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The choice of fluid resuscitation in Traumatic Hemorrhagic shock (THS) remains a critical aspect of patient management. Bicarbonated Ringers solution (BRS) has shown promise due to its composition resembling human Extracellular Fluid and its potential benefits on hemodynamics. To evaluate the efficacy, mortality rates, hemodynamic effects, and adverse outcomes of Sodium Bicarbonate Ringer's Solution in the treatment of hemorrhagic shock, as compared to other relevant interventions. A comprehensive examination of the available literature was performed by conducting systematic searches in prominent databases such as Cochrane, EMBASE, MEDLINE, and PubMed. The process employed predefined criteria to extract relevant data and evaluate the quality of the studies. The outcome measures considered encompassed survival rates, mortality, mean arterial pressure (MAP), heart rate (HR), and adverse events. The meta-analysis of three studies showed that compared to the other crystalloids, the use of BRS had an odds ratio for survival of 1.86 (95% CI: 0.94, 3.71; p = 0.08; I2 = 0%), an odds ratio for total adverse events of 0.14 (95% CI: 0.06, 0.35; p < 0.0001; I2 = 22%), a mean difference in heart rate of −4.49 (95% CI: −7.55, −1.44; p = 0.004; I2 = 13%), and a mean difference in mean arterial pressure of 2.31 (95% CI: −0.85, 5.47; p = 0.15; I2 = 66%). BRS demonstrated a significant reduction in complications, including adult respiratory distress syndrome (ARDS), Multiple Organ Dysfunction (MODS), and Total Adverse Effects, when compared to other solutions in the treatment of THS. Additionally, THS patients resuscitated with BRS experienced a notable decrease in heart rate. The findings suggest BRS may contribute to organ stability and potential survival improvement due to its similarity to human Extracellular Fluid and minimal impact on the liver. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate the clinical value of emergent triglyceride (TG)-lowering therapies for hyperlipidemic acute pancreatitis (HLAP). 126 HLAP patients were assigned randomly to receive either conventional treatment (CT), normal saline (NS) alone, or continuous veno-venous hemofiltration (CVVH) as an intensive TG-lowering therapy. TG levels, clinical outcomes, and inflammatory biomarkers were compared among the three groups. Baseline characteristics did not differ significantly among the groups. CVVH removed TG from the plasma and achieved its target TG (<500 mg/dL) in approximately 25 h, compared to 40 h in the NS alone group and no targeted effect within 48 h in the CT group (P < 0.05). Although the majority of clinical outcomes did not differ significantly, an unexpectedly higher incidence of organ failure occurred in the CVVH group compared to the others. Hospital costs, severe AP patients and length of stay were significantly higher in the CVVH group compared to the other groups (P < 0.005). Early CVVH lowers TG levels more efficiently than NS alone or CT therapy, but is not superior in terms of clinical outcomes and costs. NS also lowers TG levels and is significantly less costly than the other two treatments. Further multicenter studies are needed to determine the feasibility of NS alone treatment for HLAP patients. [ABSTRACT FROM AUTHOR]

Recipient safety measures play a key role in overall transfusion efficacy. The key advances in safety over the first century of transfusion medicine have been the development of techniques to prevent hemolytic transfusion reactions, hemolytic disease of the newborn and transmission of viral pathogens. While these risks remain important, they affect many fewer patients than previously. We propose that some of the most important current safety issues relate to toxicities broadly encompassed by the immunomodulatory effects of allogeneic transfusion. These include (1) universal leukoreduction to mitigate nosocomial infections, inflammation and organ injury, (2) removal of stored supernatant and its attendant toxic contents that cause dysfunctional immunity and organ injury, (3) avoiding infusing ABO incompatible antigen and antibody that can lead to bleeding, platelet refractoriness and inflammation, (3) minimizing prophylactic transfusions (particularly of plasma and platelets) except where benefit is proven, and (4) avoiding use of normal saline which is linked to renal failure and possibly hemolysis. Accompanying these safety measures will be the continued growth of one of the most important safety measures, patient blood management, which has as one benefit the avoidance of unnecessary and harmful transfusions. Reducing the toxicity of transfusions will enhance the improved clinical outcomes seen with patient blood management. [ABSTRACT FROM AUTHOR]

