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PubMed2006

The influence of canal curvature on the mechanical efficacy of root canal irrigation in vitro using real-time imaging of bioluminescent bacteria.

There are no quantitative data on the mechanical efficacy of irrigation in the removal of bacteria from curved canals. This study quantitatively analyzed the effects of root canal curvature and preparation size on the mechanical efficacy of irrigation using 33 mandibular single-rooted bicuspids allocated to groups according to root canal curvatures, group 1 (straight) 4 to 8 degrees, group 2 (intermediate curvature) 15 to 19 degrees, and group 3 (greatest curvature) 24 to 28 degrees. Teeth were sequentially instrumented to sizes 27/.04, 36/.04, and 46/.04 using a crown-down technique. Suspensions of the bioluminescent reporter strain Pseudomonas fluorescens 5RL (1.5 x 10(6) cells) were inoculated into canals of sterilized teeth after each sequential instrumentation. Canals were irrigated with 6 ml of irrigant delivered 1 mm from working length using a 30-gauge needle. Remaining bacteria were quantified using real-time bioluminescent imaging. Irrigation was significantly less effective in 24 to 28 degrees curvature canals prepared to size 27/.04 compared to 46/.04 (p < 0.007, repeated-measures ANOVA).

Bicuspid↗
PubMed2006

Effect of chemical irrigants on the bond strength of a self-etching adhesive to pulp chamber dentin.

The aim of this study was to evaluate the influence of endodontic irrigants on adhesion to pulp chamber dentin. Seventy crowns of bovine incisors were cut to expose the pulp chamber. Specimens were divided into seven groups, according to the irrigant solution used: G1, 0.9% sodium chlorite (control); G2, 5.25% NaOCl; G3, 5.25% NaOCl + 17% EDTA; G4, 2% chlorhexidine solution; G5, 2% CHX solution + 17% EDTA; G6, 2% chlorhexidine in a gel base; and G7, 2% CHX gel + 17% EDTA. After irrigation, Clearfil SE Bond was applied to pulp chamber dentin, followed by Filtek Z250 composite. Six rectangular sticks were obtained from each specimen and dentin/resin interface was tested in tension. Bond strength means were analyzed by ANOVA and Tukey test. There was a significant decrease in bond strength associated to NaOCl, whereas chlorhexidine irrigation showed no effects on adhesion. It was concluded that endodontic irrigants affected differently bond strength to pulp chamber dentin.

Adhesives↗
PubMed1980

Intrauterine irrigation with cefamandole nafate solution at cesarean section: a preliminary report.

The effectiveness of intrauterine irrigation with an antibiotic solution of cefamandole nafate in reducing the incidence of endometritis after cesarean section was studied in a prospective, double-blind fashion. Ninety patients who underwent cesarean section at Tripler Army Medical Center were divided into three equal groups. Each group received one of the following treatments at the time of operation: (1) intrauterine irrigation with the antibiotic solution, (2) irrigation with normal saline solution, or (3) no irrigation. The resulting incidences of endometritis were 0%, 26.7%, and 23.3%, respectively. Intrauterine irrigation with cefamandole nafate solution at the time of cesarean section significantly reduced the incidence of endometritis.

Cefamandole↗
PubMed1997

The role of irrigation in the development of hypothermia during laparoscopic surgery.

OBJECTIVES: Our purpose was to determine the incidence and etiology of hypothermia during laparoscopic surgery and to evaluate the role of irrigation fluid temperature. STUDY DESIGN: A prospective randomized study was performed of 35 women undergoing operative laparoscopy under general anesthesia who received surgical irrigation fluid either at ambient temperature or warmed to 39 degrees C. The core body temperature was determined with use of both an esophageal sensor and a tympanic membrane sensor and was expressed as the change from baseline. Additional data collected included age, height, weight, amount of irrigation fluid and intravenous fluid used, room temperature, length of anesthesia, and amount of carbon dioxide used for pneumoperitoneum. RESULTS: Hypothermia occurred in 94% of all patients, with no difference in incidence between the groups. The minimal core temperature was lower in the ambient temperature group (-1.7 degrees +/- 0.2 degrees C) than in the warmed fluid group (-1.0 degrees +/- 0.2 degrees C). Of the variables measured, length of anesthesia and the amount of ambient temperature fluid alone explained the drop in core temperature. CONCLUSION: Hypothermia is extremely common in laparoscopic surgery and is related to the length of anesthesia and the use of ambient temperature irrigation fluid. The use of warmed irrigation fluid can decrease, but not eliminate, this drop in core temperature.

Adult↗
PubMed1985

Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double-blind clinical trial.

