The effect of different flushing and locking techniques on catheter occlusion rates in central venous catheters: protocol for a multicentre, randomized controlled, parallel-group, open-label, superiority clinical trial.

BACKGROUND: Maintaining venous access is of great clinical importance. Running a slow continuous infusion to keep the vein open (KVO) is often used in peripheral intravenous catheters (PIVCs). Previous studies have compared the effects of intermittent flushing and continuous infusion via peripherally inserted central catheters (PICCs). In this study, we applied KVO to central venous catheters (CVCs) and compared the occlusion rate of this technique with that of the intermittent flushing technique. METHOD: This is a randomized controlled trial of 14 hospitals in China. A total of 250 patients will be recruited in this study, and they will be randomized at a 1:1 ratio. After study inclusion, patients who will undergo CVC insertion will receive intermittent flushing with prefilled saline syringes (control group) or KVO infusion with elastic pumps (test group). All the catheters will be checked for patency by scoping Catheter Injection and Aspiration (CINAS) Classification on Days 3 and 7. The primary outcome is the rate of catheter occlusion in 7 days. Patients will be followed up until 9 days after CVC insertion, catheter occlusion, or catheter removal. The secondary outcomes are the rate of catheter occlusion in 3 days, nurse satisfaction, cost-effectiveness, adverse event rate, catheter-related bloodstream infection rate, catheter-related thrombosis rate, extravasation rate, phlebitis rate, and catheter migration. DISCUSSION: We expect that the trial will generate findings that can provide an evidence-based basis for the improvement and optimization of clinical catheter flushing techniques. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2200064007. Registered on 23 September 2022. https://www.chictr.org.cn/showproj.html?proj=177311 .

[Surgical Treatment with Pulsed Lavage Irrigation for Infective Endocarditis].

INTRODUCTION: Pulsed lavage irrigation (PLI) is a procedure used to wash contaminated soft tissues and prevent infection in orthopedic surgery. We applicated PLI for surgical treatment of infective endocarditis( IE). SUBJECTS AND METHODS: From January 2017 to June 2021, 6 cases underwent surgical treatment IE using PLI. We investigated an efficacy of PLI. RESULTS: Infected valves were mitral valve in 4 cases, aortic valve in 1 case, and aortic prosthetic valve in 1 case. The performed procedures were mitral valve plasty in 4 cases, aortic valve replacement in 1 case, and 1 removal of vegetation on the aortic prosthetic valve. No recurrence of IE or no deterioration of the native valve or the prosthetic valve was observed in follow-up periods. CONCLUSION: PLI was useful for surgical treatment of IE because of no recurrence of IE or no deterioration of native mitral valves or the aortic prosthetic valve.

[Clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage â £ ischial tuberosity pressure ulcers].

Objective: To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers. Methods: This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up. Results: All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions: When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.

In vivo study to assess fat embolism resulting from the Reamer-Irrigator-Aspirator 2 system compared to a novel aspirator-based concept for intramedullary bone graft harvesting.

INTRODUCTION: Fat embolism (FE) following intramedullary (IM) reaming can cause severe pulmonary complications and sudden death. Recently, a new harvesting concept was introduced in which a novel aspirator is used first for bone marrow (BM) aspiration and then for subsequent aspiration of morselized endosteal bone during sequential reaming (A + R + A). In contrast to the established Reamer-Irrigator-Aspirator (RIA) 2 system, the new A + R + A concept allows for the evacuation of fatty BM prior to reaming. In this study, we hypothesized that the risk of FE, associated coagulopathic reactions and pulmonary FE would be comparable between the RIA 2 system and the A + R + A concept. MATERIALS AND METHODS: Intramedullary bone graft was harvested from intact femora of 16 Merino sheep (age: 1-2 years) with either the RIA 2 system (n = 8) or the A + R + A concept (n = 8). Fat intravasation was monitored with the Gurd test, coagulopathic response with D-dimer blood level concentration and pulmonary FE with histological evaluation of the lungs. RESULTS: The total number and average size of intravasated fat particles was similar between groups (p = 0.13 and p = 0.98, respectively). D-dimer concentration did not significantly increase within 4 h after completion of surgery (RIA 2: p = 0.82; A + R + A: p = 0.23), with an interaction effect similar between groups (p = 0.65). The average lung area covered with fat globules was similar between groups (p = 0.17). CONCLUSIONS: The use of the RIA 2 system and the novel A + R + A harvesting concept which consists of BM evacuation followed by sequential IM reaming and aspiration of endosteal bone, resulted in only minor fat intravasation, coagulopathic reactions and pulmonary FE, with no significant differences between the groups. Our results, therefore, suggest that both the RIA 2 system and the new A + R + A concept are comparable technologies in terms of FE-related complications.

Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation.

AIMS: Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated RF ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrigant were used for normal saline (NS) and HNS but could increase risks related to steam pops and lesion size. This study aims to assess periprocedural complications and acute ablation outcome of ventricular arrhythmias ablation with HNS. METHODS AND RESULTS: Prospective assessment of outcomes was performed in 1024 endocardial and/or epicardial RF ablation procedures in 935 consecutive patients (median age 64 years, 71.2% men, 73.4% cardiomyopathy, 47.2% sustained ventricular tachycardia). Half-normal saline was selected at the discretion of the treating physician. Radiofrequency ablation power was generally titrated to a ≤15â€…Ω impedance fall with intracardiac echocardiography monitoring. Half-normal saline was used in 900 (87.9%) and NS in 124 (12.1%) procedures. Any adverse event within 30 days occurred in 13.0% of patients treated with HNS RF ablation including 4 (0.4%) strokes/transient ischaemic attacks and 34 (3.8%) pericardial effusions requiring treatment (mostly related to epicardial access). Two steam pops with perforation required surgical repair (0.2%). Patients who received NS irrigation had less severe disease and arrhythmias. In multivariable models, adverse events and acute success of the procedure were not related to the type of irrigation. CONCLUSION: Half-normal saline irrigation RF ablation with power guided by impedance fall and intracardiac echocardiography has an acceptable rate of complications and acute ablation success while administering half of the saline load expected for NS irrigation.

Metabolic acidemia due to saline absorption during transurethral and transcervical surgery: a report of 2 cases.

BACKGROUND: The development of endoscopic systems that include bipolar electrocautery has enabled the use of normal saline irrigation in transurethral or transcervical endoscopic surgery. However, excessive saline absorption can cause hyperchloremic metabolic acidosis. CASE PRESENTATION: Patient 1: A 76-year-old man was scheduled for transurethral resection of the prostate with saline irrigation. Approximately 140 min after the surgery, abdominal distension and cervical edema were observed. Abdominal ultrasound examination indicated a subhepatic hypoechoic lesion, which suggested extravasation of saline. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient was extubated 2 h after the operation with no subsequent airway problems, and the electrolyte imbalance was gradually corrected. Patient 2: A 43-year-old woman was scheduled for transcervical resection of a uterine fibroid with saline irrigation. When the drape was removed after the operation was finished, notable upper extremity edema was observed. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient's acidemia, electrolyte imbalance, and neck edema gradually resolved, and the patient was extubated 16 h after the operation without subsequent airway problems. CONCLUSIONS: Anesthesiologists should be aware of acidemia, cardiopulmonary complications, and airway obstruction caused by excessive saline absorption after saline irrigation in endoscopic surgery.

Massive Subcutaneous Emphysema after Hydrogen Peroxide Irrigation of a Penetrating Facial Injury.

We present the case of a child impaled in the face by a meat thermometer who subsequently suffered a significant complication due to the administration of hydrogen peroxide to the wound. The soft tissues of the face rapidly expanded and blanched, the child experienced mental status changes, and imaging revealed massive subcutaneous emphysema, pneumomediastinum, and pneumo-orbit. Herein we review the literature on this rare complication and provide photodocumentation in the hopes that other practitioners, patients, and parents avoid administering hydrogen peroxide into or near any penetrating injury. Laryngoscope, 134:2954-2957, 2024.

Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

Endotracheal tube cuff pressure increases in patients undergoing shoulder arthroscopy: a single cohort study / Aumento da pressão do balonete do tubo endotraqueal em pacientes submetidos a artroscopia do ombro: estudo de coorte

Abstract Background and objectives Several airway complications can occur during shoulder arthroscopy including airway obstruction, pleural puncture, and subcutaneous emphysema. It was hypothesized that the irrigation fluid used during a shoulder arthroscopic procedure might increase the cuff pressure of the endotracheal tube, which can cause edema and ischemic damage to the endotracheal mucosa. Therefore, this study aimed to evaluate the relationship between irrigation fluid and endotracheal tube cuff pressures. Methods Forty patients aged 20 to 70 years with an American Society of Anesthesiologists (ASA) score I or II, scheduled for elective arthroscopic shoulder surgery under general anesthesia, participated in our study. We recorded endotracheal tube cuff pressures and neck circumferences every hour from the start of the operation. We also recorded the total duration of the anesthesia, operation, and the total volume of fluid used for irrigation. Results A positive correlation was shown between endotracheal tube cuff pressures and the amount of irrigation fluid (r = 0.385, 95% CI 0.084 to 0.62, p = 0.0141). The endotracheal tube cuff pressure significantly increased at 2 and 3 hours after starting the operation (p = 0.0368 and p = 0.0245, respectively). However, neck circumference showed no significant difference. Conclusions Endotracheal tube cuff pressures increased with operation time and with increased volumes of irrigation fluid used in patients who underwent shoulder arthroscopy. We recommend close monitoring of endotracheal tube cuff pressures during shoulder arthroscopy, especially during long operations using a large amount of irrigation fluid, to prevent complications caused by raised cuff pressures.

Resumo Justificativa e objetivos Diversas complicações das vias aéreas podem ocorrer durante a artroscopia do ombro, incluindo obstrução das vias aéreas, punção pleural e enfisema subcutâneo. Levantou‐se a hipótese de que o fluido de irrigação utilizado durante artroscopia do ombro possa aumentar a pressão do balonete do tubo endotraqueal, podendo causar edema e lesão isquêmica na mucosa traqueal. Portanto, este estudo teve como objetivo avaliar a relação entre o fluido de irrigação e a pressão do balonete do tubo endotraqueal. Métodos Participaram do estudo 40 pacientes com idades entre 20 e 70 anos com classificação do estado físico I ou II da American Society of Anesthesiologists (ASA), programados para cirurgia artroscópica do ombro, eletiva e sob anestesia geral. Registramos as pressões do balonete do tubo endotraqueal e as circunferências do pescoço a cada hora, a partir do início da cirurgia. Também registramos a duração anestésica e cirúrgica, assim como o volume total de líquido de irrigação empregado. Resultados Foi encontrada correlação positiva entre a pressão do balonete do tubo endotraqueal e a quantidade de líquido de irrigação (r = 0,385; 95% IC 0,084 a 0,62; p = 0,0141). A pressão do balonete do tubo endotraqueal registrou aumento significante 2 e 3 horas após o início da cirurgia (p = 0,0368 e p = 0,0245, respectivamente). No entanto, a circunferência do pescoço não mostrou diferença significante. Conclusões As pressões do balonete do tubo endotraqueal aumentaram com o tempo de cirurgia e com o aumento do volume de líquido de irrigação utilizado em pacientes submetidos a artroscopia do ombro. Recomendamos a monitorização rigorosa da pressão do balonete do tubo endotraqueal durante artroscopia do ombro, especialmente nos procedimentos longos em que grandes volumes de fluido de irrigação são empregados, para evitar complicações causadas por pressões elevadas do balonete.

Embolismo gaseoso tras el uso del sistema de lavado CarboJet® durante la hemiartroplastía de cadera: Caso clínico y revisión de la literatura / Gas embolism after the use of the CarboJet® lavage system during hip hemiarthroplasty: Clinical case and literature review

Presentamos el caso de una paciente de 89 años de edad que sufrió paro cardiorrespiratorio durante la realización de hemiartroplastía de cadera cementada que precisó resucitación cardiopulmonar. Esta complicación ocurrió inmediatamente después de usar el sistema de lavado mediante dióxido de carbono CarboJet®, y se atribuyó a embolismo gaseoso, tras descartar otras entidades. Se discuten los posibles factores que pueden contribuir a esta complicación quirúrgica.

Case report of an 89 year-old patient who had cardiorespiratory arrest during cemented hip hemiarthroplasty and required cardiopulmonary resuscitation. This complication occurred immediately after using the carbon dioxide-based lavage system known as CarboJet® and was attributed to gas embolism once other entities were ruled out. The possible factors that may contribute to this surgical complication are discussed.

