mg/dL to 102.84±22.92mg/dL by 3rd day. Thus, there was significant difference in levels of sodium and RBS in patients receiving DNS as maintenance fluid in addition to RL in acute phase.RL is not an ideal fluid for maintenance as it is low in sodium (130mEq/L) as well as potassium (4mEq/L) in view of daily electrolyte requirement. There is no glucose content in it to provide calories. Therefore, DNS should be added as daily maintenance fluid with RL as replacement for evaporative losses following burns.

Treatment options are limited for acute pancreatitis (AP). Early aggressive fluid resuscitation (AFR) has been widely considered beneficial because of theoretical improvement in end-organ perfusion, including the pancreas and gut, with pancreatic necrosis and bacterial translocation as consequences of ischemia. There is scarce direct evidence for its association to improved outcomes. Furthermore, it has been described that AFR may be associated with poor outcomes in severe AP. WATERFALL is an investigator-initiated international multicenter open-label randomized controlled trial comparing AFR vs. moderate fluid resuscitation (MFR) in AP. The main outcome variable will be the incidence of moderate to severe AP (a clinically relevant outcome that has been validated). Aggressive fluid resuscitation will consist in lactated Ringer solution (LR) 20-mL/kg bolus (administered over 2 h) followed by LR 3 mL/kg per hour. Patients randomized to MFR will receive an LR bolus 10 mL/kg in case of hypovolemia or no bolus in patients with normal volemia, followed by LR 1.5 mL/kg per hour. The patients will be assessed at 3 (±1), 12 (±4), 24 (±4), 48 (±4), and 72 (±4) h from recruitment, and fluid resuscitation will be adjusted to the patient's clinical and analytical status according to a protocol. Based on a prospective multicenter study, the incidence of moderate to severe AP is 35%. Sample sizes of 372 patients per group (overall 744) achieve 80% power to detect a difference in the incidence of moderate to severe AP of 10%, at a significance level (α) of 0.05 using a two-sided z-test, assuming a 10% dropout rate. These results assume that three sequential tests are made using the O'Brien–Fleming spending function to determine the test boundaries.

Background Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern. Sepsis should be defined as life-threatening organ dysfunction caused by a dys-regulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Objective To compare between ringer lactate and voluven in resuscitation of patient with sever sepsis in intensive care unit. Patients and Methods It is a prospective analytical study to compare ringer lactate versus voluven in resuscitation in sever sepsis. The required sample size has been estimated to be 30 patients for each group. A total number of 60 patients were treated for severe sepsis in our ICU during the study period. 30 patients assigned to ringer lactate and 30 patients assigned to HES 130/0.42, there was 40% of patients known to have HTN and 66.7% know to have DM. Results In comparison between the studied groups regarding the ABG data in first day, we found a PH improvement in Voluven group more than Ringer lactate group by P-value 0.020. Pao2 was worsened in Voluven group than Ringer lactate group by p-value 0.022. The laboratory data showed no specific significance between the two groups and C-Reactive protein results were not in the two study groups. Conclusion There’s no significant difference in Patients with severe sepsis assigned to fluid resuscitation with Voluven compared to those receiving Ringer’s lactate in SOFA score results as well as mortality index.

Background: Sepsis is the second leading cause of death in intensive care unit and one of the top 10 cause of deaths worldwide. In sepsis, an inflammation response occurs that leads to the tissue destruction. According to the Survival Sepsis Campaign in 2012, early management in septic patients with 30 ml/kg of crystalloid fluids will have better outcomes. Objective: This study aimed to determine the optimal crystalloid fluid in the resuscitation of septic patients. Method: This double-blinded study was held from March 2017- May 2017 in Haji Adam Malik General Hospital. A total of 40 patients who passed the inclusion and exclusion criteria were assessed for interleukin-6 changes before and after treatment with ringer acetate malate and ringer lactate. Results and Discussion: From 40 Patients who passed the criteria, we compared the administration of Ringer's acetate and Ringer's lactate malate in septic patients. The mean systolic and diastolic blood pressure were increased in both study groups (p Conclusion: Ringer's acetate malate in EGDT of septic patients is superior in decreasing interleukin-6 Compared with Ringer lactate.

The aim of this study was to compare different wound-rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound-rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl-betain) were applied on standardised test models (one- and three-chamber model, flow-cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one-chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow-cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte-containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant-containing solution because of the interference with the protein measurement. The flow-cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound-rinsing procedure. The three-chamber and the less-pronounced modified one-chamber method as well as the biofilm model had generated inhomogeneous results.

Background and Objectives Autologous haematopoietic progenitor cell (HPC) is a prerequisite for high-dose chemotherapy in treatment of several haematologic and non-haematologic malignancies. HPCs are collected by apheresis and cryopreserved until infusion. Postinfusion adverse events have been in part related to the dimethyl sulphoxide (DMSO) used as cryoprotectant. The aim was to evaluate (i) an automated sequential washing procedure for DMSO removal in thawed HPC grafts and (ii) washing solutions in replacement of hydroxyethyl starch (HES)-based solutions. Materials and Methods A total of 26 HPC bags cryopreserved with 10% DMSO and intended for disposal were used. The Sepax-2 (Biosafe, Eysins, Switzerland) was evaluated using a sequential washing procedure. Outcomes were CD34+ cell recovery and viability after washing. Results The Ringer lactate supplemented or not with albumin 2·5–5% presented satisfactory results compared with HES solution in terms of CD34+ cell recovery and viability after washing. However, the apparition of aggregates led us to renounce to these alternative solutions. Using HES solution and a sequential washing of three bags, we showed the elimination of 95% of the DMSO, a postwash viable CD34+ cell recovery of 79·9 ± 9·4% and a total nucleated cell viability of 66·5 ± 9·3%. Conclusion The preclinical evaluation of an automated sequential washing procedure for DMSO removal in thawed HPC grafts has proven to be effective and comparable to previously published data. Despite our attempt to find an alternative solution to the HES solution, more efforts should be done on this side to reach a consensus on cryopreservation protocols.

Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins, and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.