In a prospective, randomized double-blind trial, the efficacy of whole gut irrigation as preoperative bowel preparation for elective colorectal surgery was evaluated alone and in combination with two antimicrobial agents in 148 patients. The antimicrobial regimens were metronidazole alone or metronidazole and ampicillin administered systemically preoperatively and continued for 3 days. Whole gut irrigation was completed without any discomfort in 87 percent of the patients. In 3 percent, the irrigation was stopped and the patients were excluded from the study. Abdominal wound infection developed in 32 percent of the patients after whole gut irrigation, and the addition of metronidazole decreased this incidence to 22 percent (not significant). The incidence in wound infections in the group receiving metronidazole as well as ampicillin was 2 percent, and this difference was highly significant compared with both other groups. No significant difference was found for the incidence of intraabdominal abscesses (p = 0.06), infection of the perineal wound, or anastomotic leakage. No difference in the postoperative infection rate was found between a bowel containing fecal fluid or fecal masses, but when a bowel was clean, significantly fewer infectious complications were found. Whole gut irrigation is a rapid, well-tolerated, easily performed, and safe form of preoperative bowel preparation in elective colorectal surgery if combined with systemic antimicrobial prophylaxis consisting of antimicrobial agents effective against anaerobic and aerobic organisms.

Adult↗
PubMed1998

A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy.

BACKGROUND: Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine. METHODS: One hundred and five consecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mL 0.5% bupivacaine in 500 mL saline and control group (A, n = 50) received an equal volume of normal saline. Each dome of the diaphragm was irrigated with 250 mL of either solution at the end of surgery. Laparoscopic procedures performed included cholecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). Patients' anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery room immediately following surgery and at 4, 10, and 24 hours thereafter. RESULTS: The overall incidence of STP in patients undergoing laparoscopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complained of shoulder pain during the recording period (P = 0.003). Mean STP scores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (P < 0.01). Postoperative analgesia requirements were also significantly reduced in those patients receiving bupivacaine irrigation (P < 0.04). CONCLUSION: Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.

Adolescent↗
PubMed1985

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema is described. Initial thoracoscopy under general anesthesia enabled full debridement and division of loculi within the empyema cavity under direct vision. Irrigation with two tubes was instituted until three consecutive cultures of irrigation fluid became sterile; then the chest drains were removed. The results in 12 patients are presented. Using this method, irrigation was required for an average of 14 days and chest drains were removed after an average of 20 days. Patients remained in the hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contraindication to the irrigation technique.

Adult↗
PubMed1987

Miconazole: a cost-effective antifungal genitourinary irrigant.

Miconazole was used as a fungistatic genitourinary irrigant in the management of 10 patients with persistent candiduria. All patients were in the older age group, with a mean age of 77.6 years, and they were debilitated by a variety of medical problems, including major surgery, neoplasia, recurrent bacterial infection, diabetes or other metabolic dysfunction. Miconazole at a concentration of 50 mcg. per ml. was administered continuously during 24 hours for 5 consecutive days via a urethral catheter. Candiduria resolved in 8 of the 10 patients, with 1 requiring a second course of miconazole at a concentration of 100 mcg. per ml. Two patients manifested other foci of infection, necessitating intravenous and intravesical amphotericin B. Stability studies showed that the miconazole irrigation solutions maintain their antifungal activity for 11 days at room temperature. The 5-day cost (drug and materials) of the miconazole irrigation at 50 mcg. per ml. was $17.75 versus $76.75 for an equal course of therapy with amphotericin B. In addition, compared to amphotericin B as an antifungal genitourinary irrigant, miconazole is prepared more easily, requires less labor and preparation time, and does not require refrigeration or protection from light. These clinical observations indicate that miconazole is a cost-effective antifungal genitourinary irrigant.

Aged↗
PubMed1985

Intravesical irrigation with alum for the control of massive bladder hemorrhage.

Continuous vesical irrigation with 1 per cent alum solution was performed without anesthesia in 9 patients in whom massive bladder hemorrhage persisted despite evacuation of clots and normal saline irrigation for at least 24 hours. Hematuria ceased promptly in all patients, although the effect was transient in 3. No side effect was observed. Biopsy of the tumor subsequent to alum irrigation showed no alteration in the histological characteristics. Biopsy of the normal-appearing bladder mucosa also showed no evidence of epithelial damage. Ultrastructure of the tumor in 1 patient in whom transurethral resection was performed 2 weeks after alum irrigation revealed well preserved nuclear chromatin, thus, suggesting that whatever changes occur after alum irrigation are short-lived.

