Juri Karjagin

Moderate intra-abdominal hypertension is associated with an increased lactate-pyruvate ratio in the rectus abdominis muscle tissue: a pilot study during laparoscopic surgery

BackgroundThe development of intra-abdominal hypertension [IAH] in critically ill patients admitted to the ICU is an independent predictor of mortality. In an attempt to find an early, clinically relevant metabolic signal of modest IAH, we investigated abdominal wall metabolite concentrations in a small group of patients undergoing laparoscopic surgery. We hypothesized that elevated intra-abdominal pressure [IAP] due to pneumoperitoneum leads to an increased lactate/pyruvate [L/P] ratio in the rectus abdominis muscle [RAM], indicating anaerobic metabolism.MethodSix patients scheduled for elective laparoscopic gastric fundoplication were studied. Two hours before surgery, a microdialysis catheter (CMA 60, CMA Small Systems AB, Solna, Sweden) was inserted into the RAM under local anaesthesia. Catheter placement was confirmed by ultrasound. The microdialysis perfusion rate was set at 0.3 μL/min. Dialysate was collected hourly prior to pneumoperitoneum, during pneumoperitoneum, and for 2 h after pneumoperitoneum resolution. IAP was maintained at 12 to 13 mmHg during the surgery. The glucose, glycerol, pyruvate and lactate contents of the dialysate were measured.ResultsThe median (interquartile range) L/P ratio was 10.3 (7.1 to 15.5) mmol/L at baseline. One hour of pneumoperitoneum increased the L/P ratio to 16.0 (13.6 to 35.3) mmol/L (p = 0.03). The median pneumoperitoneum duration was 86 (77 to 111) min. The L/P ratio at 2 h post-pneumoperitoneum was not different from that at baseline (p = 1.0). No changes in glycerol or glucose levels were observed.ConclusionsIAH of 12 to 13 mmHg, even for a relatively short duration, is associated with metabolic changes in the abdominal wall muscle tissue of patients undergoing laparoscopic surgery. We suggest that tissue hypoperfusion occurs even during a modest increase in IAP, and intramuscular metabolic monitoring could therefore serve as an early warning sign of deteriorating tissue perfusion.

Pharmacokinetics and pharmacodynamics of piperacillin/tazobactam during high volume haemodiafiltration in patients with septic shock

The purpose of the study was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of piperacillin and tazobactam during high‐volume haemodiafiltration (HVHDF).

Pharmacokinetics of doripenem during high volume hemodiafiltration in patients with septic shock

Pharmacokinetics (PK) of doripenem was determined during high volume hemodiafiltration (HVHDF) in patients with septic shock. A single 500 mg dose of doripenem was administered as a 1 hour infusion during HVHDF to 9 patients. Arterial blood samples were collected before and at 30 or 60 minute intervals over 8 hours (12 samples) after study drug administration. Doripenem concentrations were determined by ultrahigh performance liquid chromatography‐tandem mass spectrometry. Population PK analysis and Monte Carlo simulation of 1,000 subjects were performed. The median convective volume of HVHDF was 10.3 L/h and urine output during the sampling period was 70 mL. The population mean total doripenem clearance on HVHDF was 6.82 L/h, volume of distribution of central compartment 10.8 L, and of peripheral compartment 12.1 L. Doses of 500 mg every 8 hours resulted in 88.5% probability of attaining the target of 50% time over MIC for bacteria with MIC = 2 µg/mL at 48 hours, when doubling of MIC during that time was assumed. Significant elimination of doripenem occurs during HVHDF. Doses of 500 mg every 8 hours are necessary for treatment of infections caused by susceptible bacteria during extended HVHDF.

Sublingual microcirculatory changes during transient intra-abdominal hypertension--a prospective observational study in laparoscopic surgery patients.

