To Compare the effect of 'lactate-based' and 'acetate-based' intravenous fluids on the electrolytes and the acid-base status

INTRODUCTION: The choice of the intravenous fluid during surgery is often assumed to be of little significance. Isotonic crystalloid solutions are used for volume repletion during surgery, but various crystalloids can impact electrolyte and acid-base balance. Although, 0.9% (normal) saline has been used for over half a century, administration of large volumes of this fluid can lead to hyperchloremic acidosis. This is not seen with the administration of balanced salt solutions such as Ringer lactate or Plasmalyte 148 despite having similar pH. However, intravenous administration of large amounts of Ringer lactate can increase serum lactate levels. Plasmalyte A, an acetate-based balanced salt solution with a Ph of 7.4, is currently available. This study is an effort to compare the effects of Plasmalyte A and Ringer lactate, on the electrolyte and acid-base status in patients undergoing major abdominal surgery. AIM OF THE STUDY: To compare the effect of lactate-based and acetate-based intravenous fluids on the electrolytes and the acid-base status, in patients undergoing major abdominal surgery. METHODOLOGY: The study protocol was approved by the institutional review board, prior to the commencement of the clinical trial. The study was explained to all the patients and an informed consent was obtained from each patient who volunteered. Sixty, ASA (American Society of Anesthesiologists) grade I or II, patients scheduled for upper abdominal surgery were enrolled and randomly allocated to one of the two groups. Group A - Plasmalyte A, Group B - Ringer lactate. Anesthetic Technique: The anesthetic technique was standardized in all the patients. General anesthesia was induced with thiopentone-vecuronium-fentanyl and maintained with O2-air-isoflurane. The peri-operative monitoring of the patient included electrocardiogram (ECG), Pulse oximetry (SpO2), noninvasive blood pressure (NIBP), central venous pressure (CVP), end-tidal carbon-dioxide (ETCO2), urine output and nasopharyngeal temperature. Statistical Analysis: The basic structure of the analysis was a comparison of two groups of patients. The primary aim was to detect any post-operative change in the acid-base status of these patients. The analysis was done using ‘SPSS for Windows’ version11 software. The mean and the standard deviation of the pre- and the post-operative measured parameters were calculated and the test of significance was applied. The post-operative values were independently subjected to t-test for change. RESULTS: Sixty, ASA grade I or II, patients scheduled for major abdominal surgery, were randomly allocated to either Group 1 (Plasmalyte A) or Group 2 (Ringer lactate). The demographic characteristics of the patients were comparable between the two groups (Table 1). The type of surgery and the duration of surgery were also similar. There was no statistically significant difference in the volume of study crystalloid administered between the two groups. None of the patients had any significant complications during or immediately after the surgery. CONCLUSION: The choice of the intravenous fluid during surgery is often assumed to be of little significance. However, the widely used 0.9% saline has been shown to cause significant acidosis when compared to balanced salt solutions such as Ringer lactate or Plasmalyte. This study was an effort to compare the effect of administering lactate-based and acetate-based intravenous fluids on the electrolytes and the acid-base status. This double-blind randomized control study was approved by the Institutional Review Board and all the patients enrolled signed an informed consent. Sixty, ASA grade I or II, patients scheduled for major abdominal surgery, were randomly assigned to receive either Ringer lactate or Plasmalyte A at the rate of 5-7 ml.kg-1.hr-1. The arterial blood gas analysis and the electrolytes were measured before and at the end of surgery. The patient characteristics were comparable between the two groups. The pre-operative and the post-operative electrolyte levels showed no significant difference in either group. However, when the pre-operative and postoperative values were compared, there was statistically significant decrease in pH in both the groups, with it being marginally more among those who received Ringer lactate. There was both a slight rise in PaCO2 as well as a slight decrease in bicarbonate. However, the post-operative pH was within normal limits and was not clinically significant. This study concludes that in patients undergoing major abdominal surgery, the administration of 5-7 ml.kg-1.hr-1 of either Plasmalyte A or Ringer lactate leads to statistically significant decrease in pH, but this change is not clinically significant. However, when the two groups are compared, there is no statistically significant difference in the electrolyte and the acid-base status

Assessment of the Diagnostic Accuracy of Ultrasound for the Detection of Rotator Cuff Tear With Respect to Magnetic Resonance Imaging.

Objectives: To assess the sensitivity and specificity of ultrasound for the detection of rotator cuff tendon tear with respect to Magnetic Resonance Imaging (MRI). Methods: Study protocol was approved by the institutional review board. Sample size was calculated as 35 MRI positive cases for specificity of 80% for the test (ultrasound). Patients planned for MRI of shoulder were counselled for ultrasound of the same joint. 70 subjects (35 positive cases) were included. Ultrasound performer and MRI reporting doctor were blinded to the results of the other test. 2x2 tables were used to calculated sensitivity, specificity, positive and negative predictive value and accuracy of the test. Results: For the diagnosis of any rotator cuff tendon tear ultrasound showed sensitivity of 73.08%, specificity of 88.39%, negative predictive value of 90.73%, positive predictive value of 67.86% and accuracy of 84.54% with respect to MRI. For the diagnosis of any tear of the supraspinatus tendon ultrasound showed a sensitivity of 84% and specificity of 78.79%. Age and hypertension showed a significant association for the presence of supraspinatus tendon tear. For the diagnosis of subacromial and subdeltoid bursitis ultrasound showed a sensitivity of 81% and specificity of 42.86%