Context: There is no consensus regarding the concentration of dextrose supplementation to be used in pediatric patients intraoperatively. Aims: The primary objective was to assess the effect of using Ringer lactate (RL) with 1% versus 2% dextrose as maintenance fluid in infants on intraoperative blood glucose levels. The secondary objectives included assessment of incidence of hyperglycemia and hypoglycemia in both groups. Settings and Design: This was a prospective randomized study conducted in a tertiary care teaching institute. Subjects and Methods: Forty infants undergoing cheiloplasty or palatoplasty were included. All patients fasted 6 h for solids and formula feeds, 4 h for breast milk, and 2 h for clear fluids and received general anesthesia as per standardized protocol. Patients belonging to Group 1 received RL with 1% dextrose supplementation, whereas Group 2 received RL with 2% dextrose added to it as an intraoperative maintenance fluid. Random blood sugar (RBS) was checked preoperatively and then at 60 min and 120 min after induction. Hypoglycemia was defined as RBS 150 mg/dL. Statistical Analysis Used: Independent sample ttest and Pearson's Chisquare test were used for statistical analysis. Results: Preoperative RBS was comparable in both groups. RBS at 60 and 120 min was significantly higher in Group 2 compared to Group 1. There was no incidence of hypoglycemia in both groups, and the incidence of hyperglycemia was similar in both groups. Conclusion: Use of RL with 2% dextrose as intraoperative maintenance fluid in infants resulted in significant increase in blood sugar levels as compared to addition of 1% dextrose although the incidence of hyperglycemia remained comparable in both groups.

Introduction: Post-partum haemorrhage is a leading cause of maternal mortality and morbidity worldwide. There are different management procedures adopted for the treatment of postpartum haemorrhage. Aim: To evaluate the efficacy of dextrose in Post-partum Haemorrhage (PPH) and compare it with Oxytocin (a conventional method). Materials and Methods: A two-arm randomised controlled trial was conducted among 120 pregnant women admitted to the delivery room of the Obstetric and Gynaecological Unit of a Teaching Hospital. Participants were randomised to receive either 20 unit of oxytocin in 1000 mL ringer lactate solution (routine administration, control group) or 200 mL of 10% dextrose solution (intervention group). The primary outcome measured in this study was amount of blood loss. The outcome was assessed at 1 hour and 2 hours. Data were analysed using SPSS version 22.0, chi-square and student’s t-tests. Authors used expected maximisation to handle missing data to enable an intention-to-treat analysis. Results: At baseline, the groups were homogeneous in regards to socio-demographic variables. The average blood loss was significantly lower in the intervention group (dextrose 10%) compared to the control group (oxytocin) (p

Resumo O objetivo deste estudo foi avaliar o reparo da cartilagem hialina equina, por meio de análises macroscópica (através de videoartroscopia) e histológica (através de fragmentos de biopsia), em defeitos condrais induzidos na tróclea lateral do fêmur tratados pela técnica de microperfurações subcondral associada ou não com administração intra-articular de cartogenina. Foram utilizados seis equinos pesando em média (±DP) 342±1,58 kg, com a idade aproximada de 7,2±1,30 anos e escore corporal de 7,1±0,75, que foram submetidos a videoartroscopia para indução da lesão condral de 1 cm2 na tróclea lateral do fêmur e realização da técnica de microperfuração do osso subcondral de ambos os joelhos. Foram realizadas quatro aplicações semanais com 20 μM de cartogenina intra-articulares em um dos joelhos (grupo tratado) e solução de ringer com lactato na articulação contralateral (grupo controle). Após o período de 60 dias, foram feitas as avaliações macroscópicas, através de videoartroscopias, e histológicas, através de biopsia. Não foram observadas diferenças significativas nos escores macroscópicos e histológicos para reparação condral entre animais dos grupos tratados e não tratados (P>0,05). De modo geral, a porcentagem média de cartilagem hialina no tecido de reparo (17,5%) foi condizente com a literatura internacional usando outros tipos de perfuração condral. Entretanto, não se observaram diferenças estatísticas entre grupos (P>0,05). A terapia com cartogenina, segundo protocolo utilizado, não produziu melhora do processo cicatricial em lesões condrais induzidas e tratadas com microperfurações na tróclea lateral do fêmur em equinos. Abstract The aim of this study was to evaluate the joint cartilage repair by macroscopic (via arthroscopy) and histological (biopsy fragments) analyses in chondral defects induced into equine femoral trochlea treated by microperforation associated with or without intra-articular administration of kartogenin. Six horses weighing 342±1.58 kg (mean ± SD), aged approximately 7.2±1.30 years and with a body condition score of 7.1±0.75, were used. The horses underwent arthroscopy for induction of 1-cm2 chondral lesions in lateral femoral trochlea immediately treated by microperforation of the subchondral bone of both knees. Four weekly intra-articular injections of kartogenin (20μM) in one knee (treated group) and Ringer lactate solution in the contralateral joint (control group) were performed during the postoperative period. After 60 days, macroscopic evaluations were performed by video-arthroscopy, and biopsy samples of the repair tissue were taken for histopathological healing evaluation. No significant change was observed in macroscopic and histological scores for chondral healing between treated and untreated groups (P>0.05). The overall mean percentage of hyaline cartilage in both groups (17.5%) was consistent with other international studies using other types of chondral microperforation; however, no statistical differences were observed between groups (P>0.05). In conclusion, the therapy with kartogenin, according to the used protocol, did not produce any macroscopic and histological healing improvement in induced chondral lesions treated with microperforations in equine femoral trochlea.

