The Greek e-journal of Perioperative Medicine

3-9

Authors: Mitos G, Thoma G, Tsaousi G

Volatile induction of anesthesia with sevoflurane is an old and conventional technique. However, there is no consensus on the appropriate mode and duration of sevoflurane administration when attempting inhalational induction to adults in order to achieve acceptable intubating conditions. This article attempts to gather the evidence presented in the literature that dictate the optimal method of sevoflurane inhalational induction until intubation is achieved.

23-38

Authors: Grosomanidis V, Fyntanidou B, Amaniti A, Chatsiou E, Karagkouni D, Fengoudaki M, Theodosiadis E, Ourailoglou V.

Hypertonic solutions combined or not with colloids have been used successfully to restore intravascular volume and to enhance cardiovascular function. The aim of the present study was to investigate the hemodynamic effects of hypertonic saline solution administration in normovolemic patients. Forty-five patients who underwent elective surgery were included in the study. After anesthesia induction, initiation of mechanical ventilation and fluid replacement of fasting deficit all patients received 4ml/kg NaCl 7,5% intravenously in the maximum possible infusion rate. Esophageal Doppler Monitoring (ODM II) was used in all patients to assess cardiac function throughout the study period. Measurements were obtained before NaCl 7,5% administration (Phase 1), after completion of NaCl 7,5% administration (Phase 2) and every 5 min thereafter for one hour (Phases 3 to 14). Furthermore, at Phases 1, 2 and 14 sodium plasma levels (Na), hemoglobin (Hb) and hematocrit (Hct) were also measured. Altogether recorded parameters included heart rate (HR), blood pressure (BP) (Systolic, Diastolic and Mean), cardiac output (CO), stroke volume (SV), peak velocity (PV), mean acceleration (MA), flow time corrected (FTc), Na, Hb and Hct. At Phase 1 SV and CO were 62,4ml and 4l/min respectively. Both parameters increased and reached 100ml and 7,3l/min at Phase 2. Thereafter, SV and CO had gradually decreased and at the end of the study their values were 78ml και 5,2l/min respectively. PV increased from 57,7cm/sec (Phase 1) to 77,7cm/sec (Phase 2) and finally to 66 cm/sec at the end of the study (Phase 14). At Phase 1, MA and FTc were 5,7cm/sec2 and 0,4sec respectively, then both increased and reached 7,5cm/sec2 and 0,5sec respectively (Phase 2) and finally at Phase 14 their values were 6,1cm/sec2 and 0,5sec respectively. All before mentioned parameter values increased in a statistically significant manner after NaCl 7,5% administration compared to baseline measurements. The increase remained to be statistically significant throughout the study. HR increased from 64b/min before NaCl 7,5% administration to 74b/min after NaCl 7,5% administration but reached baseline values after 10min. BP (SBP, DBP and MBP) decreased from 118/64mmHg to 92/53mmHg and then reached rapidly baseline values. NaCl 7,5% administration resulted in CO and SV increase and contributed to cardiac function enhancement. This beneficial impact remained statistically significant for 60min throughout the study period. Those positive effects can be attributed to the intravascular volume increase, the vascular resistance decrease and possibly to the enhancement of left heart contractility which are all caused by the hypertonic saline solution administration.

49-56

Authors: Varvarousi G, Loukeri A, Lappas T, Haidopoulos D, Valsamidis D.

The novel coronavirus disease 2019 (COVID-19) caused by severe respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global health emergency since its declaration as a pandemic by the World Health Organization. Advanced maternal age is considered a high-risk pregnancy and therefore may affect the severity of Covid-19. In this case report, we discuss the perioperative management of an in vitro fertilization (IVF) cesarean section in a 48-year-old woman with Covid-19 infection. A 48-year-old parturient with pregnancy of 37 weeks 3 was scheduled for cesarean section, due to advanced maternal age, after she had a positive result for real time polymerase chain reaction (RT-PCR) test for (SARS-CoV-2). In our case of extremely advanced maternal age cesarean section the obstetric outcome was positive. Physiologic and vascular changes in advanced maternal pregnancies may exacerbate Covid-19 symptoms and increase the risk for poor pregnancy outcome. Further studies are needed to investigate the factors that influence the outcome in pregnancy of increased maternal age with Covid-19 infection.