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PubMedDate not supplied

Anterior chamber concentrations of vancomycin in the irrigating solution at the end of cataract surgery.

PURPOSE: To verify that therapeutic levels of vancomycin were present in the irrigating solution at the end of cataract surgery. SETTING: Service d'ophtalmologie, Université de Limoges, France. METHODS: An irrigating solution that contained 20 mg/L of vancomycin was used in 15 patients having phacoemulsification. Antibiotic concentrations in the phacoemulsification handpiece and in the aqueous humor were measured at the end of surgery. RESULTS: Passage through the phacoemulsifier did not affect antibiotic concentration. In the aqueous humor, after wound closure, the concentration constantly exceeded the minimal inhibitory concentration of the principal gram-positive bacteria responsible for human endophthalmitis. CONCLUSION: Vancomycin added to the irrigating solution used during cataract surgery was found in effective concentrations in the anterior chamber at the end of surgery.

Aged↗
PubMed1997

Anterior chamber irrigation with unpreserved lidocaine 1% for anesthesia during cataract surgery.

PURPOSE: To assess the effectiveness of using anterior chamber irrigation of unpreserved lidocaine 1% as anesthesia during cataract surgery. SETTING: Private group ophthalmology practice. METHODS: This study prospectively evaluated 1000 of 1012 consecutive eyes having temporal corneal incision cataract surgery to determine whether anterior chamber lidocaine provides adequate anesthesia for cataract surgery. Twelve eyes were excluded because the patients had preoperative sedation. Surgery on the remaining 1000 eyes was performed by one surgeon without patients receiving preoperative or intraoperative sedation or other medications other than the local anesthetic and dilating agents. Each received one drop of topical proparacaine before entering the operating room. After an initial corneal stab incision was made, 0.25 to 0.50 cc of unpreserved lidocaine 1% was irrigated into the anterior chamber. RESULTS: One patient was so uncomfortable from the microscope that he required supplemental retrobulbar anesthesia. A second patient was extremely uncomfortable during the case but did not require supplemental anesthesia. Two patients received additional dosages of anesthetic because of discomfort late in the operation. The remaining 996 patients were comfortable and pain-free during the operation with a single dose of the anesthetic. CONCLUSION: Anterior chamber irrigation with unpreserved lidocaine 1% was an effective method for anesthetizing an eye for temporal corneal incision cataract surgery.

Anesthetics, Local↗
PubMed1991

Comparison between electric toothbrushing and manual toothbrushing, with and without oral irrigation, for oral hygiene of orthodontic patients.

This study evaluated the effectiveness of one electric toothbrush and oral irrigation system in comparison with manual toothbrushing in 20 orthodontic patients. Twenty patients performed four oral hygiene routines for at least 4 weeks each. The routines included manual toothbrushing alone, electric toothbrushing alone, manual toothbrushing plus irrigation, and electric toothbrushing plus irrigation. Baseline plaque and gingival scores were recorded, and both indices were again recorded after each routine. The index used to evaluate gingival health was a slight modification of the Silness and Löe gingival index, while the plaque index was similar to the patient hygiene performance (PHP) index developed by Podshadley and Haley. The average overall scores for plaque and gingival condition for all patients who used each of the four oral hygiene routines were compared with a repeated-measures, analysis-of-variance statistical evaluation. The values obtained from the analysis showed that there were no significant differences between the means for plaque and gingival health in each group. The probabilities that these conclusions are incorrect are 18% for plaque and 2% for gingival health. Testing for validity of the data was done by more than one researcher, with consistent results.

Adolescent↗
PubMed2000

Sources of error when tracking irrigation fluids during hysteroscopic procedures.

STUDY OBJECTIVE: To evaluate the ability of circulating nurses to estimate input and outgo of irrigating fluids used during hysteroscopic procedures in a hospital operating room. DESIGN: Simulation of intraoperative measurements (Canadian Task Force classification II-1). SETTING: Operating room. Intervention. Circulating nurses estimated fluid volumes under circumstances simulating actual conditions of hysteroscopic ablative or resection procedures. MEASUREMENTS AND MAIN RESULTS: Three-liter glycine irrigation bags were overfilled by an average of 2.8% (62-125 ml). Estimates of fluid remaining in partially emptied bags were in error by an average ranging from 4% to 50%/bag (largest error 10-55%, 157-401 ml). Estimates of fluid in kick buckets were in error by an average of 10% to 39% (largest error 22-66%, 232-903 ml). Visual estimates of fluid on the operating room floor were in error by an average of 56% to 67% (largest error 65-81%, 182-840 ml). Estimates of fluid in suction canisters were consistent among nurses. The accuracy of measurements for partially filled suction canisters primarily depended on the accuracy of canister calibration. Volume contained in cascaded suction canisters from an actual surgical procedure was grossly different from rated capacity. CONCLUSION: Accurate tracking of irrigation fluid during hysteroscopic procedures is difficult. Even with a mechanical measuring system, fluid lost on the floor can introduce sizable errors. Estimation errors can easily and quickly accumulate to clinically significant volumes. Use of an automated mechanical fluid-tracking system with devices to capture fluid lost from the surgical field is recommended.