Background: Intravenous (IV) fluids are an integral part of perioperative management. Intraoperative hyperglycemia is associated with poor clinical outcomes in patients undergoing major surgeries even in nondiabetics. Aim: This study was conducted to observe the effect of different maintenance fluid regimens on intraoperative blood glucose levels in nondiabetic patients undergoing major surgeries under general anesthesia. Settings and Design: Randomized double-blind study. Materials and Methods: One hundred nondiabetic patients of either sex were divided randomly into two Groups I and II of 50 each undergoing elective major surgeries of more than 90 min duration under general anesthesia. Both groups were given calculated dosage of IV fluids accordingly 4-2-1 formula while Group I was given Ringer lactate (RL) and Group II was given 0.45% dextrose normal saline and potassium chloride 20 mmol/L. Changes in vital parameters, % oxygen saturation, and urine output were monitored at regular intervals. Capillary blood glucose (CBG) was measured half-hourly until end of surgery. If CBG level was more than 150 mg%, then calculated dose of human insulin (CBG/100) was given as IV bolus dose. Statistical Analysis: Statistical analysis was done using SPSS 22.0 software (IBM Corporation, Armonk, New York, USA), paired t-test and Chi-square test. Results: A significant increase of CBG level and was observed during intraoperative and immediate postoperative period (P < 0.001) in Group II. Conclusion: RL solution is probably the alternative choice of IV fluid for perioperative maintenance and can be used as replacement fluid in nondiabetic patients undergoing major surgeries.

Background: Nasal douching is a best effective and simple treatment procedure for chronic rhinosinusitis. This study compares the efficacy of nasal douching with isotonic saline solution versus ringer lactate solution in patients suffering from chronic rhinosinusitis.Methods: This randomized control trial was conducted among the patients with chronic rhinosinusitis who were attending the outpatient department of Otorhinolaryngology in Chettinad Hospital and Research Institute, Chennai, during the study period from June 2019 to December 2019. After randomization group A and B includes thirty cases of chronic rhinosinusitis each and they received nasal douching with saline and Ringer lactate two times a day for a period of three weeks and assessed using sino-nasal outcome test (SNOT) 20 during pre-treatment and post treatment. Data was entered in Microsoft excel and data analysis was done using SPSS version 17. Results: On assessing the overall SNOT 20 mean score, in both group A and group B, there was statistically significant improvement post treatment score when compare to pre-treatment scores. But the differences in improvement between the two groups were not found to be significant.Conclusions: Though isotonic saline and ringer lactate solution showed significant improvement after treatment both these are same with respect to efficacy in the treatment of douching for chronic rhinosinusitis with no difference in outcome.

Introduction: Propofol has been known as one out of many inductive drugs which, can cause pain during intravenous injection. There has been a high prevalence of injection pain in pediatric patients. The mechanism of injection pain has not been known. Some therapeutic methods have been tested to reduce the pain, with several success rates. Objective: To compare the effectivity of 5% dextrose-diluted propofol and ringer lactate-diluted propofol, with dilution comparison of 1:1, in their role to reduce intravenous injection pain in pediatric patients, from age 2-15 years old during elective surgery in the Integrated Surgical Building Center of Dr. Soetomo General Hospital Surabaya. Method and Material: Forty-five patients PS ASA I-II, which fulfill inclusion criteria, were induced with general anesthesia. Patients had been selected randomly into three groups. Group I (control group) were injected with propofol without dilution. Group II was injected with propofol with a dilution of 5% dextrose, into 5 mg/ml liquid. Group III was injected with propofol with a dilution of ringer lactate, into 5 mg/ml liquid. Result and Discussion: The level of pain was evaluated afterward, with responding to the four-point scale and spontaneous expression. Patients’ blood pressure, mean arterial pressure, heart rate, and oxygen saturation were also examined after injection. Compared to the control group, those in groups with 5% dextrose-diluted and ringer lactate-diluted propofol are not effective in reducing intravenous injection pain, with analytical statistics p=0.503 (p > 0.05). Also, the dilution of propofol has no significant difference to the hemodynamic measurement of patients. Systolic and diastolic blood pressure, and mean arterial pressure were declined after the induction, but statistically insignificant. The heart rate of patients was inclined but also not significant. Conclusion: 5% dextrose-diluted and ringer lactate-diluted propofol with a comparison of 1:1 were not significantly effective in reducing intravenous injection pain in pediatric patients.

Background and Aims: Dextrose is commonly added to the intraoperative maintenance fluids of pediatric patients. The primary objective was to evaluate the effect of addition of 1% dextrose to Ringer's lactate (RL) on blood glucose levels in infants undergoing facial cleft surgeries. Material and Methods: This prospective, randomized, single blinded study was conducted in forty infants undergoing either cheiloplasty or palatoplasty. Random blood sugar (RBS) was assessed using a glucometer after induction of anaesthesia, and at 1 and 2 hours later. Group R received RL and Group D received RL with 1% dextrose as intraoperative maintenance fluid. Hypoglycemia was defined as RBS 150 mg/dL. Results: Baseline RBS levels and those at 60 min and 120 min post-induction were comparable in both groups. The increase in blood sugar levels from baseline to 60 min and to 120 min in each group was significant. Incidence of hyperglycemia was comparable in both groups. There were no episodes of hypoglycemia, intraoperatively. Conclusion: Use of Ringer lactate alone or with addition of 1% dextrose resulted in comparable intraoperative blood sugar levels when used as maintenance fluid in infants undergoing facial cleft surgeries.

Background: Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used. Aims: The primary objective was to assess the incidence of hyperglycemia with use of lactate versus acetate-based intravenous fluids in nondiabetics undergoing major surgeries. Incidence of lactatemia and metabolic acidosis were also assessed. Settings and Design: Prospective parallel group observational study conducted in a tertiary care institute. Subjects and Methods: A total of 208 nondiabetic patients undergoing major head and neck free flap or abdominal surgeries were included in the study. Group A received Ringer lactate, and Group B received Ringer acetate as intraoperative maintenance fluid. Intraoperative blood sugar, pH, and lactate levels were monitored. Statistical Tests Used: Chi-square test and independent “t” test were used for analysis. Results: Intraoperative hyperglycemia was more frequent in Group A than B (17.3 vs. 18.4%). Group B patients undergoing gastrointestinal (GI) surgeries showed higher blood glucose at 2, 4, 6, and 8 h when compared to flap surgeries. In Group A, significantly higher blood sugar values were noted at 2 and 8 h in those undergoing GI surgeries. Group B patients undergoing GI surgeries had significantly higher lactate levels at 6 and 8 h. Group B patients had significant acidosis when surgeries lasted >6 h. Conclusion: Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.