Background: Prevention of surgical site infection (SSI) after gastrectomy has received increasing attention. Prophylactic incisional wound irrigation has been advocated to reduce SSI, but the choice of solution remains under debate.Aims: To compare the efficacies of wound irrigation with normal saline (NS) and povidone-iodine (PVI) for the prevention of SSI after gastrectomy, and to identify the risk factors for SSI.Methods: This randomized, single-centre clinical trial included 340 patients with gastric cancer. They were assigned at random into two groups (ratio 1:1) to receive either 0.9% NS or 1.0% PVI solution for incisional irrigation before wound closure. The primary endpoint was postoperative SSI within 30 days of gastrectomy, and the secondary endpoint was the length of hospital stay.Findings: In total, 333 patients were included in the modified intent-to-treat group, and the SSI rate did not differ significantly between the PVI group (11/167, 6.59%) and the NS group (9/166, 5.42%) [odds ratio (OR) 1.131, 95% confidence interval (CI) 0.459-3.712; P=0.655]. Moreover, the difference between the two groups in terms of length of hospital stay was not significant (P=0.301). Body mass index (BMI) (OR 2.639, 95% CI 1.040-6.694; P=0.041) and postoperative complications (OR 2.565, 95% CI 1.023-6.431; P=0.045) were identified as independent risk factors for SSI.Conclusions: NS and PVI had similar efficacy as prophylactic wound irrigation for the prevention of SSI after gastrectomy. The risk of SSI was higher in patients with high BMI or postoperative complications. [ABSTRACT FROM AUTHOR]

Recent studies have evaluated and compared the efficacy of normal saline (NS) and lactated Ringer's (LR) in reducing the severity of acute pancreatitis (AP) and improving outcomes such as length of stay, the occurrence of the systemic inflammatory response syndrome (SIRS), ICU admission and mortality. We performed an updated systematic review and meta-analysis of the available studies to assess the impact of these fluids on outcomes secondary to AP. We systematically searched the following databases: PubMed/Medline, Embase, Cochrane, and Web of Science through February 8th, 2021 to include randomized controlled trials (RCTs) and cohort studies. Random effects model using DerSimonian-Laird approach was employed and risk ratios (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated for binary and continuous outcomes, respectively. 6 studies (4 RCTs and 2 cohort studies) with 549 (230 in LR and 319 in NS) were included. The overall mortality (RR: 0.73, CI: 0.31–1.69) and SIRS at 24 h (RR: 0.69, CI: 0.32–1.51) was not significantly different. The overall ICU admission was lower in LR group compared to NS group (RR: 0.43, CI: 0.22–0.84). Subgroup analysis of RCTs demonstrated lower length of hospital stay for LR group compared to NS group (MD: 0.77 days, CI: 1.44 –0.09 days). Our study demonstrated that LR improved outcomes (ICU admission and length of stay) in patients with AP compared to NS. There was no difference in rate of SIRS development and mortality between LR and NS treatments. [ABSTRACT FROM AUTHOR]

Fluid resuscitation is a fundamental component of the management of critically ill patients, but whether choice of crystalloid affects patient outcomes remains controversial. Therefore, we performed this meta-analysis to compare the efficacy and safety of balanced crystalloids with normal saline. We searched the MEDLINE, Cochrane Central and EMBASE up to October 2018 to identify randomized controlled trials (RCTs) that compared balanced crystalloids versus normal saline in critically ill patients. The primary outcome was mortality. The secondary results were the incidence of acute kidney injury (AKI) and risk of receiving renal replacement therapy (RRT). Two authors independently screened articles based on the inclusion and exclusion criteria. The meta-analysis was conducted using Revman 5.3, trial sequential analysis (TSA) 0.9 and STATA 12.0. Nine RCTs were identified. The pooled analyses showed that there were no significant differences in mortality (relative risk (RR) = 0.93, 95% confidence interval (CI) = 0.86, 1.01, P = 0.08), incidence of AKI (RR 0.94, 95% CI 0.88, 1.00, P = 0.06) or RRT use rate (RR 0.94, 95% CI 0.69, 1.27, P = 0.67) between balanced crystalloids and normal saline groups. However, TSA did not provide conclusive evidence. Among critically ill patients receiving crystalloid fluid therapy, use of a balanced crystalloid compared with normal saline did not reduce the mortality, risk of severe AKI or RRT use rate. Further large randomized clinical trials are needed to confirm or refute this finding. A protocol of this meta-analysis has been registered on PROSPERO (registration number: CRD42018094857). [ABSTRACT FROM AUTHOR]

