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      Intravenous Administration of Hypertonic Glucose Solution to Prevent Dizziness in Patients Undergoing Gastrointestinal Endoscopy Under General Anesthesia: A Randomized Clinical Trial

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          Abstract

          Background and Objective:

          Dizziness is a common complication of gastrointestinal endoscopy under general anesthesia. Dizziness is primarily caused by a lack of energy and blood volume following fasting and water deprivation. Hypertonic glucose solution (HGS) is an intravenous energy replenishment, that increases blood volume due to its hyperosmotic characteristics and can be directly absorbed from blood circulation. This study aimed to HGS can prevent dizziness after gastrointestinal endoscopy.

          Methods:

          This was a double-blind, randomized, controlled study. Eligible patients were randomly allocated into two groups based on the intravenous agent administered before gastrointestinal endoscopy: Group A, saline (0.9%; 20 mL); and group B, HGS (50%; 20 mL). Overall, 840 patients were included in the statistical analysis. The scores and incidence of dizziness were assessed.

          Results:

          The dizziness score were higher in group A than in group B (1.92 ± 0.08 vs. 0.92 ± 0.06; p < 0.01). The incidence of mild dizziness and moderate-to-severe dizziness was significantly lower in group B than in group A (40.10% vs. 51.78% and 3.10% vs. 19.72%, respectively; p < 0.01). The incidence and score of dizziness were significantly lower in males than in females (30.81% vs. 51.82% and 0.64 ± 0.08 vs. 1.12 ± 0.08, respectively; p < 0.01) after pretreatment with HGS.

          Conclusion:

          Pretreatment with HGS effectively prevents dizziness after gastrointestinal endoscopy under general anesthesia. The mechanism of action is unclear but might be related to body energy replacement and an increase in blood volume following HGS administration. The registration number: ChiCTR1900020887.

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          Most cited references31

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          Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

          Main Recommendations ESGE recommends a low fiber diet on the day preceding colonoscopy. Strong recommendation, moderate quality evidence. ESGE recommends the use of enhanced instructions for bowel preparation. Strong recommendation, moderate quality evidence. ESGE suggests adding oral simethicone to bowel preparation. Weak recommendation, moderate quality evidence. ESGE recommends split-dose bowel preparation for elective colonoscopy. Strong recommendation, high quality evidence. ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing. Strong recommendation, high quality evidence. ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure. Strong recommendation, moderate quality evidence. ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.
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            Is Open Access

            Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants

            Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed. To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age. The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
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              Intraoperative fluids: how much is too much?

              There is increasing evidence that intraoperative fluid therapy decisions may influence postoperative outcomes. In the past, patients undergoing major surgery were often administered large volumes of crystalloid, based on a presumption of preoperative dehydration and nebulous intraoperative 'third space' fluid loss. However, positive perioperative fluid balance, with postoperative fluid-based weight gain, is associated with increased major morbidity. The concept of 'third space' fluid loss has been emphatically refuted, and preoperative dehydration has been almost eliminated by reduced fasting times and use of oral fluids up to 2 h before operation. A 'restrictive' intraoperative fluid regimen, avoiding hypovolaemia but limiting infusion to the minimum necessary, initially reduced major complications after complex surgery, but inconsistencies in defining restrictive vs liberal fluid regimens, the type of fluid infused, and in definitions of adverse outcomes have produced conflicting results in clinical trials. The advent of individualized goal-directed fluid therapy, facilitated by minimally invasive, flow-based cardiovascular monitoring, for example, oesophageal Doppler monitoring, has improved outcomes in colorectal surgery in particular, and this monitor has been approved by clinical guidance authorities. In the contrasting clinical context of relatively low-risk patients undergoing ambulatory surgery, high-volume crystalloid infusion (20-30 ml kg(-1)) reduces postoperative nausea and vomiting, dizziness, and pain. This review revises relevant physiology of body water distribution and capillary-tissue flow dynamics, outlines the rationale behind the fluid regimens mentioned above, and summarizes the current clinical evidence base for them, particularly the increasing use of individualized goal-directed fluid therapy facilitated by oesophageal Doppler monitoring.
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                Author and article information

                Journal
                Combinatorial Chemistry & High Throughput Screening
                CCHTS
                Bentham Science Publishers Ltd.
                13862073
                July 2023
                July 2023
                : 26
                : 8
                : 1571-1577
                Affiliations
                [1 ]Department of Anesthesiology, Renmin Hospital, Wuhan University, Wuhan, Hubei, 430071, China
                [2 ] Department of Anesthesiology, Renmin Hospital, Wufeng Tujia Autonomous County, Yichang, Hubei, 443400, China
                [3 ] Laboratory of Anesthesiology and Critical Care Medicine, Renmin Hospital, Wuhan University, Wuhan, Hubei, 430071, China
                [4 ]Department of Emergency Medicine, General Hospital of Central Theater Command, Wuhan, Hubei, 430071, China
                [5 ]Department of Otolaryngology, Head and Neck Surgery, Wuhan Red Cross Hospital, Wuhan, Hubei, 430090, China
                [6 ]Laboratory of Anesthesiology and Critical Care Medicine, Renmin Hospital, Wuhan University, Wuhan, Hubei, 430071, China
                [7 ] Department of Critical Care Medicine, Renmin Hospital, Wuhan University, Wuhan, Hubei, 430071, China
                [8 ]Department of Anesthesiology, Renmin Hospital of Hannan District, Wuhan University, Wuhan, Hubei, 430090, China
                Article
                10.2174/1386207326666230120111036
                1d407450-7c33-4c6a-9783-5457467d9885
                © 2023
                History

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