BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recomme...BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed.CONCLUSIONS: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.展开更多
目的探讨在目标导向液体管理下,胶体液联合晶体液与单纯晶体液对剖宫产术产妇及新生儿的影响。方法选取2015年3~9月首都医科大学附属北京妇产医院拟行腰硬联合麻醉下剖宫产产妇60例,美国麻醉医师协会(American society of anesthesiolog...目的探讨在目标导向液体管理下,胶体液联合晶体液与单纯晶体液对剖宫产术产妇及新生儿的影响。方法选取2015年3~9月首都医科大学附属北京妇产医院拟行腰硬联合麻醉下剖宫产产妇60例,美国麻醉医师协会(American society of anesthesiologist, ASA)分级Ⅰ~Ⅱ级,单胎足月,随机分为羟乙基淀粉130/0.4氯化钠注射液+乳酸钠林格注射液组(H组)和乳酸钠林格注射液组(L组),每组30例。在LIDCO-rapid连续无创血流动力学监测系统监测并指导下,比较两组产妇的血流动力学变化以及新生儿脐动、静脉血气指标。结果两组各时点血流动力学参数组间差异无统计学意义(P> 0.05)。两组脐动、静脉血气分析,pH、BE、PCO2组间差异无统计学意义(P> 0.05)。两组脐动脉血PaO2和SaO2组间差异有统计学意义(P <0.05),H组Pa-vO2及Sa-vO2均大于L组,且差异有统计学意义(P <0.05)。结论胶体液联合晶体液在剖宫产术中应用,能增加新生儿脐动-静脉氧分压差,增加胎儿的氧利用度,较单纯晶体液更有优势。展开更多
Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, rece...Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ‘‘crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity(fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy basedon functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity(fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ‘‘default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.展开更多
BACKGROUND Postpartum posterior reversible encephalopathy syndrome(PRES) is not uncommon.Its mechanisms and risk factors are not clear.CASE SUMMARY A 28-year-old woman underwent cesarean section but had inadvertent du...BACKGROUND Postpartum posterior reversible encephalopathy syndrome(PRES) is not uncommon.Its mechanisms and risk factors are not clear.CASE SUMMARY A 28-year-old woman underwent cesarean section but had inadvertent dural puncture during epidural anesthesia.To manage the symptoms of intracranial hypotension,crystalloid fluid was infused.However,the patient developed postpartum preeclampsia and PRES.The patient was treated with diazepam and dehydration therapy.The signs of cerebral lesions on magnetic resonance imaging disappeared on postpartum day 7.CONCLUSION Postpartum preeclampsia and PRES can develop concomitantly.Treating postdural puncture headaches with infusion of crystalloid fluid may precipitate the development of PRES.展开更多
文摘BACKGROUND: Fluid intervention and vasoactive pharmacological support during hepatic resection depend on the preference of the attending clinician, institutional resources, and practice culture. Evidence-based recommendations to guide perioperative fluid management are currently limited. Therefore, we provide a contemporary clinical integrative overview of the fundamental principles underpinning fluid intervention and hemodynamic optimization for adult patients undergoing major hepatic resection. DATA SOURCES: A literature review was performed of MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials using the terms 'surgery', 'anesthesia', 'starch', 'hydroxyethyl starch derivatives', 'albumin', 'gelatin', 'liver resection', 'hepatic resection', 'fluids', 'fluid therapy', 'crystalloid', 'colloid', 'saline', 'plasma-Lyte', 'plasmalyte', 'hartmann's', 'acetate', and 'lactate'. Search results for MEDLINE and EMBASE were additionally limited to studies on human populations that included adult age groups and publications in English. RESULTS: A total of 113 articles were included after appropriate inclusion criteria screening. Perioperative fluid management as it relates to various anesthetic and surgical techniques is discussed.CONCLUSIONS: Clinicians should have a fundamental understanding of the surgical phases of the resection, hemodynamic goals, and anesthesia challenges in attempts to individualize therapy to the patient's underlying pathophysiological condition. Therefore, an ideal approach for perioperative fluid therapy is always individualized. Planning and designing large-scale clinical trials are imperative to define the optimal type and amount of fluid for patients undergoing major hepatic resection. Further clinical trials evaluating different intraoperative goal-directed strategies are also eagerly awaited.
文摘目的探讨在目标导向液体管理下,胶体液联合晶体液与单纯晶体液对剖宫产术产妇及新生儿的影响。方法选取2015年3~9月首都医科大学附属北京妇产医院拟行腰硬联合麻醉下剖宫产产妇60例,美国麻醉医师协会(American society of anesthesiologist, ASA)分级Ⅰ~Ⅱ级,单胎足月,随机分为羟乙基淀粉130/0.4氯化钠注射液+乳酸钠林格注射液组(H组)和乳酸钠林格注射液组(L组),每组30例。在LIDCO-rapid连续无创血流动力学监测系统监测并指导下,比较两组产妇的血流动力学变化以及新生儿脐动、静脉血气指标。结果两组各时点血流动力学参数组间差异无统计学意义(P> 0.05)。两组脐动、静脉血气分析,pH、BE、PCO2组间差异无统计学意义(P> 0.05)。两组脐动脉血PaO2和SaO2组间差异有统计学意义(P <0.05),H组Pa-vO2及Sa-vO2均大于L组,且差异有统计学意义(P <0.05)。结论胶体液联合晶体液在剖宫产术中应用,能增加新生儿脐动-静脉氧分压差,增加胎儿的氧利用度,较单纯晶体液更有优势。
基金Supported by Canada Research Chair in Critical Care NephrologyClinical Investigator Award from Alberta Innovates-Health Solutions to Bagshaw MS
文摘Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ‘‘crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity(fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy basedon functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity(fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ‘‘default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.
文摘BACKGROUND Postpartum posterior reversible encephalopathy syndrome(PRES) is not uncommon.Its mechanisms and risk factors are not clear.CASE SUMMARY A 28-year-old woman underwent cesarean section but had inadvertent dural puncture during epidural anesthesia.To manage the symptoms of intracranial hypotension,crystalloid fluid was infused.However,the patient developed postpartum preeclampsia and PRES.The patient was treated with diazepam and dehydration therapy.The signs of cerebral lesions on magnetic resonance imaging disappeared on postpartum day 7.CONCLUSION Postpartum preeclampsia and PRES can develop concomitantly.Treating postdural puncture headaches with infusion of crystalloid fluid may precipitate the development of PRES.