Periprocedural intravenous hydration is suggested to decrease the risk of post-ERCP pancreatitis (PEP). However, quality of evidence supporting this suggestion remains poor. Here we hypothesized that aggressive hydration(AH) could be an effective preventive measure. Pubmed, EMBASE, CINAHL, Google Scholar, Clinical Trials. gov, Clinical Key, International Standard Randomized Trial Number registry as well as secondary sources were searched through January 2019 to identify randomized controlled studies comparing AH to standard hydration (SH) for prevention of PEP. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using the random-effects model. RevMan 5.3 was used for analysis. A total of 9 RCTs, with 2094 patients, were included in the meta-analysis. AH reduced incidence of PEP by 56% compared to SH (OR = 0.44, CI:0.28–0.69; p = 0.0004). The incidence of post-ERCP hyperamylasemia also decreased with AH compared to SH (OR = 0.51; p = 0.001). Length of stay decreased by 1 day with AH (Mean Difference (MD): −0.89 d; p = 0.00002). There was no significant difference in adverse events related to fluid overload between two groups (OR:1.29; p = 0.81) and post-ERCP abdominal pain (OR:0.35; p = 0.17). Numbers of patient to be treated with AH to prevent one episode of PEP was 17. Final results of the meta-analysis were not affected by alternative effect measures or statistical models of heterogeneity. Aggressive hydration is associated with a significantly lower incidence of PEP and it appears to be an effective and safe strategy for the prevention of Post ERCP pancreatitis. [ABSTRACT FROM AUTHOR]

We present a case of severe hypokalemia, metabolic acidosis, and arrhythmia after absorption of 2500 mL normal saline during a hysteroscopic myomectomy. The patient was a 36-year-old woman with abnormal uterine bleeding caused by a submucosal leiomyoma. She received a total of 3500 mL normal saline (2500 mL was absorbed via the uterus and 1000 mL given intravenously) during hysteroscopy. This resulted in hemodilution, electrolyte disturbances, and arrhythmia. She was treated with electrolyte replacement and closely monitored. Normal saline may result in severe metabolic derangements caused by hemodilution and hyperchloremic metabolic acidosis when used as a hysteroscopic distension medium even when adhering to the American Association of Gynecologic Laparoscopists guidelines. [ABSTRACT FROM AUTHOR]

Intravenous maintenance fluids are life sustaining and form one of the cornerstones of paediatric in-patient management. Similar to other medical therapies fluids come with side effects and the potential for significant associated morbidity and mortality. An appreciation of their side effect profiles in the context of paediatric physiology, particularly during critical illness, is essential in order to minimise the risks. This article summarises the history of paediatric fluid prescribing practice, highlighting the associated iatrogenic risks and provides a strategy for safer practice. [ABSTRACT FROM AUTHOR]

Background/Objectives Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy. Methods We performed a randomized controlled trial in patients with acute pancreatitis. The patients were randomized into two groups. Each group received Normal Saline solution (NSS) or Lactated Ringer's solution (LRS) through a goal-directed fluid resuscitation protocol. Systemic inflammatory response syndrome (SIRS) at 24 and 48 h, mortality, presence of local complications and inflammatory markers were measured. Results Forty-seven patients were included. Twenty-four patients (51%) received NSS and 23 patients received LRS. There was significant reduction in SIRS after 24 h among subjects who resuscitated with LRS compared with NSS (4.2% in NSS, 26.1% in LRS, P = 0.02). However, SIRS reduction at 48 h was not different between groups (33.4% in NSS, 26.1% in LRS, P = 0.88). Mortality was not different between NSS and LRS (4.2% in NSS, 0% in LRS, P = 1.00). CRP, ESR and procalcitonin increased at 24 h and 48 h after admission with no difference between the two groups. Local complications were 29.2% in NSS and 21.7% in LRS (P = 0.74). The median length of hospital stay was not significantly different in the two groups (5.5 days in NSS, 6 days in LRS, P = 0.915). Conclusions Lactated Ringer's solution was superior to NSS in SIRS reduction in acute pancreatitis only in the first 24 h. But SIRS at 48 h and mortality were not different between LRS and NSS. [ABSTRACT FROM AUTHOR]

Background and aims Development of high-performance submucosal injection materials (SIMs) contribute to the advancement of endoscopic therapy for early-stage gastrointestinal neoplasms. This study aimed to develop a new ex vivo model that mimics the human gastrointestinal tract to evaluate the performance (the height and duration of the submucosal elevation) of various SIMs in detail. Methods A new ex vivo model that applies a constant tension to the tested specimen (the porcine gastric specimen) was developed. SIMs were injected into the submucosa at the center or edge of the tested specimen, and submucosal elevation heights (SEHs) were measured over time. Results The average value and standard deviation of SEH determined using the conventional model (the tested specimen was fixed with pins) were higher than those obtained using the new model, which showed that the new model could precisely measure the SEH of a given SIM. In addition, the performance (SEH) of SIMs decreased with increasing tension applied to the specimen, suggesting that the performance of SIMs deteriorates with the over-expansion of the gastrointestinal tract. The submucosal elevation formed at the specimen edge disappeared faster than that formed at the specimen's center. Conclusions The proposed new ex vivo model allows accurate SEH measurement under uniform conditions and detailed comparison of the performances of various types of SIMs and can contribute to the development of high-performance materials. [ABSTRACT FROM AUTHOR]

