The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated. AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery. METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio), RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001). CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care

The importance of neck circumference to thyromental distance ratio (NC/TM) as a predictor of difficult intubation in obstructive sleep apnea (OSA) patients

Background: The trial to find a bedside examination that is helpful for foreseeing difficult intubation is quite inspiring. It was reported that thyromental distance (TM), body mass index (BMI), neck circumference (NC) and a Mallampati score >3 were the only helpful bedside test predictors. By using magnetic resonance imaging, it was established that more fat was present in areas around the collapsible parts of the pharynx in OSA patients. So distribution of fat may provide a better suggestion of difficult intubation than neck circumference. The current work studied the neck circumference to thyromental distance ratio as a new predictor of difficult intubation in obstructive sleep apnea (OSA) patients and comparing it to the formally standard Mallampati score. Patients and methods: After approval of the ethical committee in Kasr Al Ainy University hospital and patients consent 50 ASA class 1 and II OSA patients, 18–60 years of both sexes, undergoing surgery under general anesthesia with tracheal intubation were enrolled in the study. It was a single group study. Body mass index, neck circumference (cm), thyromental distance (cm) and the ratio of the NC to TM (NC/TM) and Mallampati classification were recorded. Difficulty of intubation was assessed using the Intubation Difficulty Scale (IDS). Correlation between all variables and IDS, comparison between NC/TM ratio and Mallampati score as reliable tests for predicting difficult intubation and also measuring sensitivity and specificity of both. Results: Among the 50 patients, 11 patients experienced difficult intubation according to IDS scale. The Mallampati score and NC/TM were the only statistically significant variables that were associated with a difficult intubation. NC/TM ratio was strongly correlated to difficult intubation where P value = 0.01 odds ratio 37.5 with cut-off point is NC/TM ⩾5.15, but the correlation of Mallampati score was weaker P value = 0.05 and odds ratio was 14.5. Moreover, NC/TM ratio showed higher sensitivity (100%) and a negative predictive value (82%), than the Mallampati score sensitivity (90%) and specificity (61%). Conclusion: Difficult intubation in OSA obese patients was independently associated with a Mallampati score of III or IV, and NC/TM ⩾5.15. Moreover, NC/TM yielded a high sensitivity, specificity and a negative predictive value

Hemodynamic effects of lateral tilt before and after spinal anesthesia during cesarean delivery: an observational study

Abstract Background Post-spinal hypotension is a common maternal complication during cesarean delivery. Aortocaval compression by the gravid uterus has been assumed as a precipitating factor for post-spinal hypotension. The role of left lateral tilting position in improving maternal cardiac output after subarachnoid block (SAB) is unclear. The aim of this work is to investigate the effect of left lateral tilting on maternal hemodynamics after SAB. Methods A prospective observational study was conducted including 105 full term pregnant women scheduled for cesarean delivery. Mean arterial pressure, heart rate, cardiac output (measured by electrical cardiometry), stroke volume, and systemic vascular resistance were recorded in three positions (supine, 150, and 300 left lateral positions) before SAB, after SAB, and after delivery of the fetus. Results Before SAB, no significant hemodynamic changes were reported with left lateral tilting. A significant decrease was reported in mean arterial pressure, cardiac output, stroke volume, and systemic vascular resistance after SAB (in supine position). When performing left lateral tilting, there was an increase in cardiac output, heart rate, and mean arterial pressure. No difference was reported between the two tilt angles (150 and 300). Conclusions Changing position of full term pregnant woman after SAB from supine to left lateral tilted position results increased cardiac output and mean arterial pressure. There is no difference between the two tilt angles (150 and 300). Trial registration clinicaltrials.gov ( NCT02828176 ) retrospectively registered