BACKGROUND Microvascular alterations and intra-abdominal hypertension are both involved in development of organ failure. It is not known whether increased intra-abdominal pressure (IAP) is associated with microcirculatory perfusion derangements. HYPOTHESIS Transient increase in IAP induced by pneumoperitoneum affects sublingual microcirculation. METHODS 16 laparoscopic cholecystectomy patients were studied. Sidestream dark field (SDF) imaging was used to evaluate sublingual microcirculation. Microcirculatory videos were done before surgery, at least 15 minutes after initiation of pneumoperitoneum and 1 hour after the pneumoperitoneum. Microcirculation cut-off value for vessels was 20 μm. RESULTS IAP was held at 12.6 (from 12 to 14) mmHg, mean (SD) duration of pneumoperitoneum was 41 (14) minutes. At the baseline, mean total vascular density was 18.8 (2.6) and perfused vessel density 13.2 (2.9) per mm². Proportion of perfused vessels was 59 (11) % and microvascular flow index 2.2 (0.4). Median (IQR) heterogeneity index was 0.6 (0.4-0.9) and mean De Backer score 13.6 (1.5). Increase in IAP did not cause significant changes in sublingual microcirculatory parameters. CONCLUSIONS Transiently increased IAP due to pneumoperitoneum does not affect sublingual microcirculatory blood flow and vessel density in patients undergoing laparoscopic surgery. However, the low proportion of perfused vessels indicates the prevalence of perioperative microcirculatory deficiency in these patients.

Eesti Anestesioloogide Selts 50

1 TÜ kliinilise meditsiini instituudi anestesioloogia ja intensiivravi kliinik, 2 TÜ Kliinikumi anestesioloogia ja intensiivravi kliinik, 3 Lõuna-Eesti haigla, 4 Järvamaa Haigla Ok toobr i s möödub 171 aastat maailma esimesest eeternarkoosi edukast demonstratsioonist. Eesti üks suuremaid erialaseltse, Eesti Anestesioloogide Selts, tähistab aga oma 50. sünnipäeva. Selts asutati 21. oktoobril 1967 ENSV Anestesioloogide ja Reanimatoloogide Teadusliku Seltsina. Seltsi sündimise ajendiks oli Üleliidulise AnestesioloogideReanimatoloogide Ühingu loomine 1966. aastal. Austamiskoosolekul osales 44 anestesioloogi. Esimesse juhatusse osutusid valituks Anton Kivik (foto 1), Jüri Samarütel (foto 2), Arvo Tikk, Peeter Grossberg, Maano Kivilo, Bernhard Lehepuu (foto 3) ja Jaak Usk. Juhatuse esimeheks sai Bernhard Lehepuu. Fotol 4 on seltsi juhatus 1977. aastal. Oma peamiseks ülesandeks pidas selts oma li ikmete kvalifikatsiooni täiendamist, erialaste teadmiste laiendamist ja süvendamist, ideelist kasvatust, kodumaiste meditsiini ja loodusteaduste parimate traditsioonide propageerimist. On hea meel tõdeda, et v i iekümne aasta kestel on selts aktiivselt seisnud ennekõike erialase teadusja haridustöö eest. Esimese 12 aasta jooksul korraldati 66 töökoosolekut. Märkimisväärne oli väliskontaktide loomine Soome kolleegidega 1968. aastal, mille tulemusel korraldati kaks ühiskoosolekut. Omas ajas oli see tähelepanuväärne sündmus, misläbi sai Eesti anestesioloogia k ind last i olu l i se arengutõuke. Kohe esimestest aastatest käivitus aruandlus, kus kõik Eesti osakonnad esitasid oma aasta töö kokkuvõtted ja tulemused. Nii saavutusi kui ka probleeme ja vajakajäämisi arutati seltsi iga-aastasel koosolekul. Ühena vähestest on sel l ine traditsioon erialal säilinud tänaseni. Iga-aastasel Pühajärvel toimuval talveseminaril on põhjaliku vaatluse ja arutluse all anestesioloogia ja intensiivravi töötulemused. Anestesioloogide ja reanimatoloogide kahepäevasete üle-eestiliste konverentside korraldamist alustati 1968. aastal. 1974. aastal toimus teine ja 1979. aastal kolmas teaduskonverents. Konverentside korraldamisel ja eriala edendamisel kandsid olulist rolli eriala juhtivad õppejõud ülikoolis dots Anton Kivik, dots Jüri Samarütel, prof Raul Talvik jt. Alus

Metronidasooli kontsentratsioon septilises šokis olevate patsientide vereplasmas ja lihaskoes

Antibiootikumidel, sh metronidasoolil, on oluline koht sepsise ravis. Samas ei ole enamiku preparaatide kohta teada, kas septilise soki puhul jouab ravim piisavas kontsentratsioonis toimekohani, s.t interstitsiaalruumi. Rakkudevahelise ruumi koostist voimaldab hinnata mikrodialuus.