The management of central venous catheter (CVC) occlusion remains an area without clear evidence-based guidelines. Studies have been conducted that compare the use of heparin and normal saline for reducing thrombosis, but the evidence is not strong enough to suggest a significant advantage of one over the other. Therefore, the study aimed to assess the effectiveness of heparin and normal saline flushing in preventing CVC occlusion in pediatric patients with cancer. A comprehensive search was conducted in PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Embase, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov platform using specific keywords. The search was conducted until March 2022. Five randomized controlled trials are included in this study. Five studies with a total of 316 pediatric cancer patients met the inclusion criteria. The studies were found to be heterogeneous due to variations in the types of cancer, heparin concentration, flushing frequency of CVCs, and methods used to measure occlusion. Despite these differences, there was no significant difference in the effect of flushing with heparin and normal saline in preventing CVC occlusion. The analysis revealed that normal saline is as effective as heparin in preventing CVC occlusion among pediatric cancer patients. This systematic review and meta-analysis demonstrated that there is no significant difference between the use of heparin and normal saline flushing in preventing CVC occlusion among pediatric cancer patients. Considering the potential risks of heparin, the use of normal saline flushing may be recommended to prevent CVC obstruction. [ABSTRACT FROM AUTHOR]

Background: Current guidelines for the management of patients with severe sepsis and septic shock recommend crystalloids as the initial fluid solution of choice in the resuscitation of these patients. In recent years, there have been numerous studies published on the type of fluid used in the resuscitation of patients with sepsis. The primary goal of this article is to determine the preferred intravenous fluid for the resuscitation of patients with severe sepsis and septic shock.Methods: A MEDLINE literature review was completed to identify studies that investigated the type of resuscitation fluid in the management of patients with severe sepsis and septic shock. Articles included were those published in English between 2011 and 2016, enrolled human subjects, and limited to the following types: randomized controlled trial, prospective observational trial, retrospective cohort trial, and meta-analyses. All selected articles then underwent a structured review by the authors.Results: Nine thousand sixty-two articles were identified in the search. After use of predetermined criteria, 17 articles were selected for review. Eleven of these were original investigations and six were meta-analyses and systemic reviews.Conclusion: Crystalloids are the preferred solution for the resuscitation of emergency department patients with severe sepsis and septic shock. Balanced crystalloids may improve patient-centered outcomes and should be considered as an alternative to normal saline, if available. There is strong evidence that suggests semi-synthetic colloids decrease survival and should be avoided. The role of albumin in the resuscitation of patients with severe sepsis and sepsis is uncertain. [ABSTRACT FROM AUTHOR]

Background and objectives The lay open technique is well established as an efficient treatment for chronic sacrococcygeal pilonidal sinus, but the postoperative care of the laid open wound is not well studied. In our study, we aim to evaluate four wound care methods that we used in our protocol to treat chronic sacrococcygeal pilonidal sinus by the lay open technique. Materials and methods A retrospective cohort study of 800 patients with chronic sacrococcygeal pilonidal sinus who accepted the lay open procedure was done. Postoperative care consisted of four methods: sitz bath three times daily at home (using warm water and 20 g salt for 10 minutes), normal saline cleaning three times daily at home, povidone iodine cleaning three times daily at home, and 3% hydrogen peroxide cleaning three times daily at home. Results No major side effects related to the material used in the wound care requiring surgical, medical intervention, or necessitating change of method were reported by any patient. The recurrence rate was zero (0%) in the hydrogen peroxide and the povidone iodine group after five years follow-up, while it was (1%) in the sitz bath group, and (2.5%) in the normal saline group. Conclusion The lay open technique could successfully achieve a zero (0%) recurrence rate with a very low rate of postoperative complications. Special consideration should be attributed to the wound care methods and materials used because they play a major role in the outcome. Hydrogen peroxide showed a superior wound care efficacy. [ABSTRACT FROM AUTHOR]