Body Fluids↗
PubMed1999

Irrigating solution and pressure effects on tooth sectioning with surgical burs.

OBJECTIVE: The purpose of this study was to determine the influence of the applied load on the handpiece, type of cooling agent, and type of tooth on surgical tooth dissection with a tapered crosscut fissure bur. STUDY DESIGN: Cutting studies were performed at handpiece loadings of 295 and 590 g through use of an oral surgery straight handpiece, tapered crosscut fissure burs, and an established cutting regimen. Extracted molars were dissected under irrigation with water, 0.9% saline solution, and lactated Ringer's solution at constant flow rates of 15 and 25 mL/min. Cutting efficiencies were analyzed by 1-way analysis of variance and Scheffé tests. RESULTS: No difference in cutting efficiency was found at low loads under irrigation with water or saline solution, but under irrigation with lactated Ringer's solution, a higher cutting efficiency was found (P < .05). There was no difference in cutting efficiency for lactated Ringer's solution and saline solution at high loads, but both cut more efficiently than water (P < .01). CONCLUSIONS: Saline solution is a useful coolant/irrigant for the dissection of teeth under most conditions, but lactated Ringer's solution might be beneficial with respect to cutting efficiency when lower handpiece loads are required.

Analysis of Variance↗
PubMedDate not supplied

Prophylaxis of experimental Pseudomonas aeruginosa endophthalmitis after vitrectomy using ceftazidime in the irrigating solution.

PURPOSE: To test the efficacy of ceftazidime in irrigating solution during vitrectomy to prevent experimental Pseudomonas aeruginosa endophthalmitis. METHODS: Thirty-two rabbit eyes were divided into 6 groups. Vitrectomy using one of two different irrigating solutions was followed by intravitreal injection of P. aeruginosa: Group 1, balanced salt solution (BSS) followed by 100 colony-forming units (CFU) P. aeruginosa; Group 2, BSS fortified with ceftazidime 175 microg/mL (CBSS) followed by intravitreal injection of 100 CFU P. aeruginosa; Group 3, BSS followed by 500 CFU P. aeruginosa; Group 4, CBSS followed by 500 CFU P. aeruginosa; Group 5, BSS followed by 5000 CFU P. aeruginosa; and Group 6, CBSS followed by 5000 CFU P. aeruginosa. The eyes were examined clinically. Vitreous samples were cultured and histology was performed. RESULTS: Group 1: Three of 5 eyes showed mild to moderate vitreous opacities. Group 2: No vitreous opacities developed. Group 3: All eyes demonstrated endophthalmitis. Group 4: All 6 eyes had clear vitreous with visible fundus. Group 5: Severe endophthalmitis occurred in all 6 eyes. Group 6: Four eyes had clearly visible fundus, 2 eyes had hazy vitreous with red reflex of the fundus. Bacterial growth in groups 3, 4, 5, and 6 was seen in 4/4, 1/6, 6/6, and 0/6 eyes, respectively. CONCLUSION: When 100-5000 CFU P. aeruginosa were injected after vitrectomy, ceftazidime in the irrigating solution inhibited the signs of intraocular inflammation, and the rate of positive bacterial culture.

Administration, Topical↗
PubMed1998

Antibiotics in irrigation solution for cataract surgery. A laboratory investigation of the pharmacological stability and bacteriological susceptibility.

PURPOSE: To evaluate the appropriateness of a prophylactic use of Gentamicin and Vancomycin in the irrigation solution for cataract surgery. METHODS: A laboratory study of the pharmacological stability and the bacteriological susceptibility of the two antibiotics and epinephrine in the irrigation solution. RESULTS: Gentamicin and Vancomycin are pharmacologically stable in concentrations above the MIC-values of most Gram positive and Gram negative bacteria without reaching toxic levels. CONCLUSION: Although it seems tempting to add Gentamicin and Vancomycin in irrigation solutions for cataract surgery, major objections to such a prophylactic use of antibiotics have been stated, specially focusing on the risk of emerging resistance to the antibiotics, and the financial implications.