Fluid volume kinetics of dilutional hyponatremia; a shock syndrome revisited

OBJECTIVE: To evaluate whether the pathophysiology of shock syndromes can be better understood by comparing central hemodynamics with kinetic data on fluid and electrolyte shifts. METHODS: We studied the dilutional hyponatremic shock that developed in response to overhydration with electrolyte-free irrigating fluid - the so-called ‘transurethral resection syndrome' - by comparing cardiac output, arterial pressures, and volume kinetic parameters in 17 pigs that were administered 150 ml/kg of either 1.5% glycine or 5% mannitol by intravenous infusion over 90 minutes. RESULTS: Natriuresis appeared to be the key factor promoting hypovolemic hypotension 15-20 minutes after fluid administration ended. Excessive sodium excretion, due to osmotic diuresis caused by the irrigant solutes, was associated with high estimates of the elimination rate constant (k10) and low or negative estimates of the rate constant describing re-distribution of fluid to the plasma after translocation to the interstitium (k21). These characteristics indicated a high urinary flow rate and the development of peripheral edema at the expense of plasma volume and were correlated with reductions in cardiac output. The same general effects of natriuresis were observed for both irrigating solutions, although the volume of infused 1.5% glycine had a higher tendency to enter the intracellular fluid space. CONCLUSION: Comparisons between hemodynamics and fluid turnover showed a likely sequence of events that led to hypovolemia despite intravenous administration of large amounts of fluid. .

Irrigación ultrasónica pasiva comparada con irrigación manual en la eliminación del enterococcus faecalis del sistema de conductos (estudio in vitro) / Passive ultrasonic irrigacion compared with conventional manual irrigation in the elimination of enterococcus faecalis of duct radicular system (in vitro study)

La clave del éxito de la terapia endodóntica es la limpieza y desinfección del sistema de conductos radiculares, por esto hoy en día los diferentes sistemas de irrigación han adquirido especial importancia para disminuir la permanencia bacterias como el Enterococcus faecalis, considerado el microorganismo causante principal de los fracasos endodónticos. El propósito del estudio fué determinar la efectividad de la técnica de irrigación ultrasónica pasiva en la eliminación del Enterococcus faecalis con la técnica de irrigación manual convencional en dientes monorradiculares extraídos. En relación a la metodología la investigación se enmarcó dentro del tipo explicativo, con un diseño de experimento puro. La muestra estudiada estuvo conformada por 64 dientes monorradiculares divididos en dos grupos, 30 unidades dentarias (Ud.) con la técnica de irrigación manual, 30 Ud. con la técnica de irrigación ultrasónica pasiva, 2 controles positivos y 2 controles negativos. Para la recolección de la información se empleó la técnica de observación y como instrumento una guía de observación. Los datos fueron analizados mediante la estadística descriptiva e inferencial. En la técnica de irrigación manual convencional se logró una desinfección de 83.4% en el tercio cervical, un 33.4% en el tercio medio y el tercio apical. En la técnica de irrigación ultrasónica pasiva se logró una eliminación del 100% en el tercio cervical y medio del diente, y el 83% en el tercio apical del diente, la cual indica que la irrigación ultrasónica pasiva fué significativamente más efectiva en la eliminación del Enterococcus faecalis que la irrigación manual convencional.

The key to success in endodontic therapy is the cleaning and disinfection of the root canal system, which is why today the different irrigation systems have become particularly important to reduce the persistence of Enterococcus faecalis, considered the main causative endodontic failure. The purpose of this study was to determine the effectiveness of passive ultrasonic irrigation technique in the elimination of Enterococcus faecalis compared with conventional manual irrigation technique in single-rooted teeth extracted. Regarding the research methodology was framed within the explanatory type, with experimental design. The study sample consisted of 64 single-rooted teeth divided into two groups, 30 teeth with conventional manual irrigation technique, 30 teeth with ultrasonic irrigation technique, 2 positive and 2 negative controls. For data collection was used observation and an observation guide instrument. Data were analyzed using descriptive and inferential statistics. In the conventional manual irrigation technique is achieving a disinfection of 83.4% in the cervical third, a 33.4% in the middle third and the apical third. In the passive ultrasonic irrigation technique achieved a 100% removal in the cervical and middle third of the tooth, and 83% in the apical third of the tooth, indicating the passive ultrasonic irrigation significantly more effective in eliminating Enterococcus faecalis that manual irrigation conventional.