Introduction: The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringer's lactate is also an efficient option for nasal washes and humidification. Objective: To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5 mg/g and 6.0 mg/g through questionnaires answered by the patients. Methods: A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3). Results: A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0 mg/g concentration gel. No difference in humidification was observed between the two treatments. Conclusion: Ringer's lactate at the concentration of 6.0 mg/g was superior to that at 4.5 mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification. Resumo: Introdução: O uso de soluções salinas para lavagem nasal está consagrado no tratamento de quadros inflamatórios e infecciosos nasossinusais. Além das soluções salinas, o ringer lactato é uma importante opção tanto para lavagem quanto para a hidratação nasal. Objetivo: Avaliar a tolerabilidade (ardência e conforto) e umidificação do produto gel nasal cloreto de sódio 4,5 mg/g em relação ao ringer lactato 6,0 mg/g, por meio de questionários respondidos pelos pacientes. Método: Foram incluídos 60 pacientes, 56 mulheres (22-66 anos; média: 47 anos) e quatro homens (36-66 anos; média: 49 anos) foram incluídos no estudo de 17 dias (± 2 dias) de tratamento. Os pacientes foram supervisionados por um clínico geral durante todo o período do estudo. Os pacientes usaram os produtos com uma borrifada em cada narina duas vezes ao dia, durante sete dias (± 2 dias). As formulações foram avaliadas antes do uso do primeiro produto na visita 0 (V0), após sete dias (± 2 dias) de tratamento na visita 1 (V1), após três dias de interrupção do primeiro tratamento na visita 2 (V2) e após sete dias (± 2 dias) de uso do segundo produto na visita 3 (V3). Resultados: Foi observada diferença significante para o conforto das vias nasais, (significância de 5%), na comparação entre os tratamentos nos atributos de conforto e ardência. O conforto das vias nasais foi superior e a ardência inferior para o gel nasal ringer lactato 6,0 mg/g em comparação ao gel cloreto de sódio 4,5 mg/g. Não foi observada diferença significante para a umidificação entre os tratamentos. Conclusão: O gel ringer lactato 6,0 mg/g foi superior ao produto gel cloreto de sódio 4,5 mg/g nos quesitos conforto e ardência. Não foi observada diferença estatisticamente significante entre os tratamentos em relação à umidificação das vias nasais. Keywords: Dryness, Nasal hydration, Nasal wash, Rhinitis, Nasal gel, Ringer lactate, Palavras-chave: Ressecamento, Hidratação nasal, Lavagem nasal, Rinite, Gel nasal, Ringer lactato

Subdural fluid collections following intraventricular and/or paraventricular procedures in pediatric neurosurgery are common and can be hard to treat. We describe our technique to close cortical defects by the aid of a fibrin adhesive and subsequent Ringer inflation with the aim to avoid cortical mantle collapse and to prevent the development of subdural fluid collections. We report the preliminary results of a prospective study on a consecutive series of 29 children who underwent 37 transcortical or transcallosal surgical procedures since 2008 in our department. In 17 procedures, we performed a transcortical approach on lesions, and in other 19 operations, we operated by a transcallosal. In 5/17 transcortical approaches (29 %) and in 3/20 transcallosal approaches (15 %), we observed a 5-mm-thick subdural fluid collection of the 5 patients with subdural fluid collections in the transcortical group, 3 patients (17 %) underwent surgery for symptomatic or progressive subdural fluid collections. Of the 3 patients in the transcallosal group, a subduro-peritoneal shunt was necessary only for 1 patient (5 %). At the very end of the treatment (including chemotherapy and radiotherapy), it was possible to remove the subduro-peritoneal shunt in all these patients because of disappearance of the subdural fluid collections. In pediatric patients after transcortical or transcallosal procedures, the use of a fibrin adhesive to seal surgical opening and subsequent inflation of the residual cavity with Ringer lactate solution to avoid cortical mantle collapse seems safe and appears to prevent the development of subdural fluid collections.

AIMS: In this study, we compared the effect of preloading with crystalloid, colloid and intravenous ephedrine against the hypotensive effects of propofol induction in ASA I-II patients scheduled for elective surgical procedures. MATERIAL AND METHODS: 120 patients aged 20yrs to 50yrs were randomly allocated to one of the four groups of 30patients each. Group-1 (control) did not receive any study medication, group-2 received degraded gelatin 10ml/kg over a period of 15min, group-3 received ringer lactate 20ml/kg over a period of 15 min and group-4 received intravenous ephedrine 0.2mg/kg prior to induction of anesthesia. Midazolam 1mg was given 1hour before induction of anesthesia. Anesthesia was induced with propofol 2.5mg/kg over 20 to 30 seconds. Heart rate and blood pressure were recorded before induction and then every minute for 5 minutes after induction of anesthesia. After the study period patients were intubated and anesthesia was continued as required. Hypotension was defined as a drop in systolic arterial pressure more than or equal to 20% of baseline. RESULTS: A significant decrease in systolic arterial pressure occurred in patients of group preloaded with ringer lactate as well as the control group. Less decrease in systolic arterial pressure was seen in the patients preloaded with degraded gelatine and ephedrine group. The incidence of hypotension was also lower in ephedrine group when compared with degraded gelatin group. CONCLUSION: We conclude that crystalloid preloading is not efficacious in preventing hypotension while as degraded gelatine and ephedrine markedly attenuates, but does not fully abolish the decrease in blood pressure caused by induction.

