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Extracellular Fluid Accumulation Predicts Fluid Responsiveness after Hydroxyethyl Starch 70/0.5 Bolus Infusion during Major Abdominal Surgery

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Open Journal of Anesthesiology 2013年第9期3卷 413-420页

作者： Takeshi Ide Tsuneo Tatara Takahiko Kaneko Shinichi Nishi Department of Anesthesiology Hyogo College of Medicine Nishinomiya Japan Department of Intensive Care Medicine Hyogo College of Medicine Ni-shinomiya Japan

Objective: The purpose of this study was to test the hypothesis that extracellular fluid accumulation predicts fluid responsiveness after hydroxyethyl starch (HES) solution bolus infusion during major abdominal surgery. Methods: Twenty patients who underwent elective pancreaticoduodenectomy under general anesthesia were studied. Patients received 4 mL/kg boluses of Ringer’s acetate or 6% HES 70/0.5 solution over 15 min in random order when urine output decreased below 1.0 mL/kg/h. Stroke volume variation (SVV) and stroke volume index (SVI) were measured using the FloTracTM/VigileoTM system at pre-bolus, 15, 30, and 60 min after initiating bolus infusion. The percent change in pre-bolus extracellular fluid volume relative to that at the skin incision for arm (ΔVECF) was measured by bioelectrical impedance. Prediction of fluid responsiveness (an increase in SVI of ≥5%) by pre-bolus SVV or pre-bolus ΔVECF was tested by calculating the area under the receiver operating characteristic curve (AUC). Results: Fluid bolus infusions in this study consisted of 61 Ringer’s acetate infusions and 62 HES infusions. The best AUCs for identifying fluid responsiveness were seen with pre-bolus ΔVECF for HES at 30 min and 60 min (AUC = 0.74, P = 0.022;AUC = 0.74, P = 0.0054, respectively). Optimal threshold values of pre-bolus ΔVECF for predicting fluid responsiveness were 6.5% for 30 min (sensitivity: 78%, specificity: 58%) and 7.7% for 60 min (sensitivity: 56%, specificity: 76%). Conclusion: Extracellular fluid volume predicts fluid responsiveness after HES solution bolus infusion during major abdominal surgery. Substantial fluid responsiveness is observed upon increased accumulation of extracellular fluids.

关键词： Plasma expanders Blood Volume Fluid Therapy Abdominal Surgery

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Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

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World Journal of Clinical Oncology 2014年第3期5卷 478-494页

作者： Alexandre Mendon?a Munhoz Eduardo Montag José Roberto Filassi Rolf Gemperli Division of Plastic Surgery Hospital Sírio-LibanêsS?o PauloSP 01239-040Brazil Cancer Institute of S?o Paulo University of S?o Paulo School of Medicine S?o PauloSP01246-903Brazil Plastic Surgery Division University of S?o Paulo School of MedicineS?o PauloSP 01246-903Brazil

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to defi

关键词： Breast reconstruction Skin-sparing mastectomy Nipple-sparing mastectomy Outcome Complications Silicone breast implants Tissue expanders Oncoplastic surgery

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