Neumoperitoneo secundario al lavado quirúrgico de absceso isquiorrectal con agua oxigenada / Pneumoperitoneum secondary to ischiorectal abscess surgical scrub with hydrogen peroxide

El agua oxigenada es una sustancia usada frecuentemente como un agente seguro e inocuo; sin embargo, se han descrito diversas complicaciones que establecen la voz de alarma sobre su uso. Presentamos un caso de neumoperitoneo secundario al lavado quirúrgico con agua oxigenada en un paciente con diagnóstico de absceso isquiorrectal. Ante las complicaciones observadas del uso de una sustancia tan ampliamente extendida en cirugía, debería replantearse su uso o al menos darle un empleo más restringido, en cavidades o espacios semicerrados y usar en su lugar sustancias más seguras que hasta ahora no hayan mostrado efectos tan nocivos (AU)

Hydrogen peroxide is a substance often used as a safe and harmless agent, various complications have been described that set the alarm on their use. We present a case of pneumoperitoneum secondary to surgical scrub with hydrogen peroxide in a patient with ischiorectal abscess. Given the complications of the use of a substance as widespread in surgery, we should rethink their use or at least give it more restricted use, in cavities or semi-enclosed spaces and instead use other safer chemicals (AU)

Fatores de risco para complicações perioperatórias em cirurgias endoscópicas com irrigação / Risk factors for perioperative complications in endoscopic surgery with irrigation / Factores de riesgo para complicaciones perioperatorias en cirugías endoscópicas con irrigación

JUSTIFICATIVA E OBJETIVOS: A medicina endoscópica está cada vez mais sendo usada atualmente, porém não é isenta de riscos. Portanto, este estudo avaliou os fatores associados com complicações perioperatórias em cirurgias endoscópicas com irrigação intraoperatória. MÉTODO: Estudo de coorte durante seis meses. Foram incluídos pacientes com > 18 anos, submetidos a cirurgias endoscópicas que usariam fluidos de irrigação no intraoperatório. Pacientes em uso de diuréticos, com insuficiência renal, distúrbios cognitivos, hiponatremia prévia a cirurgia, gestantes e moribundos foram excluídos. Foram alocados em dois grupos os pacientes que apresentaram complicações ou não no período perioperatório. As complicações avaliadas estavam relacionadas a alterações neurológicas, cardiovasculares, renais e sangramentos no perioperatório. RESULTADOS: Foram incluídos 181 pacientes e 39 excluídos, portanto 142 preencheram os critérios. Apresentaram complicações 21,8% dos pacientes, com maior ocorrência em cirurgias endoscópicas de próstata, seguidas de histeroscopias, bexiga, artroscopia de joelho e ombro, respectivamente 58,1%, 36,9%, 19,4%, 3,8% e 3,2%. Comparando os grupos, apresentaram associação com complicações na análise univariada; idade, sexo, tabagismo, cardiopatia, ASA, sódio sérico no fim da cirurgia, total de fluido de irrigação administrado, ressecção transuretral de próstata, histeroscopia. Entretanto, apenas idade (OR = 1,048), sódio sérico (OR = 0,962) e volume de fluido de irrigação administrado no intraoperatório (OR = 1,001) foram variáveis independentes para complicações na regressão múltipla. CONCLUSÃO: Graves complicações em cirurgias endoscópicas têm grande ocorrência. O sódio sérico no fim da operação, a quantidade de fluido de irrigação e a idade foram fortes fatores independentes associados ao problema. Dessa forma, tais fatores devem ser levados em consideração nesses tipos de cirurgias.

BACKGROUND AND OBJECTIVES: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. METHOD: A cohort study of six months duration. Patients aged > 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. RESULTS: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively). When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048), serum sodium (OR = 0.962), and volume of irrigation fluid administered during surgery (OR = 1.001) were independent variables. CONCLUSION: The incidence of serious complications in endoscopic surgeries is high. Serum sodium at the end of the operation, amount of irrigation fluid, and age were strong independent factors associated with the problem. Thus, these factors must be taken into account in these surgeries.