Background: Spinal blockade provides excellent anesthesia for patients undergoing cesarean section. However, hypotension after spinal anesthesia is a common adverse effect that is commonly experienced in patients undergoing cesarean section. The aim of our study was to analyze if a simple technique like leg wrapping with elastic crepe bandage would be effective in controlling postspinal hypotension. Materials and Methods: Sixty full-term pregnant patients who were posted for cesarean section belonging to American Society of Anesthesiologists I and II were divided into two groups. Patients in Group W had their legs wrapped with elastic crepe bandage and in the other Group N, leg wrapping was not done. All the patients were preloaded with Ringer lactate at 10 ml/kg before the spinal anesthesia. The hemodynamic parameters were monitored every 3 min until the delivery of the baby and every 5 min until the end of surgery. If hypotension occurred, then along with crystalloid loading a bolus dose of mephentermine 6 mg was given intravenously. Statistical Analysis: Statistical software “Numbers version 3.6.1 (2566)” was used for statistical calculations. Results: Frequency of hypotension in Group W (10%) was significantly less compared to Group N (60%). Vasopressor requirement was significantly less in Group W (P = 0.009), which was highly significant. Conclusion: Wrapping of lower extremities was a simple, easy, and an effective method of decreasing episodes of hypotension and vasopressor requirement after spinal anesthesia in cesarean patients and needs to be practiced routinely.

PurposeTo determine a way to prevent the formation of adhesions and delay the time of suture adjustment in the course of adjustable strabismus surgery, an animal study was performed to assess and compare the effects of mitomycin C (Mit-C) and viscoelastic material Viscoat (sodium hyaluronate 3% and chondroitin sulphate 4%, Alcon, Fort Worth, TX).MethodsRight eyes of 47 rabbits were divided into three groups. After recession of the superior rectus muscle (SRM), Mit-C was administered beneath and over the SRM in Group M (16 eyes), Viscoat was administered beneath and over SRM in Group V (16 eyes), and ringer lactate was administered in Group C (15 eyes). SRM then recessed 5 mm with adjustable strabismus surgery technique. Animals in each group were subdivided into 1 and 2, where 1 = adjustment 1 week postoperatively and 2 = adjustment 3 weeks postoperatively. Delayed adjustment was performed in M1group (6 eyes), V1group (6 eyes), and C1group (7 eyes) after 1 week; in M2group (6 eyes), V2 group (6 eyes), and C2group (6 eyes) after 3 weeks. Histopathologic examinations were performed for the remaining 10 eyes without suture adjustment at the end of first and third weeks after adjustable strabismus surgery. The possible length and the necessary force to adjust and the degree of adhesions were recorded.ResultsWhen length and strength of the adjustment, adhesions between muscle and sclera, and adhesions between muscle and conjunctiva were taken into consideration, there was no statistically significant difference among M, V, and C groups at postoperative weeks 1 and 3. The force needed for adjustment in M1group was statistically lower than M2group.ConclusionsThe intraoperative use of Mit-C (0.4 mg/mL) may decrease adhesion formation in the early postoperative period, especially in the first week. The intraoperative use of Viscoat was not effective in reducing postoperative adhesions and delaying adjustment.

Background: Arterial cannulation and intra-arterial (IA) fluid and blood resuscitation in the patients with severe shock is an easier approach compared with the intravenous (IV) access if concerns regarding the efficiency and safety of this approach are addressed. Objectives: We hypothesized that IA fluid resuscitation is more effective than IV resuscitation in restoring cardiac contractions (CC) of cardiac-arrested mice following severe hemorrhagic shock. Methods: Mice (N = 22) were anesthetized using ketamine/xylazine. Arterial and venous systems accessed through cannulation of the carotid artery and the Jugular vein, respectively. As much blood as possible was aspirated from the carotid artery access. Mice were observed until the complete cessation of chest wall motions. Following 30 seconds delay, IV (N = 5) and IA access (N = 6) were used for fluid resuscitation using Ringer Lactate (RL) in a similar volume to the aspirated blood. Mice were observed for restoration of chest wall motions. In phase-IIof the study, after cessation of chest motions, mice (N = 11) underwent a thoracotomy and CCs were observed. In three mice, IV RL Infusion after cardiac arrest failed to restore CCs and was followed by IA RL infusion. In eight mice, following cardiac arrest intermittent IA RL infusion was performed. Results: While IV RL Infusion failed to restore chestmotion inmice (N = 5), IA RL infusion restored chestmotion in allmice examined (N = 6) (P = 0.0067). In three mice, IV RL infusion after cardiac arrest showed no effect on CC. After failure of venous infusion, IA RL infusion was performed which resulted in restoration of CC for 13.33 ± 1.76 minutes. In eight mice, intermittent IA infusion of RL after cardiac arrest, sustained CC for 31.43 ± 10.9 minutes (P = 0.017). Conclusions: IA fluid resuscitation is superior to IV resuscitation in hemorrhagic shock induced cardiac arrest.

Introduction: In paediatric cardiac surgery, there is still not any information with regard to the best choice of priming fluids for Cardiopulmonary Bypass (CPB). Albumin, Hydroxyethyl Starch (HES) & ringer lactate are equally used, but each has its advantages & disadvantages. Albumin & HES had better fluid balance which affect outcome in paediatric cardiac surgery significantly. Aim: To compare priming solution containing albumin, hydroxyethyl starch and ringer lactate during elective openheart surgery in paediatrics aged up to 3 years. Materials and Methods: All patients were managed by standardized institution protocol and were randomly distributed into three groups based on the priming solution which is used in the CPB Circuit and having 35 patients in each group. Group A: Receive albumin 10 ml/kg in priming solution, Group B: Receive Hydroxyethyl starch (HES130/0.4) 6% 20ml/kg in priming solution, Group C: Receive ringer lactate priming solution. Primary outcome variable included perioperative haemoglobin, total protein, colloid osmotic pressure, platelets, fluid balance, urine output, post-operative blood loss, blood products usage, renal & liver function, extubation time, ICU stay & outcome. Results: Patients receiving albumin had higher perioperative platelet count, total protein level & colloid osmotic pressure, lesser post-operative blood loss & blood products requirement. Patients receiving HES had lower level of platelets postoperatively than ringer lactate group but not associated with increase blood loss. HES did not affect renal function & haemostasis in this dose. Patients receiving ringer lactate had positive fluid balance intraoperatively. All three groups have similar effect on renal & liver function, urine output, time to extubation, ICU stay & outcome. Conclusion: We conclude that albumin is expensive but better prime as maintain haemostasis, colloid oncotic pressure & reduced blood product requirement. HES will not hamper haemostasis & renal function in lower dose & better than crystalloid as maintain negative fluid balance. Patient outcome & ICU stay was similarly affected by priming solutions.

