Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.

BACKGROUND & AIM: The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats. METHODS: Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination. RESULTS: Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05). CONCLUSION: Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

[The comparison of the effects and side effects of local anesthetic and opioid combinations in epidural patient controlled analgesia]. / Epidural hasta kontrollü analjezi yönteminde lokal anestezik -- opioid birlikteliginin etkinlik ve yan etkilerinin arastirilmasi.

The aim of this study was to retrospectively evaluate the efficacy and side effects of local anesthetic and opioid combinations in 457 patients who have received epidural patient-controlled analgesia (EPCA). Hemodynamic parameters, numeric rating scale, sedation scores, the degree of motor and sensory blockage, the presence of side effects, the parameters of PCA device were recorded from the postoperative pain records. 253 patients received 0.1 % bupivacaine + 3 microg/ml fentanyl (Group B1F3), 80 patients received 0.125 % bupivacaine + 3 microg/ml fentanyl (Group B12F3), 43 patients received 0.125 % bupivacaine + 4 microg/ml fentanyl (Group B12F4), 46 patients received 0.1 % bupivacaine + 0.1 mg/ml morphine (Group B1M1) and 35 patients received 0.125 % bupivacaine + 0.1 mg/ml morphine (Group B12M1). Nausea was significantly higher in group B1M1 compared to B12F3, in group B12M1 compared to B1F3 and B12F3 (p<0.05), vomiting was significantly higher in group B1M1 and B12M1 (p<0.05) compared to B12F3, pruritus was significantly higher in group B12F4 compared to B12F3 and B1F3, in group B1M1 compared to B1F3 and B12F3 and in group B12M1 compared to B1F3 and B12F3 (p<0.05). As a result, in EPCA, the combination of bupivacaine and fentanyl provides as effective analgesia as the combination of bupivacaine and morphine and 3 mg/ml fentanyl admixture may be preferred with less side effects such as nausea, vomiting and pruritus.

Histopathologic effects of lipid content of enteral solutions after pulmonary aspiration in rats.

OBJECTIVE: We compared the pulmonary histopathologic effects of different enteral formulas with various lipid contents during the subacute period of aspiration in rats. METHODS: Fifty Wistar albino rats, weighing 180 to 300 g, were randomly assigned to one of five groups (n = 10). Anesthesia was induced with an intraperitoneal injection of 100 mg/kg of ketamine hydrochloride, rats were intubated endotracheally with a 16-gauge angiocatheter, and 0.9% saline (group 1, control), Impact (group 2), Jevity (group 3), Biosorb Energy Plus (group 4), or Pulmocare (group 5) with a lipid content of 0, 28, 39.3, 58, or 93.3 g/L, respectively, was injected into the lungs in a volume of 3 mL/kg. Seven days later, rats were killed, and lungs with trachea were removed en bloc for histopathologic examination. For histopathologic assessment, slides were examined for the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. The degree of severity was assessed by using a 4-point scale. One-way analysis of variance and Student-Newman-Keuls test were used for statistical analysis. RESULTS: Peribronchial inflammatory cell infiltration was present in all groups but was significantly more severe in group 2 than in groups 1, 4, and 5 (P < 0.05). Alveolar edema was statistically higher in group 2 than in group 1 (P < 0.05). Alveolar septal infiltration was statistically higher in group 4 than in group 1. Alveolar histiocytes were statistically higher in groups 2 and 3 (P < 0.01) and groups 4 and 5 (P < 0.05) than in group 1. Alveolar exudate, interstitial fibrosis, granuloma, and necrosis formation were absent in all groups. CONCLUSION: The pulmonary histopathologic effects of aspiration of Impact were severe peribronchial inflammatory cell infiltration (greater than aspiration of Biosorb and Pulmocare), abundant alveolar histiocytes, and alveolar edema in comparison with aspiration of saline, even though Impact had the lowest lipid content of all studied formulas. We concluded that the tissue damage occurring after pulmonary aspiration of Impact is more severe than after aspiration of Pulmocare.

Early postoperative respiratory acidosis after large intravascular volume infusion of lactated ringer's solution during major spine surgery.

UNLABELLED: In this study, we compared the effects of large intravascular volume infusion of 0.9% saline (NS) or lactated Ringer's (LR) solution on electrolytes and acid base balance during major spine surgery and evaluated the postoperative effects. Thirty patients aged 18-70 yr were included in the study. General anesthesia was induced with 5 mg/kg thiopental and 0.1 mg/kg vecuronium IV. Anesthesia was maintained with oxygen in 70% nitrous oxide and 1.5%-2% sevoflurane. In Group I, the NS solution, and in Group II, the LR solution were infused 20 mL. kg(-1). h(-1) during the operation and 2.5 mL. kg(-1). h(-1), postoperatively. Electrolytes (Na+, K+, Cl-) and arterial blood gases were measured preoperatively, every hour intraoperatively and at the 1st, 2nd, 4th, 6th, and 12th hours postoperatively. In the NS group, pHa, HCO3 and base excess decreased, and Cl- values increased significantly at the 2nd hour and Na+ values increased at the 4th hour intraoperatively (P < 0.001). The values returned to normal ranges at the 12th hour postoperatively. In the LR group, blood gas analysis and electrolyte values did not show any significant difference intraoperatively, but the increase in PaCO2 and the decrease in pHa and serum Na+ was significant at the 1st hour postoperatively. Although intraoperative 20 mL. kg(-1). h(-1) LR infusion does not cause hyperchloremic metabolic acidosis as does NS infusion, it leads to postoperative respiratory acidosis and mild hyponatremia. IMPLICATIONS: The infusion of large-volume lactated Ringer's solution does not cause hyperchloremic metabolic acidosis as does 0.9% saline during major surgery, but leads to postoperative mild hyponatremia and respiratory acidosis.