Endothelial cell activation and injury is common after hematopoietic stem cell transplant (HSCT) and is associated with many post-transplant complications. An underexplored mechanism of endothelial cell damage in this population is the infusion of normal saline (NS, 0.9 % sodium chloride) and other crystalloids, as NS use is associated with adverse outcomes in other patient populations. We hypothesized that the infusion of unbalanced crystalloids during HSCT may lead to changes in biomarkers commonly associated with red blood cell (RBC) hemolysis in patients before and after infusion, and that markers of endothelial and end-organ damage during admission may be associated with markers of hemolysis and total crystalloid use. Samples were collected from 97 patients. From pre-fluid infusion to post-fluid infusion, mean haptoglobin decreased (11.7 ug/ml vs 8.4 ug/ml; p < 0.0001), hemopexin decreased (549 vs 512 μg/ml; p = 0.005), and red cell distribution width (RDW) decreased (15.7 vs 15.6; p = 0.0009). During admission (mean 19.4 days, SD 9.9), all markers of tissue and organ damage, including mean creatinine, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), total bilirubin, AST, and ALT, increased from admission to peak levels (p < 0.0001). On linear regression, fluid volume (ml/kg) of crystalloid infusion positively predicted post-fluid infusion cell-free hemoglobin (r(96) = 0.34, p < 0.0001), free heme (r(96) = 0.36, p < 0.0001), and peak LDH during admission (r(75) = 0.23, p = 0.041), and negatively predicted post-fluid infusion hemopexin (r(96) = − 0.34, p < 0.0001). Unbalanced crystalloids may contribute to hemolysis and endothelial damage in HSCT patients. Alternatives such as buffered crystalloid solutions (PlasmaLyte, Lactated Ringer's) may be worth investigating in this population. • Unbalanced crystalloids (e.g., NS) are commonly used in HSCT. • Crystalloids may be associated with hemolysis and immune dysfunction. • Markers of hemolysis significantly changed pre- to post-crystalloid infusion. • Crystalloid volume was associated with greater hemolysis and endothelial damage. • Alternatives like buffered solutions may be considered in the HSCT population. [ABSTRACT FROM AUTHOR]

Background Povidone-iodine is a broad spectrum antiseptic irrigation solution which has been used in wound management processes for decades but some recent studies have questioned its superiority to normal saline and even tap water in decreasing the infection rate in different types of wounds. Objective This study compares the efficacy and safety of diluted povidone-iodine solution with normal saline as in decreasing the infection rate in simple traumatic wounds repaired in emergency department. Method Patients with simple traumatic were included and randomly allocated to 2 groups. In 223 patients, wounds were irrigated with 1% povidone-iodine solution. In the other 223 patients, wounds were irrigated with 0.9% normal saline solution. Wound infection rates were compared by assessing the signs and symptomsof infection including cellulitis, abscess, lymphangitis and pus formation. Result Infectious complications were seen in 29 of 446 (7.4%) patients (15 in povidone-iodine versus 14 in normal saline groups). Nineteen (7.91%) patients in povidone-iodine group and 13 (6.68%) patients in normal saline group showed the evidences of infection in follow up visits. There was no statistically significant difference between infection rates in two studied groups (p = 0.86). Conclusion Irrigation with 1% Povidone-iodine did not increase or decrease the infection rate in traumatic wounds compared to wound irrigation with 0.9% saline solution. [ABSTRACT FROM AUTHOR]

Purpose Our aim was to determine the non-inferiority of normal saline flushing compared to heparin flushing in maintaining the patency of totally implanted venous access devices (TIVADs). Method Four hundred and thirty patients were recruited from 14 Italian centres. Patients were randomized to heparin group or to normal saline group. The primary outcome of the study was TIVAD occlusion. Results After randomisation, 203 patients were assigned to normal saline group and 212 to heparin group. Median follow up time was 204 days in normal saline group and 294 in the heparin group. We observed 24 withdrawal occlusions (5.78%): 10 in the heparin group and 14 in the normal saline group. One total occlusion was observed in the normal saline group. Taking as reference the arm treated with heparin, the absolute risk difference was 2.67 with the 90% CI including the non – inferiority margin of 4%. No significant difference between hazards of occlusion was found. Conclusions This study failed to demonstrate that normal saline flushing is not inferior to heparin flushing, even if a significant difference between the two treatments was not found. The use of heparin is controversial and other prospective trials are necessary in this field. Trial registration EudraCT number: 2009-013620-22. [ABSTRACT FROM AUTHOR]

Objective To compare the incidence of postoperative pain after the use of calcium hydroxide powder mixed with normal saline or 0.2% chlorhexidine digluconate as intracanal medicament. Participants Fifty-five subjects aged 17–60 years with teeth diagnosed to have apical periodontitis. Intervention Two-visit conventional root canal treatment of seventy teeth. The teeth were divided by randomization (balloting) into two groups: control group and experimental group, each with thirty-five teeth treated with calcium hydroxide mixed with normal saline or with 0.2% chlorhexidine digluconate as intracanal medicament respectively. Incidence of postoperative pain was assessed using the universal pain assessment tool and whether or not analgesic was taken. Main outcome measured Incidence of post-operative pain. Result Postoperative pain occurred only at 1-day and 1-week reviews. In the control group, the overall incidence of pain was the same at both review periods (5.7%), while the experimental group showed a slight decrease in incidence between 1-day (17.2%) and 1-week (11.4%) reviews. Incidence of flare-ups was more in the experimental group (11.4%) than in the control group (5.7%). No significant statistical differences between the two groups were observed ( p > 0.05). Conclusion The incidence of postoperative pain was lower in the normal saline treatment group, but the difference was not statistically significant. [ABSTRACT FROM AUTHOR]