Objective. In this study, it was aimed to compare the effectiveness of Hydroxyethyl Starch (HTS), HTS +7.2% NaCl combination and Ringer Lactate solutions in the treatment of hypovolemic calves with diarrhea. Materials and methods. A total of 21 holstein calves (12 female, 9 male, weighted 28-52 kg), at the age of 0-30 days, were enrolled in the present study. The calves were randomly divided into 3 groups. Calves in the first group received HTS (10 mL / kg), calves in the second group received Hydroxyethyl starch + 7.2% NaCl combination (4 mL/kg) and calves in the third group were treated with lactated Ringer’s solution (32 mL/kg) intravenously. Calves in each group were administered with oral rehydration solution immediately, and at 8th and 16th hours after intravenous applications. Clinical examinations and laboratory findings were obtained at 0 hour, 30th minutes, 1st, 2nd, 4th, 12th and 24th hours respectively. Results. Calves in all groups achieved clinical remission with a positive response to treatment and there was no statistically significant difference in the vast majority of the variables examined, although dehydration, capillary refill time, mental status and pulse quality were better in hydroxyethyl starch group and especially in hydroxyethyl starch + 7.2% NaCl group than those of Ringer’s lactate group (p

Purpose To compare the effect of phacoemulsification on the corneal endothelium using fortified balanced salt solution (BSS Plus) and Ringer lactate as the intraocular irrigating solution. Setting P.D. Hinduja Hospital, Mumbai, India. Design Prospective randomized controlled double-blinded clinical study. Methods Patients with senile cataract up to nuclear grade III were randomized to have phacoemulsification with posterior chamber intraocular lens implantation performed using fortified balanced salt solution (Group A) or Ringer lactate (Group B) as the intraocular irrigating solution. The corneal endothelial cell density (primary outcome) and pachymetry were measured preoperatively and 1 week and 1 and 6 months postoperatively. Results Each group comprised 35 eyes (35 patients). The postoperative percentage of endothelial cell loss was not significantly different between the 2 groups at 1 week ( P =.582), 1 month ( P =.668), or 6 months (5.03% and 8.35% in Group A and Group B, respectively) ( P =.483) and was within the limits reported in the literature. The postoperative percentage change in pachymetry was not significantly different between the 2 groups at 1 week ( P =.179) or 1 month ( P =.170) but was significant at 6 months ( P Conclusion Corneal endothelial cell loss after phacoemulsification with Ringer lactate was similar to that with fortified balanced salt solution over the long term. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Introduction: Systemic hypotension is frequently and immediately seen after spinal anaesthesia. Historically Ringer lactate is used to substitute the acute relative volume loss after spinal anesthesia, although it remains in intravenous circulation for a short period. The preloading with 5% albumin and gelatine have become popular and effective as they remain intravascular for a longer duration providing sustained normotension. The aim of this study was to assess the efficacy of equal volume of Ringer lactate and Haemaccel as a preloading fluid for the prevention of hypotension after spinal anaesthesia in patients undergoing Lower Segment Cesarean Section. Methods : This was a prospective comparative study in which Patients were randomly allocated in to Group A and group. Group A patients were preloaded with Ringer lactate 10ml/kg body weight and Group B were preloaded with Haemaccel 10 ml/kg body weight within a period of 5-10 minutes before spinal anaesthesia. After giving the block, blood pressure (systolic, diastolic and mean) were recorded every 2.5 minutes for initial 20 minutes and every 5 minutes during the rest of the period of surgery. Onset of hypotension along with other parameters were recorded and analysed using SPSS ver. 13. Results: All together 100 patients were enrolled in the study, 50 in Group A (Ringer lactate) and 50 in Group B (Haemaccel). The episodses of hypotension was higher in patients who received Ringer lactate as preloading fluid than who received haemaccel as preloading fluid (42% versus 24%). Conclusion: Preloading with Haemaccel gives better hemodynamic stability and lesser incidence of hypotension than that of Ringer lactate. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6405 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 1-5

Studies have suggested that shockwave lithotripsy (SWL) stone fragmentation rates can be affected by characteristics of the fluid media surrounding the stone, although evidence to implicate the impact of urine specific gravity (SG) is limited and inconclusive. Our aim is to further explore the impact fluid media and SGs have on stone fragmentation using a variable focus lithotripter.Artificial stones were presoaked for 24 hours in urine and then shocked in various fluid media including artificial urine (SG 1.010 control, 1.020, and 1.07), human pooled urine (HPU), degassed HPU, Pentastarch, 100% and 30% contrast, degassed 30% contrast, 100% ethanol, deionized water (dH(2)O), degassed dH(2)O, 5% glucose, Ringer lactate, 0.9% saline, glycerol, whole blood, and lubricating gel. After soaking, SWL using the Modulith SLX-F2 electromagnetic lithotripter was performed. Fragments were dried and sieved using a 4-mm diameter opening grid. Fragments4 mm were weighed and fragmentation coefficients (FCs) calculated (pre-SWL weight - post-SWL weight)/(pre-SWL weight) × 100. Fifteen stones were shocked for each fluid group.Fluid type, viscosity, and degassing all significantly impacted stone fragmentation. While the solutions' SG, per se, did not appear to affect stone fragmentation, the use of degassed 30% contrast significantly improved stone destruction over the SG 1.010 artificial urine control (95.3% vs 71.4, P0.01). Furthermore, degassing improved comminution rates by increasing the number of completely fragmented stones (FC = 100%). Using degassed 30% contrast, 12/15 stones were completely fragmented, compared with only 2/15 in the control group (P = 0.007). Among the whole blood, glycerol, and lubricating gel groups, only 1/15, 0/15, and 1/15 stones reached 100% FC respectively in the narrow focus, possibly because of the detrimental impact of increased viscosity.Different fluid media can significantly affect FC in vitro. Among the various fluids tested, degassed 30% contrast significantly increased the FC and total number of completely fragmented stones.