JUSTIFICATIVA Y OBJETIVOS: Hoy por hoy, la medicina endoscópica se usa cada vez más aunque no esté exenta de riesgos. Por eso, este estudio evaluó los factores que están asociados con las complicaciones perioperatorias en las cirugías endoscópicas con irrigación intraoperatória. MÉTODO: Estudio de cohorte durante seis meses. Se incluyeron pacientes con > 18 años, sometidos a cirugías endoscópicas que usarían fluidos de irrigación en el intraoperatorio. Pacientes que usaban diuréticos, que tenían insuficiencia renal, trastornos cognitivos, hiponatremia previa a la cirugía, gestantes y moribundos quedaron fuera del estudio. Fueron divididos en dos grupos los pacientes que tenían complicaciones o no en el período perioperatorio. Las complicaciones evaluadas estaban relacionadas con las alteraciones neurológicas, cardiovasculares, renales y con los sangramientos en el perioperatorio. RESULTADOS: Fueron incluidos 181 pacientes quedando fuera 39, por tanto 142 respetaron los criterios. Tenían complicaciones el 21,8% de los pacientes, con una incidencia mayor en las cirugías endoscópicas de próstata, seguidas de histeroscopias, vejiga, artroscopia de rodilla y de hombro, respectivamente 58,1%, 36,9%, 19,4%, 3,8% y 3,2%. Comparando los grupos, tenían una asociación con las complicaciones en el análisis univariado; edad, sexo, tabaquismo, cardiopatía, ASA, sodio sérico al final de la cirugía, total de fluido de irrigación administrado, resección transuretral de próstata, histeroscopia. Sin embargo, solamente la edad (OR = 1,048), sodio sérico (OR = 0,962) y el volumen de fluido de irrigación administrado en el intraoperatorio (OR = 1,001), fueron variables independientes para las complicaciones en la regresión múltiple. CONCLUSIONES: Las graves complicaciones en las cirugías endoscópicas tienen un gran porcentaje de incidencia. El sodio sérico al final de la operación, la cantidad de fluido de irrigación y la edad, fueron fuertes factores independientes asociados al problema. Tales factores deben ser tenidos en cuenta en esos tipos de cirugías.

Lesiones por hipoclorito sódico en la clínica odontológica: causas y recomendaciones de actuación / Sodium hypochlorite lesions in clinical dentistry: causes and recommendations for action

La irrigación durante el tratamiento endodóntico es fundamental para conseguir la limpieza adecuada del conducto. En la actualidad, el irrigante más usado, debido a sus propiedades y capacidad bactericida y de disolver tejidos, es el hipoclorito sódico, a concentraciones entre 0,5% y 5,25%. Sin embargo, es conocida su alta toxicidad cuando entra en contacto con los tejidos blandos. Los eventos adversos por hipoclorito sódico, no son muy frecuentes, aunque cuando suceden, la extrusión provoca cuadros muy aparatosos, pese a que no suelen comprometer la vida del paciente. A pesar de que existan una serie de recomendaciones cuyo fin es disminuir la incidencia de estos accidentes, no se pueden evitar completamente, por lo que además de conocer la técnica correcta, se deberá saber también el protocolo de actuación ante estos casos (AU)

Irrigation during endodontic treatment is fundamental to adequately cleanse the root canal. Currently the most commonly used irrigant, owing to its properties and its capacity to kill bacteria and dissolve tissue, is sodium hypochlorite, at concentrations of between 0.5% and 5.25%. However, sodium hypochlorite is known to be highly toxic when it comes into contact with soft tissue. Adverse events resulting from the use of sodium hypochlorite are in frequent. When they do occur the extrusion causes very complex clinical profiles, although they are not usually life threatening for the patient. A series of recommendations exists in order to reduce the occurrence of these accidents, however, they cannot be completely avoided. It is therefore important to be aware not only of the correct techniques, but also of the protocol for action in these cases (AU)

Importancia de la monitorización de la “presión intracraneal dentro del neuroendoscopio” durante el tratamiento anestésico de la cirugía neuroendoscópica. Experiencia en 101 casos / Importance of monitoring neuroendoscopic intracranial pressure during anesthesia for neuroendoscopic surgery: review of 101 cases

