Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study.

OBJECTIVE: Because there are no studies available on the safety of venlafaxine during pregnancy, the authors' goal in this study was to determine whether venlafaxine increases the risk for major malformations. METHOD: Data on 150 women exposed to venlafaxine during pregnancy in seven pregnancy counseling centers were compared with data from studies of pregnant women who 1) received selective serotonin reuptake inhibitor antidepressants (SSRIs) (N=150) and 2) who received nonteratogenic drugs (N=150). RESULTS: Among the 150 women who were exposed to venlafaxine during pregnancy, 125 had live births, 18 had spontaneous abortions, and seven had therapeutic abortions; two of the babies had major malformations. There were no significant differences between these women and the two comparison groups on any of the measures analyzed. CONCLUSIONS: These results suggest that the use of venlafaxine during pregnancy does not increase the rates of major malformations above the baseline rate of 1%-3%.

Another feature of TURP syndrome: hyperglycaemia and lactic acidosis caused by massive absorption of sorbitol.

Endoscopic transurethral resection of the prostate (TURP) can be complicated by absorption of a large volume of irrigation fluid. The clinical features of this complication are referred as the TURP syndrome. We report a case where hyperglycaemia and lactic acidosis complicated the TURP syndrome caused by the massive absorption (approximately 15 litres) of a sorbitol- mannitol irrigation solution. The proposed mechanism is a type B lactic acidosis related to the metabolism of sorbitol.

Pregnancy outcome following first trimester exposure to sumatriptan.

We prospectively compared pregnancy outcome after exposure to sumatriptan with that of disease-matched controls and nonteratogen controls. There were no differences in the rates of live births, spontaneous abortions, therapeutic abortions, or major birth defects among the three groups. This first prospective report suggests that the use of sumatriptan during organogenesis is not associated with an apparent increased risk of major birth defects.

Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study.

CONTEXT: Although a large number of women of reproductive age use new selective serotonin reuptake inhibitors (SSRIs) and half of all pregnancies are unplanned, no data exist on the safety of these agents for the human fetus. OBJECTIVE: To assess fetal safety and risk of fluvoxamine, paroxetine, and sertraline. DESIGN: A prospective, multicenter, controlled cohort study. SETTING: Nine Teratology Information Service centers in the United States and Canada. PATIENTS: All women who were counseled during pregnancy following exposure to a new SSRI and followed up by the participating centers. Controls were randomly selected from women counseled after exposure to nonteratogenic agents. MAIN OUTCOME MEASURES: Rates of major congenital malformations. RESULTS: A total of 267 women exposed to an SSRI and 267 controls were studied. Exposure to SSRIs was not associated with either increased risk for major malformations (9/222 live births [4.1%] vs 9/235 live births [3.8%] in the controls, relative risk, 1.06, 95% confidence interval, 0.43-2.62) or higher rates of miscarriage, stillbirth, or prematurity. Mean (SD) birth weights among SSRI users (3439 [505] g) were similar to the controls (3445 [610] g) as were the gestational ages (39.4 [1.7] weeks vs 39.4 [1.9] weeks). CONCLUSION: The new SSRIs, fluvoxamine, paroxetine, and sertraline, do not appear to increase the teratogenic risk when used in their recommended doses.

Risk of cross-infection related to the multiple use of disposable syringes.

The rate of blood contamination of IV tubings used in anaesthesia practice was investigated. Only IV tubings started in the operating room were studied. First, 300 tubings of three different types were tested at the three distal injection sites. The contamination rate was 3.3 per cent at the injection site closest to the IV catheter and 0.3 per cent at the furthest. The presence of a check-valve did not affect the contamination rate. Second, 300 third injection sites fixed at a level equal to or above the IV catheter were tested. None of them was contaminated. Finally, in order to evaluate whether changing the needle alone could prevent the contamination of syringes, injections were made into a tubing where blood was flowing. Thirty-four per cent of the syringes tested positive for blood. We conclude that IV tubings have a significant contamination rate in usual practice. This rate decreases as the distance from the IV catheter increases. The use of the third site fixed at a level equal to or above the IV catheter carries a lower risk of contamination. Changing the needle alone is a useless procedure to prevent cross-contamination.

Isoflurane-induced hypotension in orthognathic surgery.

The effect of isoflurane-induced hypotension on reduction of blood loss, improvement of surgical field, and postoperative edema was investigated in 52 patients undergoing combined maxillary and mandibular osteotomies. Anesthesia was maintained with fentanyl, N2O, O2, and isoflurane. Deliberate hypotension was induced by increasing isoflurane inspired concentration. Blood loss in the hypotensive group (MAP 55-65 mm Hg) was significantly less than that in the control group (MAP 75-85 mm Hg); 454.0 +/- 211.3 mL versus 755.3 +/- 334.6 mL (P less than 0.001). Fewer patients had to be transfused in the hypotensive group, 12.0% versus 44.4% (P less than 0.02). The surgical field was significantly improved by the hypotensive technique, but operative time was not shortened. Subjective and objective measurements of postoperative edema failed to show any effect of deliberate hypotension. Our data suggest that isoflurane-induced hypotension effectively reduces blood loss and the number of transfusions in orthognathic surgery.