BACKGROUND: Acute normovolemic hemodilution (ANH) entails collecting patients blood immediately before surgery with concurrent fluid infusion to maintain intravascular volume. This reduces the red cells mass (RCM) lost during surgery by lowering the hematocrit at which surgical blood loss occurs. Blood collected from ANH is transfused back to the patient at the end of surgery METHODS: 40 ASA I patients scheduled to elective surgery under lumbar epidural anesthesia were randomly divided into two groups, the ANH group where a pre-computed amount of blood was withdrawn just prior to induction of anesthesia with simultaneous infusion of equal amount of hydroxyethyl starch (HAES-STERIL) and the non-ANH group where no blood was withdrawn nor colloid infused. All patients were monitored based on the following parameters: mean arterial pressure, cardiac rate, central venous pressure, hematocrit, prothrombin activity, platelet count, arterial blood pH and hemoglobin oxygen saturation during the five phases of the study: before hemodilution, during hemodilution, surgery proper, immediate post-op and 24 hours after the surgery. Intraoperative blood loss was likewise monitored RESULTS: Comparative studies of the mean values were curried using one-way ANOVA with Complement Scheffes test and Paired T-test with a p value of 0.05 considered significant. The perioperative changes in the hemodynamic and hematologic parameters were not clinical significant CONCLUSION: The higher final hematotocrit level and the non-requirement for homologous transfusion in the hemodiluted group prove that ANH effective as a blood conservation technique. (Author)
Human ; Adult ; Young Adult ; Adolescent ; BLOOD TRANSFUSION ; HETASTARCH ; SURGERY ; ANESTHESIA

Introduction: Propofol is a nonopioid intravenous anesthetic with a fast onset and short duration of action. It is commonly used as an induction agent, the sole agent in total intravenous anesthesia, or in short ambulatory procedures. One side effect of this drug is pain on injection. The pain on propofol injection can reach as much as 70%. Different pharmacologic interventions have been used to decrease propofol injection pain. The objective of this study is to determine the efficacy of different pharmacologic agents in reducing propofol injection pain. Materials and methods: A search for randomized controlled trials was done using electronic databases and manual searching. Letters were sent to anesthesiology departments nationwide for unpublished studies that may be included. Studies that met the inclusion criteria were appraised for methodological quality by two independent reviewers using the Physiotherapy Evidence database (PEDro) assessment tool. Meta-analysis was done using Review Manager (RevMan) Version 5.0 for Windows. Results: Sixteen studies were included in the review. Meta-analysis was done for lidocaine versus normal saline in decreasing propofol injection pain. Nineteen percent of patients complained of moderate pain and 7 percent complained of severe pain among those treated with lidocaine compared with 81% and 93%, respectively, among those given normal saline solution. the interventions not included in the meta-analysis were assessed based on the levels of evidence by Furlan. Conclusion: Lidocaine 40mg/IV given prior to propofol was efficacious in decreasing pain compared with normal saline solution. There is strong evidence for the use of remifentanil 0.01-0.02 mg or 2ug/kg as pretreatment in decreasing pain on propofol injection.
Human ; Adult ; PROPOFOL ; PAIN MANAGEMENT ; ANESTHETICS, INTRAVENOUS ; LIDOCAINE