OBJETIVOS: El objetivo del estudio es describir la monitorización específica, el manejo anestésico, y los factores predictivos de complicaciones en la cirugía neuroendoscópica.PACIENTES Y MÉTODOS: Estudiamos retrospectivamente a los pacientes sometidos a neuroendoscopia con anestesiageneral, con monitorización del valor de la presiónen el interior del neuroendoscopio, desde 1994 hasta2003. En algunos casos se monitorizó además la velocidaddel flujo sanguíneo de la arteria cerebral mediamediante doppler transcraneal. Se registró el procedimientoquirúrgico y la aparición de complicaciones.RESULTADOS: Se incluyeron 101 pacientes, 20 conregistro de doppler transcraneal. En 75 pacientes, la presiónen el interior del neuroendoscopio presentó valoressuperiores a 20 mmHg. El 45% de los pacientes con dopplertranscraneal presentaron episodios de disminuciónde velocidad diastólica de la arteria cerebral mediadurante la irrigación ventricular. La aparición de alteracioneshemodinámicas se asoció a valores más elevadosde presión en el interior del neuroendoscopio (p < 0,05).El aumento de presión en el interior del neuroendoscopiomayor de 30 mmHg, se asoció con el aumento decomplicaciones postoperatorias, siendo la más frecuenteel retraso en el despertar. En el 58% de los casos se realizaron procedimientos quirúrgicos más complejos queuna ventriculostomía simple. En estos casos, los valores de presión en el interior del neuroendoscopio fueron máselevados comparado con las ventriculostomías simples(50,5 ± 30,9 frente a 31,8 ± 25,1 mmHg; p = 0,001) y se asociaron a una aparición de más complicaciones en elpostoperatorio (p=0,003). CONCLUSIONES: La cirugía neuroendoscópica puede provocar aumentos de presión en el interior del neuroendoscopio que se asocia a alteraciones del flujo sanguíneocerebral y la aparición de complicaciones, lo que apoya la importancia de la monitorización de la presión intracraneal y el flujo sanguíneo cerebral(AU)

OBJECTIVE: The aim of this study was to describemonitoring, anesthetic management, and risk factors forcomplications in neuroendoscopic surgery.PATIENTS AND METHODS: Patients who underwentneuroendoscopy between 1994 and 2003 under generalanesthesia, with monitoring of intracranial pressurefrom inside the neuroendoscope, were studiedretrospectively. In some patients, the blood flow rate inthe middle cerebral artery was monitored usingtranscranial Doppler ultrasound. Information wascollected related to surgical procedure and thedevelopment of complications.RESULTS: Of 101 patients included in the study,transcranial Doppler ultrasound images were availablefor 20. In 75 patients neuroendoscopic intracranialpressure exceeded 20 mm Hg. Forty-five percent of thepatients with available transcranial Doppler ultrasoundimages showed episodes of reduced diastolic flow rate inthe middle cerebral artery during ventricular irrigation.Hemodynamic instability was associated with higherneuroendoscopic intracranial pressures (P<.05). Anincrease of more than 30 mm Hg in neuroendoscopicintracranial pressure was associated with morepostoperative complications, the most common of whichwas delayed awakening. Procedures that were morecomplicated than a simple ventriculostomy wereperformed in 58% of the cases. Mean (SD)neuroendoscopic intracranial pressures in such caseswere higher (50.5 [30.9] mm Hg vs 31.8 [25.1 mm Hg] inthe simpler procedures) and the postoperativecomplication rate was higher (P=.003).CONCLUSIONS: Neuroendoscopic surgery can causesincreases in neuroendoscopic intracranial pressure thatare associated with disturbances in cerebral blood flowand complications. This situation demonstrates theimportance of monitoring intracranial pressure andcerebral blood flow(AU)

Síndrome tóxico del segmento anterior: investigación de un brote / Toxic anterior segment syndrome (TASS): studying an outbreak

