Physiological and clinical effects of different infusion rates of intravenous fluids for volume expansion: A scoping review.

PURPOSE: To assess the physiological and clinical effects of different rates of intravenous fluids for volume expansion of critically ill and perioperative patients. METHODS: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for studies comparing intravenous infusion rates both in animals and studies involving healthy subjects, critically ill, and perioperative care patients of all ages. RESULTS: Seven animal studies, eleven clinical studies and three studies including healthy volunteers were identified. Slower infusion led to lower mortality in two studies, lower blood loss in one study, better or more sustained expansion of plasma volume and less edema in three studies, but slower restoration of blood pressure in one study. Three healthy volunteer studies suggested more effective plasma expansion with slower infusion, whereas one trial with postoperative patients did not show plasma volume differences between different infusion rates. One randomized trial found increased mortality with faster infusion in septic children, whereas a randomized trial found no significant differences in critically ill adults. CONCLUSIONS: In this scoping review, most studies showed that slower intravenous infusion rates result in a more efficient intravascular expansion, with a longer effect, and less edema than faster rates. Effects on clinical outcomes were inconsistent.

Evaluation of DNA damage and lipoperoxidation of propofol in patients undergoing elective surgery.

BACKGROUND AND OBJECTIVES: Inhaled anaesthetics have been studied regarding their genotoxic and mutagenic potential in vivo. Propofol differs from volatile anaesthetics because it does not show mutagenic effects and it has been reported to be an antioxidant. However, there are no studies with propofol and genotoxicity in vivo. The study aimed to evaluate the hypothesis that propofol is not genotoxic and it inhibits lipid peroxidation [malondialdehyde (MDA)] in patients undergoing propofol anaesthesia. METHODS: ASA physical status I patients scheduled for elective surgery, lasting at least 90 min, were enrolled in this study. Initially, the estimated plasma concentration of propofol was targeted at 4 microg ml(-1) and then maintained at 2-4 microg ml(-1) until the end of surgery. Haemodynamic data were determined at baseline (before premedication) and in conjunction with target-controlled infusion of propofol: after tracheal intubation, 30, 60 and 90 min after anaesthesia induction and at the end of the surgery. Venous blood samples were collected at baseline, after tracheal intubation, at the end of the surgery and on the postoperative first day for evaluating DNA damage in white blood cells (WBCs), by comet assay, and MDA levels. RESULTS: Haemodynamic data did not differ among times. No statistically significant differences were observed for the levels of DNA damage in WBCs, nor in plasma MDA, among the four times. CONCLUSION: Propofol does not induce DNA damage in WBCs and does not alter MDA in plasma of patients.

Distribuição espacial dos idosos segundo seus conceitos de qualidade de vida / Spatial distribution of elderly individuals according to their concepts of quality of life

O envelhecimento populacional tem gerado, nesta área, significativos avanços no conhecimento científico. Pesquisando a população de sessenta anos e mais de um município de médio porte do interior paulista, após amostragem estratificada das residências e, posteriormente, aleatória dos idosos, estudaram-se os significados de qualidade de vida, segundo as respostas obtidas no questionário à questão aberta: "O que é qualidade de vida para o(a) Sr(a) ". De posse das categorias, foi feita uma análise de agrupamentos segundo o método de Ward, que analisa a coincidência das categorias nas respostas dos idosos e permitiu-nos chegar à obtenção de três grupos de respostas. No grupo denominado "Obrigações", com categorias que valorizavam espiritualidade, trabalho, retidão e caridade, conhecimento e ambientes favoráveis, encontraram-se 88 idosos (24,1%); no grupo "Lazer", em que se valorizavam hábitos saudáveis, lazer e bens materiais, foram encontrados 145 idosos(39,7%) e, no grupo denominado "Valores Interiores", com categorias valorizando relacionamentos interpessoais, equilíbrio emocional e boa saúde, foram encontrados 132 idosos (36,2%). Para avaliar a distribuição espacial desses idosos, calculou-se a proporção de idosos de cada grupo de opinião em relação ao total de idosos amostrados por setor. A seguir, converteram-se os dados analógicos em digitais, usando-se, como referência, um mapa do município com as divisões dos setores censitários. A sobreposição do mapa de setores censitários permitiu identificar os idosos por setores. A análise espacial foi do tipo univariada e, afim de interpretar a distribuição espacial, foi importante conhecer o nível sócioeconômico a que pertenciam os setores estudados. Para isso, utilizou-se como parâmetro de comparação o Índice Paulista de Vulnerabilidade Social(IPVS). Como resultado, obteve-se que setores significativos para o grupo "Obrigações" estavam localizados no centro da cidade, onde se concentram famílias de bom nível...

There has been significant advancement in the scientificknowledge about the aging of the population. The meaningof quality of life was studied in a sample of 365 peopleaged 60 years or above, from a middle-sized city in thestate of São Paulo, Brazil. Participants were randomlyselected from a preliminary stratified sampling of placesof residence. The investigation was based on the answerto the following open question: ?What does quality of lifemean to you?? The Ward`s method was used to perform acluster analysis of coincidences in the categories of answersprovided. Three answer groups were identified. 88 (24.1%)were in the ?Obligations? group, with categories that valuedspirituality, work, rectitude and charity, knowledge andfavorable environments. 145 (30.7%) were in the ?Leisure?group, where features such as healthy habits, leisure andmaterial possessions were valued. 132 (36.2%) were in the?Inner Values? group, with categories valuing interpersonalrelationships, mental balance and good health. In order toevaluate the spatial distribution of the subjects, the proportionof individuals in each opinion group was calculated inrelation to the total number of persons sampled per sector.Analogical data were then converted into digital informationby using as reference a city map containing censussectors. The overlapping of the census sectors map allowedfor the identification of the individuals by sectors. Spatialanalysis was the univariate type and, in order to interpretspatial distribution, it was important to learn about thesocioeconomic level to which the study sectors belonged.To that end, the São Paulo State Social Vulnerability Index(SPSSVI) was used as a comparison parameter. Significantsectors for the ?Obligations? group were located in thecenter of the city, where families of a good...