This article reviewed selected research highlights of 2013 that pertain to the specialty of cardiothoracic and vascular anesthesia. The first major theme is the commemoration of the sixtieth anniversary of the first successful cardiac surgical procedure with cardiopulmonary bypass conducted by Dr Gibbon. This major milestone revolutionized the practice of cardiovascular surgery and invigorated a paradigm of mechanical platforms for contemporary perioperative cardiovascular practice. Dr Kolff was also a leading contributor in this area because of his important contributions to the refinement of cardiopulmonary bypass and mechanical ventricular assistance. The second major theme is the diffusion of echocardiography throughout perioperative practice. There are now guidelines and training pathways to guide its generalization into everyday practice. The third major theme is the paradigm shift in perioperative fluid management. Recent large randomized trials suggest that fluids are drugs that require a precise prescription with respect to type, dose, and duration. The final theme is patient safety in the cardiac perioperative environment. A recent expert scientific statement has focused attention on this issue because most perioperative errors are preventable. It is likely that clinical research in this area will blossom because this is a major opportunity for improvement in our specialty. The patient care processes identified in these research highlights will further improve perioperative outcomes for our patients. [Copyright &y& Elsevier]

Objective: To assess the effect of distension medium on pain during outpatient hysteroscopy. Design: Systematic review and meta-analysis. Setting: Outpatient hysteroscopy clinics. Patient(s): Women undergoing outpatient hysteroscopic examination. Intervention(s): Use of normal saline versus carbon dioxide as distension medium for outpatient hysteroscopy. Main Outcome Measure(s): Pain scores. Result(s): There was no statistically significant difference in pain scores when carbon dioxide or normal saline were used as the distension medium for outpatient hysteroscopy (standardized mean differences = –0.05; 95% CI, –0.17 to 0.07; I2 = 92%). Conclusion(s): Carbon dioxide and normal saline are both suitable distending media for outpatient hysteroscopy as the procedural pain is comparable and the views obtained are satisfactory. However, normal saline does confer advantages that may make it more suitable for clinical use. [Copyright &y& Elsevier]

Objective: To compare two distension media, carbon dioxide (CO2) and saline, with regards to patient discomfort and the adequacy of the panoramic view in diagnostic hysteroscopy by the vaginoscopic approach. Design: Randomized prospective study. Setting: Tertiary referral centers for gynecologic care. Patient(s): 264 patients randomly allocated to two groups: CO2 (132 women) and normal saline (132 women). Intervention(s): Office hysteroscopy performed with a forward-oblique 30° telescope (total diameter 5.1mm) and CO2 as the distension medium or with a forward-oblique 30° telescope (final diameter 5.1mm) and saline solution as the distension medium. Main Outcome Measure(s): Global operative time, pain experienced by patients using a visual analogue scale (VAS), severity of the pain (VAS), incidence of collateral effects (shoulder-tip pain, nausea, or dizziness), degree of difficulty, and view (VAS). Result(s): Pelvic discomfort was comparable between groups, without statistically significant differences in intensity or degree of difficulty. However, the visual quality was statistically significantly higher when hysteroscopy was performed with CO2 as the distension medium. Conclusion(s): No relevant difference in pain or technical difficulty was found between the two distension media, but CO2 was associated with better quality visualization. [ABSTRACT FROM AUTHOR]

Abstract: Background: Peritoneal adhesions are the most common complication of the abdominal surgery. Normal saline is frequently used to rinse the peritoneal cavity during abdominal surgery, although there is no well-established data describing effect of such procedure on the process of formation of peritoneal adhesions. Methods: Effect of 0.9% NaCl solution on viability, oxidative stress, and fibrinolytic activity of human peritoneal mesothelial cells maintained in in vitro culture was evaluated. Results: Exposure of mesothelial cells to 0.9% NaCl induces oxidative stress, derangement of their structure with subsequent increased release of tissue factor (+75%) and plasminogen activator inhibitor-1 (+19%), and simultaneous suppression of tissue plasminogen activator release (−39%). In effect, ration tissue plasminogen activator/plasminogen activator inhibitor-1 was reduced in 0.9% NaCl-treated cells by 50%. Pretreatment of cells with precursor of glutathione synthesis: l-2-oxothiazolidine-4-carboxylic acid prevented these changes. Conclusions: Oxidative stress in the peritoneal mesothelium caused by 0.9% NaCl activates their procoagulant activity and impairs fibrinolytic properties of these cells. These effects disqualify 0.9% NaCl as rinsing solution during abdominal surgery. [Copyright &y& Elsevier]