Introducción: En los últimos años se ha descrito una complicación asociada a la cirugía de cataratas, el síndrome tóxico del segmento anterior. Es un proceso inflamatorio que aparece en las primeras horas tras la cirugía, de carácter no infeccioso y que generalmente se resuelve bien con corticoides tópicos si el tratamiento se instaura con prontitud. En el presente trabajo se describe este síndrome y se analizan las posibles causas de un brote que tuvo lugar en nuestro centro y que afectó a 5 pacientes. Métodos: Se creó un grupo de investigación en el centro que revisó todos los procedimientos implicados, puesto que las causas del síndrome pueden ser múltiples. Se analizaron desde los métodos de lavado y esterilización de material hasta los medicamentos y sustancias utilizadas que pudieron ser causa del brote. Entre estos últimos, se revisaron las sustancias elaboradas en el servicio de farmacia, en especial la solución salina irrigadora, utilizada en todos los casos. Resultados: Los resultados bioquímicos, microbiológicos, de pH, osmolaridad y de endotoxinas indicaron que las soluciones elaboradas en el servicio de farmacia eran correctas. Discusión: Dado que los resultados de los análisis de las sustancias empleadas eran correctos, corroborados con su reintroducción sin efecto adverso alguno, se llegó a la conclusión de que el brote más bien estaría relacionado con el proceso de lavado previo a la esterilización del instrumental utilizado en la cirugía, ya que no se estaban siguiendo las recomendaciones de uso de agua destilada y estéril para este fin, sino que, por el contrario, se estaba utilizando agua corriente de la red (AU)

Introduction: An effect associated with cataract surgery known as Toxic Anterior Segment Syndrome (TASS) has been reported in recent years. It is an inflammatory non-infectious process which appears within the first few hours after surgery and generally resolves well with topical steroids if the course of treatment is started promptly. In this paper we describe the syndrome and analyze the possible causes for the TASS outbreak that occurred in our hospital and affected 5 patients. Methods: As the syndrome may be due to multiple causes, the members of a research team created at the hospital reviewed all the procedures involved. The washing and sterilization methods applied to the materials were analyzed, as well as the drugs and substances used which might have caused the outbreak. We verified the substances prepared by the Pharmacy Department, specially the irrigating solution which was used in all the cases. Results: According to the results obtained in the biochemical, micro-biological, pH, osmolarity and endotoxins assays, the solutions prepared by the Pharmacy Department were all correct. Discussion: Since the results obtained in the analyses of the substances used were correct and no adverse effect was observed after the re-administration of the substances, we may conclude that the outbreak would be related to the washing process performed previously to the sterilization of the instrumentation used in the surgery, mainly because the recommendation to use distilled and sterile water for this purpose was not followed and, on the contrary, tap water continued to be used (AU)

Neumorretroperitoneo secundario al lavado quirúrgico de un absceso perianal con agua oxigenada / Pneumoretroperitoneum secondary to surgical lavage of a perianal abscess with hydrogen peroxide

No disponible

Acidosis metabólica y lavados gastrointestinales / Metabolic acidosis and gastrointestinal lavage

A continuación describimos un caso de acidosis metabólica en un varón de 89 años originado por lavados continuos a través de sonda nasogástrica. Posteriormente analizamos la utilidad diagnóstica y terapéutica de los lavados en la hemorragia digestiva y comentamos el diagnóstico y las peculiaridades de la acidosis metabólica en IQS mayores (AU)

Absorçäo de líquido de irrigaçäo na ressecçäo transuretral da próstata em cäes / Irrigating fluid absorption during transurethral resection of the prostate in dogs

Trinta e dois cäes submetidos a entubaçäo do ducto torácico e cateterismo bilateral dos ureteres, foram divididos em 3 grupos: A- 4 cäes inoculados com RISA 131 I ou EDTA 51 Cr por via intravenosa ou peri-prostática; B- controle de 8 cäes submetidos a irrigaçäo vesical e prostática com 8 litros de glicina a 1,2 por cento contendo os marcadores radioativos; C- 8 cäes manejados como em B mas sujeitos à RTU da próstata. Os cäes foram acompanhados por 5 horas. A absorçäo de líquido de irrigaçäo foi calculada pelos métodos volumétrico e radioisotópico. Em 5 horas, 97 por cento da RISA 131 I inoculada via intravenosa permanecia neste espaço enquanto apenas 4,6 por cento da injetada no espaço peri-prostático penetrou no compartimento vascular. Para o EDTA 51 Cr, 63,6 por cento da massa inoculada no espaço peri-prostático foi recuperada na urina após 5 horas. O método volumétrico mostrou absorçäo média de 22,7 ml no grupo B e 276 ml no C, e o radioisotópico de 6,3 ml e 165,4 ml, respectivamente. O modelo experimental tem similaridades com o ser humano