BACKGROUND: Hypothermic perfusion (HP) of the liver is applied during total vascular exclusion (TVE) to reduce ischemic injury during liver resection. No studies have been performed comparing different perfusion solutions for HP. The aim of this experimental study was to compare Ringer-lactate solution (RL) with Celsior solution (Cs) for HP in a pig model of 60-min TVE. METHOD: Twenty pigs underwent 60-min TVE of the liver. Groups were TVE without HP (no-HP, n = 9), TVE with HP using RL (n = 6), and TVE with HP using Cs (n = 5). Blood and liver tissue samples were taken before TVE and during 24-h reperfusion. RESULTS: In the no-HP group, plasma aspartate aminotransferase values were significantly increased during reperfusion (p

Background: Different fluid regimens are often adopted for elderly patients, but it is not known whether they handle infused fluids differently during the induction of anesthesia than young patients. Methods: Mean arterial pressure (MAP), plasma dilution (based on hemoglobin) and volume kinetics were assessed during an intravenous (i.v.) infusion of 1000 ml of lactated Ringer’s solution over exactly 60 min in 29 patients given general anesthesia with propofol (15 65 years old) and in 16 patients receiving lumbar epidural anesthesia with titrated doses of ropivacaine (7 patients 65 years old). Results: General anesthesia caused a greater decrease in MAP than epidural anesthesia (mean 15% vs. 9%; P

Total gut irrigation (TGI) is a safe method of bowel preparation in children. Many solutions are used but none is ideal. This study has been done to compare household common salt solution prepared by dissolving 10 g of pure NaCl salt (Active Reagent Quality) in 1 l of tap water, polyethylene glycol with electrolytes (PEG) and ringers lactate for TGI in children. We prospectively evaluated the three solutions in terms of efficacy, safety, rapidity, tolerability and cost effectiveness in patients undergoing a variety of colorectal procedures. Patients (126) were randomly assigned into one of the three groups; Group I, household common salt solution, 40; Group II, Peglec, 55; Group III, Ringer lactate, 31. TGI with PEG is the most rapid method of bowel preparation but is least tolerable. Household common salt solution is inexpensive and most tolerable of the three preparations. All three are similar in safety and effectiveness in bowel preparation. Household common salt solution is effective, safe, cost effective and the most tolerable method of bowel preparation.

Objectives: Euro-Collins and University of Wisconsin are preferred solutions in cadaveric renal transplantation. There are no guidelines regarding the perfusion fluids in live donor renal transplantation. We studied whether Euro-Collins was better than Ringer lactate in terms of protecting allograft function. Materials and Methods: A double-blind permuted randomized trial comparing Euro-Collins and Ringer lactate was performed on 100 patients undergoing live related donor renal transplantation. Outcome variable was serum creatinine. Results: Age, sex, donor nephrectomy and ischemia times, kidney temperature, time of first appearance of urine was not significantly different in both the groups. Fall in serum creatinine was significantly more in Euro-Collins than Ringer lactate in the first postoperative week ( P -< 0.05). The time to reach nadir creatinine was 4.97 days in Euro-Collins and 7.75 days in the Ringer lactate group ( P -0.088). Serum creatinine was significantly lower in the Euro-Collins group till six months, thereafter it equalized with Ringer lactate. When individual parameters were analyzed for time to nadir creatinine, only the cold ischemia time of > 80 min was found to be significant ( P -0.024). Twelve kidneys in Euro-Collins and 17 in the Ringer lactate group had cold ischemia times of ≥80 min and time to nadir creatinine was 4.33 ±3.74 and 12.76± 12.68 days ( P -0.035). Conclusions: Renal function normalized rapidly when Euro-Collins was used. Cold ischemia time of ≥ 80 min was the most important factor affecting the graft function and perfusing with Euro-Collins could protect the allograft.

The solution of choice for wash-out of non–heart-beating donor (NHBD) livers is histidine tryptophan ketoglutarate (HTK). This solution has a lower viscosity, due to absence of a colloid, and is less expensive as compared to the University of Wisconsin (UW) solution. A new preservation solution for machine perfusion was developed, named Polysol. In order to apply Polysol clinically in NHBD organ retrieval, the efficacy as a wash-out solution was investigated. Methods After a warm ischemic time of 30 minutes, the rat liver was washed out via the portal vein with 50 mL of either ringer lactate (RL), HTK or Polysol. After wash-out and harvesting, the liver was reperfused with Krebs-Henseleit buffer. Samples were taken to assess hepatocellular injury and liver function. Results Liver damage parameters were elevated in the RL group as compared to the HTK and Polysol groups. Liver/rat weight ratios were significantly lower after wash-out with Polysol. Overall, no differences were seen in ammonia clearance and bile production. In conclusion, wash-out of the NHBD liver with Polysol results in equal to improved reperfusion results as compared to HTK. Polysol is feasible as a wash-out solution in combination with machine perfusion using Polysol.