Keywords: Normal saline; Albumin; Blood transfusion; Crystalloid; Colloid; Individualise; Personalise; Heterogeneous EN Normal saline Albumin Blood transfusion Crystalloid Colloid Individualise Personalise Heterogeneous 753 754 2 12/10/20 20201201 NES 201201 Intravenous fluids represent one of the most commonly used interventions in intensive care unit (ICU) patients. Just as we do not give the same antibiotic to all patients but choose the most appropriate based on individual patient factors, so we should select the most suitable type of fluid for each patient. [Extracted from the article]

: BackgroundCholestasis and endotoxemia have been demonstrated to cause hepatocyte apoptosis through caspase-mediated pathways. In vitro nitric oxide (NO) donors reduce hepatocyte apoptosis and caspase activation in several models. The nitric oxide donor molsidomine improves survival in an in vivo model of endotoxemia. We tested the effect of molsidomine on survival and hepatocyte apoptosis in a model of obstructive jaundice and endotoxemia.: Study designSprague-Dawley rats underwent common bile duct ligation on day 1. On day 3, animals were given either 100 mg/kg of molsidomine or an equivalent volume of saline, and 30 minutes later they were given endotoxin 3 mg/kg or 10 mg/kg intravenously. Animals were sacrificed 4 or 16 hours after endotoxin injection. Serum samples were analyzed for alanine aminotransferase and frozen liver samples were analyzed for caspase 3 activity. Paraffin-embedded liver sections were assayed for apoptosis using the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling assay. Survival was measured in a separate experiment in which animals underwent the same protocol, but were given three different doses of endotoxin and were observed for 72 hours before sacrifice.: ResultsAt endotoxin 3 mg/kg, the 72-hour survival in saline-treated animals was 92%, which decreased to 45% at 10 mg/kg and to 29% at 15 mg/kg. All of the molsidomine-treated animals survived all endotoxin doses. Alanine aminotransferase was reduced in molsidomine-treated animals compared with those treated with saline. Apoptosis was attenuated in molsidomine-treated animals. Caspase 3 activity was decreased in molsidomine-treated animals compared with those given saline.: ConclusionsMolsidomine attenuates caspase activation and hepatocyte apoptosis and improves survival after cholestatic endotoxic injury. [Copyright &y& Elsevier]

: ObjectiveTo compare CO2 and normal saline as distention medium in diagnostic hysteroscopy.: DesignProspective randomized study.: SettingUniversity-based artificial insemination and sterility center in Italy.: Patient(s)Seventy-four women who underwent hysteroscopy.: Intervention(s)Hysteroscopy was performed with CO2 or normal saline.: Main outcome measure(s)Quality of intrauterine images, cervical dilatation, local anesthesia, and duration of the test. In addition, each patient evaluated pain during and after the examination, irritation of the phrenic plexus, analgesic use, and side effects.: Result(s)The quality of the hysteroscopic image was statistically similar for both media. Dilatation of the cervical canal and use of local anesthesia was more often necessary in the CO2 group. The procedure time was 5.96 ± 1.55 minutes in the CO2 group and 3.12 ± 0.96 in the normal saline group. The CO2 group reported pain more frequently during and after the examination, shoulder pain, greater analgesic use, and more side effects.: Conclusion(s)For hysteroscopy, normal saline is technically equal to CO2 in terms of image quality and ease of use but offers more advantages. Hysteroscopy with normal saline is more acceptable to patients, quicker to perform, and entails fewer additional procedures. [Copyright &y& Elsevier]

: ObjectiveTo evaluate the satisfaction rate, efficacy, and complication rate of carbon dioxide (CO2) versus normal saline as a uterine distension medium for outpatient diagnostic vaginoscopic hysteroscopy in infertile patients.: DesignProspective, randomized multicenter study.: SettingHysteroscopy units in two university hospitals and in a private center.: Patient(s)One hundred eighty-nine infertile women undergoing outpatient hysteroscopy.: Intervention(s)Outpatient hysteroscopy was performed with CO2 (group A) or normal saline (group B) and with endometrial biopsy when indicated.: Main outcome measure(s)Quality of the visualization of the uterine cavity, procedure time, complications, patient discomfort, and satisfaction rate.: Result(s)Significantly lower abdominal and shoulder tip pain and a lower incidence of vasovagal reactions were observed in group B in comparison with group A. A higher satisfaction rate and a lower operative time were obtained in the normal saline group in comparison with the CO2 group. Moreover, group A required significantly more analgesics after the procedure than group B.: Conclusion(s)Uterine distension with normal saline seems to have less adverse effects and is better tolerated by patients. Moreover, it allows operative procedures to be performed with the new bipolar instruments. [Copyright &y& Elsevier]