Comparison of 2 doses of 1% 2-chloroprocaine as spinal anesthetic for perineal and lower-limb surgeries

Background: Spinal anesthesia is a commonly employed anesthetic technique for infraumbilical surgeries. Some of its properties may limit its use for ambulatory surgery. For outpatient surgery, lignocaine was anesthetic of choice for years, but its use has been associated with significant risk. Short-acting local anesthetic may therefore represent a valid alternative in this setting. Aims and Objectives: We compare the duration of action of sensory and motor block with 40 mg and 50 mg preservative-free 1% 2-chloroprocaine (2-CP), as a subarachnoid block. Materials and Methods: Patients posted for surgery were randomized to two groups A and B with 64 patients in each group to whom, 40 mg and 50 mg preservative-free 1% 2-CP was administered as spinal anesthesia, respectively. After completion of spinal injection onset time, evolution of sensory and motor block and vitals were studied. Results: The median onset time was 4 min for both 40 mg and 50 mg 1% 2-CP. The duration of sensory block with 40 mg 2-CP was 117 (74–168) and with 50 mg 2-CP was 148 (116–176) min. The duration of motor block with 40 mg 2-CP was 104 (60–150) and with 50 mg 2-CP was 134 (106–158) min. In terms of hemodynamic parameters and adverse effects, there was no statistically significant difference found between both groups. Conclusion: Our study revealed that 40 mg of 1% 2-CP produces a satisfactory surgical block for procedures lasting <90 min. When compared with 1% 2-CP 50 mg, it resulted in comparable onset of action, with significantly faster regression of the block, shorter time to ambulation

Does roflumilast induce phagocytic activity in COPD patients?

Baishakhi Ghosh,1,2 Nitin V Vanjare1 1Chest Research Foundation (CRF), Pune, Maharashtra, India; 2Faculty of Health and Biomedical Science (FOHBS), Symbiosis International University, Pune, Maharashtra, IndiaWe read the article by Porpodis et al1 with great interest. In this study, the authors have evaluated the effect of roflumilast on the phagocytic activity of systemic phagocytes in severe and very severe COPD patients by measuring the oxidative burst post-bacterial stimulation. The study group for this study involved 21 severe or very severe COPD patients who were administered roflumilast in addition to other COPD treatments such as long-acting beta-adrenoceptor agonists (LABA) + inhaled corticosteroids (ICS) + long-acting anti-muscarinic agent (LAMA) or ICS + LABA.View original paper by Porpodis and colleagues

Static lung volume should be used to confirm restrictive lung disease

Shweta A Rasam, Nitin V Vanjare Department of Pulmonary Function Laboratory, Chest Research Foundation, Pune, Maharashtra, IndiaWe read the study by Hee Jin Park et al1 with great interest. The authors have investigated the prevalence of comorbidities in Korean chronic obstructive pulmonary disease (COPD) population. We raise our concern regarding the definition of COPD in this study. The study defines COPD as airflow limitation (only pre-spirometry forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] &lt;70%) in subjects aged &ge;40 years. To differentiate, between asthma and COPD, it is essential to do a post bronchodilator spirometry. It would have been wise to report the findings as prevalence of comorbidities in obstructive airway diseases rather than specifically calling it as COPD.View original paper by&nbsp;Park and colleagues

Taxonomical account of the Indian Cyzicid Ozestheria annandalei (Daday, 1913) (Branchiopoda: Spinicaudata) from peninsular India

Padhye, Sameer M., Ingale, Prashant Arun, Vanjare, Avinash Isaac (2020): Taxonomical account of the Indian Cyzicid Ozestheria annandalei (Daday, 1913) (Branchiopoda: Spinicaudata) from peninsular India. Zootaxa 4852 (3): 396-400, DOI: 10.11646/zootaxa.4852.3.1

Taxonomical account of the Indian Cyzicid Ozestheria annandalei (Daday, 1913) (Branchiopoda: Spinicaudata) from peninsular India

Padhye, Sameer M., Ingale, Prashant Arun, Vanjare, Avinash Isaac (2020): Taxonomical account of the Indian Cyzicid Ozestheria annandalei (Daday, 1913) (Branchiopoda: Spinicaudata) from peninsular India. Zootaxa 4852 (2): 246-250, DOI: 10.11646/zootaxa.4852.2.1

First report of the freshwater gastropod Pettancylus tenuis (Bourguignat, 1862) (Gastropoda, Planorbidae) from Pune region, India

We present the first record of the freshwater gastropod Pettancylus tenuis from the Pune region of India. This species, which resembles a limpet, was found in November and December 2020 in a wetland formed near the confluence of Mula and Ram rivers in Pune city. The shell characters of the specimens match the available description of the species. The other records of this species from Maharashtra are nearly 150 km from Pune