Microalbuminuria as an early index of impairment of glomerular permeability in postoperative septic patients.

OBJECTIVE: To evaluate whether microalbuminuria increases in post-operative patients developing sepsis, and whether it is correlated to the sepsis severity score (SOFA) and the PaO2/FIO2 ratio. DESIGN: Prospective study. SETTING: University intensive care unit. PATIENT POPULATION: Fifty-five postoperative ASA II-III patients admitted to the ICU after major abdominal or vascular surgery. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Urine collection and measurement of microalbuminuria and urinary creatinine on admission and again as soon as sepsis developed or at the end of the study (72 h after admission). Results are expressed as the microalbuminuria/creatinine ratio (MACR). The MACR significantly increased as soon as sepsis (defined according to the ACPP/SCCM Consensus Conference) appeared. The MACR positively correlated to the SOFA score, but had no relation to the PaO2/FIO2 ratio. Patients not developing sepsis did not show any increase in the MACR during the study period. CONCLUSIONS: Post-operative patients developing sepsis, unlike those with an uncomplicated postoperative evolution, showed an increase in glomerular permeability which was revealed by MACR. The increase in the MACR was positively correlated to the increase in SOFA score, while it had no relation to the PaO2/FIO2 ratio.

[High-dose vecuronium in "open-eye" emergency surgery]. / Il vecuronio ad alti dosaggi nella chirurgia oftalmica di urgenza ad "occhio aperto".

BACKGROUND: Succinylcholine is contraindicated in "open eye" surgery because it raises intraocular pressure. High dose vecuronium reduces onset time for orothracheal intubation. The objective of the study was to evaluate clinical efficacy of high dose vecuronium (0.2 and 0.3 mg/kg) and its effects on intraocular pressure for its use in "open eye" emergency surgery. DESIGN: Randomized, prospective, clinical trial. SETTING: Eye clinic of University of Florence. PATIENTS: 40 patients scheduled for vitrectomy, excluding any drug action on IOP, subdivided into two groups: the first (20 patients) had 0.2 mg/kg vecuronium at the induction of anaesthesia, the second (20 patients) 0.3 mg/kg. ANAESTHESIA: Premedication: atropine 0.01 mg/kg. Preinduction: fentanyl 3 micrograms/kg. Induction: thiopentone 4 mg/kg+ after 1 minute) vecuronium. Orotracheal intubation after 90". MEASURES: IOP was obtained by applanation tonometry in three time: T0 = preinduction; T1 = 50" after thiopentone; T2 = 50" after vecuronium. Systodiatolic pressure was obtained at the same time. Neuromuscular function was evaluated by vocals cord relaxation and by clinical evaluation of response to ulnar nerve stimulation (by train of four). STATISTIC: "t"-Student. MAIN RESULTS AND CONCLUSIONS: No modification of IOP and systodiastolic pressure was caused by administration of vecuronium; no statistic differences are between T1 and T2 values. All patients were intubated after 90" vecuronium administration; the vocal cord relaxation was maxima in all the patients. High dose vecuronium seems to be useful in "open eye" emergency surgery when succinylcholine is contraindicated.

[Accident during retinal fluorescein angiography]. / Accidenti durante angiografia retinica con fluoresceina.

OBJECTIVE: To evaluate adverse reactions frequency following fluorescein i.v. administration to perform retinoic angiography (ARF). DESIGN: Retrospective study. SETTING: Eye Clinic of the University of Florence. MATERIALS AND METHODS: 6524 patients undergoing 10,003 ARF. PARAMETERS EVALUATED: For each patient age, sex, concomitant diseases, previous ARF, allergic history and any adverse reaction were evaluated. RESULTS: Adverse experiences were described in 7.5% of 6524 patients. Most of the observed reactions were mild: nausea (3.8%), vomiting (0.43%), vasovagal phenomena (1.18%), anaphylactoid reactions (1.84%). A major rate of adverse reactions were observed in patients previously submitted to ARF who reported in the anamnesis a previous adverse reaction, and in those with a positive allergic history. Severe reactions occurred in 0.27% of patients, but only in 2 of 6524 patients a rianimatory treatment (0.03) was necessary. CONCLUSION: From the data retrospective analysis it was observed that the manifestation of mild adverse effects was to be expected in many cases. It was therefore possible to point out classes of patients at risk (patients who reported a previous adverse reaction after ARF and patients with positive allergic history). Unfortunately it was not possible to expect and so to prevent the severe effects. Thus it is recommended to perform ARF in an adequately equipped room.