Objectif : Verifier les effets du remplissage intravasculaire sur la reaction inflammatoire pendant une intervention chirurgicale majeure. Methode : Trente-six patients devant subir une intervention abdominale reglee ont ete repartis au hasard et ont recu soit de l'hydroxyethylamidon a 6 % (poids moleculaire moyen de 130 000 Dalton, degre de substitution de 0,4 ; n = 18, groupe HEA), soit une solution de Ringer-lactate (groupe RL ; n = 18) comme remplissage intravasculaire. Les liquides ont ete administres avant l'operation et, pendant 48 h a l'unite des soins intensifs. Le remplissage vasculaire dependait de parametres physiologiques. Les concentrations seriques d'interleukine (IL-6, IL-8 et IL-10 et molecules d'adhesion solubles (sELAM-I et sICAM-I) ont ete mesurees apres l'induction de l'anesthesie, quatre heures apres la fin de l'operation, de meme que 24 h et 48 h apres l'operation. Resultats : Les donnees biometriques et perioperatoires, l'hemodynamique et l'oxygenation ont ete similaires chez les patients des deux groupes. Une moyenne de 4470 ± 340 mL de HEA 130/0,4 par patient ont ete administres dans le groupe HEA et de 14310 ± 750 mL de RL par patient du groupe RL pendant l'experimentation. La liberation de cytokines pro-inflammatoires IL-6 et IL-8 a ete significativement plus faible dans le groupe HEA [(valeurs maximales) 47,8 ± 12,1 pg.dL -1 de IL-6 et 35,8 ± 11,2 pg.mL -1 de IL-8 (groupe HEA) vs 61,2 ± 11,2 pg.dL -1 de IL-6 et 57,9 ± 9, 7 pg.mL -1 de IL-8 (groupe RL); P < 0,05]. Les concentrations seriques de sICAM-I ont ete significativement plus elevees dans le groupe RL [(valeurs maximales) 1007 ± 152 ng.mL -1 (groupe RL) vs 687 ± 122 ng.mL -1 (groupe HEA); P < 0,05)]. Les valeurs de sELAM- I ont ete similaires dans les deux groupes. Conclusion: Le remplissage vasculaire avec de l'HEA 130/0,4, compare a la therapie liquidienne a base de solutes cristalloides, peut reduire la reaction inflammatoire chez des patients qui subissent une operation majeure. Nous pensons que cette situation releve d'une microcirculation meilleure accompagnee d'une activation endotheliale reduite et d'une lesion endotheliale moindre.

To assess the usefulness of Ringer-lactate solution with 0.9% dextrose, fluid therapy during surgery in paediatric patients was reviewed. From the literature, the need for intravenous (i.v.) infusion and water could be established. The need for sodium was also evident and use of normonatraemic i.v. solutions should be recommended to avoid hyponatraemia. Little data were found about the value of the other electrolytes. Dextrose requirements have been the subject of debate for the last two decades. The choice of dextrose concentration is a compromise between avoiding hypoglycaemia and hyperglycaemia. Four clinical trials assessing the use of Ringer-lactate solution with 0.9 or 1% dextrose in paediatric patients suggest that it is appropriate for routine infusion in paediatric patients during the perioperative period. However, fluid therapy during surgery has rarely been studied, probably because it is inexpensive, rarely leads to problems and is used in very different clinical settings. Development of consensus clinical guidelines on the use of electrolyte infusions in paediatric surgery would be helpful.

To assess the effects of intravenous hydration on the duration of active labor in nulliparous women also allowed unrestricted oral consumption of fluids.In a randomized clinical trial 120 nulliparous women with uncomplicated singleton pregnancies at term were randomly assigned to drink fluids at will and receive either no intravenous hydration (group 1) or a Ringer lactate solution at rates of 60 mL, 120 mL, or 240 mL per hour (groups 2-4) throughout active labor.There were differences in duration for the active phase of the first stage of labor (252.3 ± 40.9 min in group 1 vs 206.7±38.3 min in group 4; P0.001) and for the second stage (64.3 ± 13.9 in group 1 vs 49.8 ± 11.4 min in group 4; P=0.01), but not for the third stage. The percentage of participants who needed labor augmentation with oxytocin was less when intravenous hydration was provided (53.3% in group 1 vs 20.0% in group 4; P=0.02).Intravenous hydration significantly decreased the duration of active labor and reduced the frequency of both prolonged labor and oxytocin administration in nulliparous women. htpp://www.irct.ir registration number: IRCT201105256575N2.

During the period from January 1992 up to the end of July 2001, theBurns Unit in King Khalid'C'Hospital treated 1735 cases of burns. The burns caseswere of varying causes, age groups, degree, depth and extent. The formula used inlTeating these burns patients was a modification of Parkland fonnula. The fluid usedwas Ringer lactate solution. This fluid was administered for the first 3 days post burnuntil the general condilion of the palient was sfabilized. Early oral intake wasencouraged in aU patients and was started as early as the second or the third day. Colloidswere given by the end of the third or even the fourth day and according to the individualpatients' needs. The results of this treatment regime significantly avoided renalcomplications and ensured patient rehydration.

Institutional Review Board (IRB) approval of this research could not be verified during an investigation by the Landesarztekammer Rheinland-Pfalz (the State Medical Association of Rheinland-Pfalz in Germany). As a result, this article has been retracted, in accordance with the Journal's regulations, at the request of the Directors and Board of the British Journal of Anaesthesia. Lack of IRB approval means that the research was unethical, and that IRB approval for the research was misrepresented in the published article. It does not mean that the research results per se are fraudulent. For further information please see Retraction.

Eighty-stx children suffering from cholera, aged 2 - 12 years, admitted to the Dr. Sutomo Hospital, Surabaya, were treated intravenously with Ringer Lactate as initial rehydration. Concomitantly young coconut water was given orally ad libitum until complete rehydration was achieved.

Background: Arterial hypotension following spinal anesthesia still remains the leading cause for maternal mortality and morbidity. Active management of hypotension and more so its prevention of its ads more safety value to spinal anesthesia, which is widely practiced worldwide. Preloading of patients with either crystalloid or colloid prevents the severity of hypotension. Objectives of the study was to compare the preloading efficacy of Ringers lactate solution (20 ml/kg) and 6% hydroxyl ethyl starch at 10 ml/kg in prevention of hypotension following spinal anesthesia in elective caesarean section.Methods: 100 ASA grade I and grade II subjects for elective caesarean section were studied in two groups. Group A (Ringer lactate group) 50 subjects and Group B (hydroxyl ethyl starch group) 50 subjects. Each group was preloaded over a period of 20 minutes before spinal anesthesia with either ringer lactate solution (Group A) at 20 ml/kg or 6% hydroxyl ethyl starch group at 10 ml/kg body weight. Main outcome measures were mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate.Results: Demographic characteristics of both groups were comparable. Incidence of hypotension was significantly more in ringer lactate group. There was no significant difference of heart rate in both the groups. No allergic reaction was noted to hydroxyl ethyl starch. Vasopressor requirement was also low in hydroxyl ethyl starch group compared to ringer lactate group.Conclusions: Preloading subjects with 6% hydroxyl ethyl starch is beneficial than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.