Adult↗
PubMed1982

Hemiacidrin renal irrigation: complications and successful management.

The complications of hemiacidrin irrigation of the kidneys for postoperative residual struvite calculi can test the ingenuity and perseverance of the clinician. The complications encountered during the irrigation of 9 kidneys in 8 patients included Candida urinary tract infection, irrigant extravasation, ureteral obstruction and chemical cystitis. Some causes and the management of these problems are discussed. Although the period of irrigation and the hospitalization are prolonged by these complications hemiacidrin irrigation remains a safe procedure when used meticulously.

Adult↗
PubMed1982

Intermittent irrigation system for dissolution of renal calculi monitored by computer.

An intermittent irrigation system was tested in vitro and in a clinical case. In vitro experiments showed that the intermittent irrigation was more efficient to dissolve calculi compared to the continuous irrigation. The pelvic irrigation was performed clinically by a cystoscopically passed angiographic catheter. The system could be operated in constant low pressure without supervision. The result shows that this system will be safe and valuable for pelvic irrigation.

Catheterization↗
PubMed1980

Hemiacidrin irrigation of renal pelvic calculi in patients with ileal conduit urinary diversion.

Five quadriplegic patients with ureteroileocutaneous urinary diversion and recurrent renal calculi underwent 8 episodes of renal pelvic irrigation with hemiacidrin solution. Irrigations were done either via a nephrostomy tube or transileostomy ureteral catheters with close monitoring of urine sterility and serum magnesium. The stones were dissolved totally in 3 of 4 patients. There were no serious complications encountered during the irrigations and the only failure was in a patient with a single ureteral catheter. Serum magnesium levels were elevated mildly in 2 patients, both of whom experienced concomitant nausea and this was relieved by discontinuing the irrigations. Hemiacidrin irrigation into collecting systems that contain interposed bowel appears to be a safe and effective form of therapy for stones.

Adolescent↗
PubMed2000

Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients.

BACKGROUND: Cisternal irrigation therapy with urokinase and ascorbic acid was introduced to prevent symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). To dissolve and wash out the subarachnoid clot, cisternal irrigation with urokinase is used. Ascorbic acid is added to degenerate oxy-hemoglobin, one of the strongest spasmogenic substances, into verdohemelike products, which are nonspasmogenic. The efficacy and safety of this therapy were evaluated. METHODS: This therapy was performed consecutively in 217 patients. The degree of SAH of the patients was classified as Fisher CT Group 3, and the highest CT number (Hounsfield number) exceeded 60 in the SAH, which suggested a significant risk for symptomatic vasospasm. All patients underwent surgery within 72 hours from the onset of SAH. After clipping the aneurysm, irrigation tubes were placed in the Sylvian fissure (inlet) unilaterally or bilaterally and in the prepontine or chiasmal cistern (outlet). Lactated Ringer's solution with urokinase (120 IU/mL) and ascorbic acid (4 mg/mL) was infused at a rate of 30 mL/hour/side for approximately 10 days. RESULTS: Of the 217 patients studied, symptomatic vasospasm was observed in 6 cases (2.8%), and two of these six cases (0.9%) demonstrated sequelae. The average total blood volume calculated from the drainage fluid was approximately 114 mL. Analysis of the absorption spectrum of the drainage fluid revealed disappearance of the oxy-hemoglobin-specific 576-nm peak. Complications occurred in eight patients during irrigation therapy; two patients experienced seizures, two patients developed meningitis, and four patients had an intracranial hemorrhage. However, all of these patients recovered without neurological deficits. CONCLUSIONS: These results suggest that cisternal irrigation therapy with urokinase and ascorbic acid is effective in preventing symptomatic vasospasm after aneurysmal SAH.

Adult↗
PubMed1995

Clinical evaluation of the efficacy of EDTA solution as an endodontic irrigant.

The effect of eliminating the smear layer by means of 15% EDTA solution as a root canal irrigant was studied in 189 single-rooted infected teeth. Each tooth was treated at two appointments, and the root canal bacteriological examination was studied on the first (pretreatment, and after enlargement and irrigation) and second (pretreatment) visits. The root canals were irrigated with 15% EDTA solution with ultrasonics agitation. No antibacterial intracanal medications were used between the appointment. When 15% EDTA solution was used, no bacteria could be recovered from 93 of 129 root canals at the sampling stage on second visit. No bacteria were found in 21 of 60 root canals when saline solution was used as an irrigant. These results suggest that 15% EDTA solution is more effective than saline solution as a root canal irrigant.

Anti-Infective Agents, Local↗
PubMed1997

Residual antimicrobial activity after canal irrigation with chlorhexidine.