: ObjectiveTo assess the efficacy and safety as a diagnostic and interventional outpatient procedure of microhysteroscopy using the coaxial bipolar electrode system (Versascope, Versapoint Electrosurgical System; Gynecare Inc., Menlo Park, CA) with normal saline solution as an irrigation medium.: DesignAnalysis of 151 cases of diagnostic and interventional procedures.: SettingUrban tertiary care center and teaching hospital.: Patient(s)One hundred fifty-one women of reproductive age.: Intervention(s)Apart from diagnostic procedures, operative procedures were carried out microhysteroscopically with the coaxial bipolar electrode system.: Result(s)Of the 151 patients who underwent the procedures, 94 received diagnostic microhysteroscopies, and 11 underwent the procedure for synechiotomy, 18 for polypectomy, 3 for submucus myoma resections, 7 for tubal cannulations, 5 for incomplete septal resection, 5 for endometrial ablation, and 8 for complete septal resection out of which 1 was completed with a 27F resectoscope using a knife monopolar electrode. All the patients were discharged the same day as admission.: Conclusion(s)Use of a microhysteroscope with the coaxial bipolar electrode system is an effective alternative for carrying out diagnostic as well as operative microhysteroscopies. Although the field of vision is limited, with experience nearly all the procedures of hysteroscopy can be carried out as outpatient procedures using normal saline as the irrigation medium, thus avoiding the complications of glycine. [Copyright &y& Elsevier]

Wound irrigation is described as the flow of a solution through an exposed fracture surface to reduce the microbial colonization, to remove apparent foreign particles and wound exudates.. While recent literature and various in-vitro and in-vivo trials have cleared some clouds of doubt from the mind, it still remains a topic of debate. Normal saline remains the standard irrigation solution as it is non tissue toxic and has the same tonicity as body fluids. The quantity and duration of washing though is not standardized and is the surgeon's choice. This adds to the dilemma in the minds of the surgeon, with the timing of the debridement and the duration of wound irrigation depending on the surgeon's discretion. Future studies should aim to regulate the duration of the wound irrigation besides guiding about the ideal fluid volume to be used for the irrigation. Further, secondary end-points like the duration of hospital stay, rate of infections and use of hospital resources, should be computed to know about the adequacy of the wound debridement and irrigation. Antimicrobial solutions can kill microorganisms in the wound but are toxic to the host tissues as well, which limits their use. In addition, pulsatile (high pressure) lavage has not been seen to increase overall effectiveness. Recent research trials have found cumulative use of innovative solutions like phenols and EDTA along with enzymes to be encouraging though large randomized controlled trials are lacking. [ABSTRACT FROM AUTHOR]

Streptococcus equi subsp. equi causes strangles in horses. Sampling to detect carriers is important for the control of the disease, and maximizing the sensitivity of this procedure is necessary. To provide a basis for the choice of sampling solution and transport temperature for samples, comparisons were made between the survival of Streptococcus equi subsp. equi in normal saline versus phosphate-buffered saline and at two different temperatures (cold and room temperature). At present, normal saline is used to sample the nasopharynx as well as the guttural pouches, and the sampling solution is transported without special cooling. The results revealed no significant difference in bacterial concentration levels between the two sampling solutions, but a significantly higher concentration of viable bacteria in the samples kept cold compared with room temperature. Hence, a change of sampling solution is not warranted, but maintaining the cold chain during storage and transport to the laboratory may be important for clinical samples. • The survival of Streptococcus equi subsp. equi was not better in phosphate-buffered saline than in normal saline. • A change of sampling solution is not warranted • Cold storage (5°C) had a positive effect on S. equi survival regardless of the sampling solution used (PBS or normal saline). • Maintaining the cold chain during storage and transport to the laboratory may be important for clinical samples. [ABSTRACT FROM AUTHOR]

Objective: To appraise critically the published randomized controlled trials (RCTs) comparing carbon dioxide (CO2) with normal saline (NS) as distension medium for diagnostic hysteroscopy. Design: Systematic review and meta-analysis of RCTs. Setting: Outpatient and inpatient hysteroscopy clinics. Patient(s): Women undergoing diagnostic hysteroscopy. refvention(s): CO2 or NS as distension medium for diagnostic hysteroscopy. Main Outcome Measure(s): Procedural and shoulder pain, side effects, satisfaction, quality of view, duration of procedure. Result(s): Ten RCTs involving 1,839 women (905 in the CO2 group, 934 in the NS group) were systematically analyzed. There was significant heterogeneity among the included trials. Compared with NS, CO2 was associated with greater procedural pain, more occurrences of shoulder pain and side effects, less satisfaction, less quality of view, and greater duration of procedure. Conclusion(s): A meta-analysis from the available moderate quality trials suggests that NS might be superior to CO2 for use in diagnostic hysteroscopy. Owing to problems of clinical diversity, statistical heterogeneity, and risk of bias, it is clear that additional pragmatic multicenter RCTs are needed to corroborate these findings before firm evidence-based guidelines can be given. [Copyright &y& Elsevier]