We previously reported that the in vitro antimicrobial activity of a 2.0% chlorhexidine endodontic irrigant was equivalent to that of 5.25% sodium hypochlorite. The purpose of this study was to determine if chlorhexidine irrigants could instill substantive antimicrobial activity in instrumented root canals in vitro. Human teeth were instrumented using 2.0% or 0.12% chlorhexidine as irrigants. After instrumentation, the root canals were filled with sterile water, and samples of the root canal fluid were absorbed with paper points at 6, 12, 24, 48, and 72 h after treatment. The paper points were assayed for antimicrobial activity by placing them on agar plate surfaces inoculated with Streptococcus mutans and measuring zones of inhibition. Antimicrobial activity was present in all 2.0% chlorhexidine-treated teeth throughout the 72-h testing period and in most teeth, in relatively lower concentrations, for 6 to 24 h after irrigation with 0.12% chlorhexidine. These results indicate that chlorhexidine instills substantive antimicrobial activity when used as an endodontic irrigant.

Analysis of Variance↗
PubMed1999

Shaping and cleaning the root canal system: a scanning electron microscopic evaluation of a new instrumentation and irrigation technique.

The purpose of the present scanning electron microscopic study was to investigate the efficacy of a combination of EDTA, NaOCl, and surface-active irrigating solutions during and after root canal preparation with ProFile nickel-titanium rotary instruments. Thirty canals were divided into three groups, instrumented and irrigated as follows: 5% NaOCl and a final flush with 17% EDTA were used for group A; group B specimens were irrigated using 17% EDTA, followed 15 s later by 1% TRITON X-100 (tensioactive agent) and then by 5% NaOCl; and group C specimens were irrigated with the same combination, but once shaping procedures were completed the irrigating sequence was repeated three times. After scanning electron microscopic evaluation, group C specimens exhibited the most effective debridement of the root canals. Results showed that tensioactive agent contributed to enhanced debridement. Cleaning was significantly improved once shaping procedures were completed.

Chi-Square Distribution↗
PubMed1992

Effects of povidone-iodine chemical preparation and saline irrigation on the perilimbal flora.

PURPOSE: To analyze the effects of 5% povidone-iodine preparation and saline irrigation on the species composition of perilimbal flora. METHODS: Cultures were taken from the perilimbal conjunctiva in 100 eyes before preparation for ophthalmic surgery, after instillation of povidone-iodine solution, and after saline irrigation. RESULTS: Bacteria were isolated in 75% of eyes before preparation, in 28% after povidone-iodine instillation, and in 24% after saline irrigation. Fifty-one culture-positive eyes became negative with povidone-iodine, while only four culture-negative eyes became culture-positive (P < 0.001). The number of eyes yielding coagulase-negative staphylococci, Staphylococcus aureus, and Propionibacterium were significantly decreased after povidone-iodine instillation. Twenty-three culture-positive eyes became negative after saline irrigation, while 19 culture-negative eyes became culture-positive (P > 0.25). CONCLUSION: Povidone-iodine solution is effective in reducing bacterial recovery from the perilimbal conjunctiva, where most incisions for intraocular surgery occur. Saline irrigation after povidone-iodine preparation has no significant effect.

Bacteria↗
PubMed1990

Interaction between whole-bowel irrigation solution and activated charcoal: implications for the treatment of toxic ingestions.

STUDY OBJECTIVES: The purpose of this study was to address the issues of safety and efficacy of combining whole-bowel irrigation and activated charcoal administration for the treatment of toxic ingestions. STUDY DESIGN: Two in-vitro studies were performed. In the first, serial ratios of polyethylene glycol (PEG) and activated charcoal (AC) powders were added to water and the solutions were analyzed for PEG concentration and osmolality. In the second, serial ratios of a pharmaceutical bowel irrigation solution and an AC preparation were combined with a constant amount of salicylic acid. Solution osmolalities, PEG, and salicylic acid concentrations were then quantified. RESULTS: Adsorption of PEG powder by AC was demonstrated; however, changes in solution osmolality were negligible. Thus, concurrent administration of these therapies appears safe. However, combining bowel irrigation solution with AC resulted in decreased salicylic acid adsorption. This was especially so with smaller amounts of AC that would pertain more to the smaller doses of AC used for multiple-dose charcoal therapy. CONCLUSION: If these in-vitro data are applicable to overdose patients, the administration of a routine initial charcoal dose to those who will be treated with whole-bowel irrigation would be appropriate. However, it is unlikely that the addition of multiple-dose charcoal therapy to whole-bowel irrigation would provide additional benefit for the patient.

Administration, Rectal↗