Anti-Bacterial Agents↗
PubMed2006

Evaluation of ideal irrigation fluid in 'Greenlight' photoselective vapourization of the prostate.

Although many anecdotal opinions are available that water gives a better visual quality, no studies have analysed the differences in the visual quality of the operative field with the use of either saline or sterile water. As part of a prospective audit we wished to assess the effect of differing irrigant fluids on intraoperative visibility during Greenlight photoselective vapourization of prostate (PVP). Twenty-nine consecutive patients with prostates less than 100 cm(3) who underwent PVP were studied. The irrigation fluid used was randomly connected on a bag-by-bag basis, with the surgeon blinded to the bag's contents. Towards the end of each bag the surgeon gave a score to the quality of vision. All surgeons were familiarized with the vision scoring system in advance. The scores were analysed in two ways. The mean scores for water and saline were compared. In addition, a mean score for each fluid in each patient where both fluids were used (n=24) was separately calculated and the means for each fluid compared. One hundred and twenty-four bags of fluid in 29 operative cases were analysed. The mean overall vision scores were 3.94% for saline and 4.01% for water (P=0.62). The paired data were analysed using the Student's t-test and there was no statistically significant difference (P=0.34). We showed no significant difference in visual quality between water and saline during PVP. Although fluid absorption is almost unknown with PVP, there seems to be no justification for using water irrigation if saline is available, particularly with a theoretical risk of absorption.

Humans↗
PubMed1988

A prospective controlled trial of topical irrigation in the treatment of delayed cutaneous healing in human leg ulcers.

1. Topical irrigation with normal saline is known to produce rapid healing in chronic leg ulcers. This study was designed to determine if the rate of healing could be improved by the addition of topical nutrition to the irrigating solution. 2. Forty-eight patients with chronic leg ulcers were admitted to hospital for a minimum of 6 weeks bed-rest. During this time the ulcers were continuously irrigated by one of four test solutions. The solutions were: normal saline; a dilute amino acid solution isotonic with the normal saline; a hyperosmolar saline solution; a hyperosmolar amino acid solution. There were 12 ulcers in each group. 3. The amino acid solutions produced significantly faster healing than the saline solutions (P less than 0.01). Concentration had no significant effect on healing (P greater than 0.15). 4. The application of amino acids does appear to enhance healing in this model of delayed wound healing. This effect does not depend only on the osmolarity of the solution used.

Amino Acids↗
PubMed2003

Transurethral vaporisation of the prostate and irrigating fluid absorption.

Transurethral vaporisation of the prostate gland (TUVP) is an emerging surgical alternative to conventional electroresection (TURP). This study examined vesical pressure and fluid absorption during TUVP in 35 patients with benign prostatic hypertrophy. The irrigating fluid was a solution of glycine 1.5% and ethanol 1%. Intraoperative intravesical pressure was monitored continuously and absorption of irrigating fluid was detected by ethanol analysis in expired breath. The incidence of absorption during TUVP was 34%. Intravesical pressures were higher amongst patients who went on to absorb than amongst patients who did not. Combining data from the current study and from 35 patients in our previous investigation into TURP (Gray et al.: Anaesthesia 2001; 56: 461-4), urological trainees operated at higher mean pressure and for longer than their consultant colleagues and their resections were significantly more likely to result in absorption. The incidence of irrigating fluid absorption during trainees' operations appeared to be less using TUVP than using conventional TURP.

Absorption↗
PubMed1999

Antimicrobial effects of various endodontic irrigants on selected microorganisms.

AIM: This study was undertaken to determine the antimicrobial effect of various endodontic irrigants against six selected microorganisms. METHODOLOGY: Staphylococcus aureus, Enterococcus faecalis, Streptococcus salivarius, Str. pyogenes, Escherichia coli and Candida albicans were included in the study. Pre-sterilized Whatman paper discs, 6 mm in diameter and soaked with the test solution, were prepared and placed onto the previously seeded agar Petri plates. Each plate was incubated aerobically. A zone of inhibition was recorded for each plate and the results were analysed statistically. RESULTS: 5.25% NaOCl was effective against all test microorganisms with a substantial zone of inhibition. Saline was always ineffective. Decreased concentration of NaOCl significantly reduced its antimicrobial effect. Cresophene showed a significantly larger (P < 0.05) average zone of inhibition compared to the other experimental irrigants. Alcohol had smaller but not significantly different zones of inhibition than chlorhexidine. CONCLUSIONS: 5.25% NaOCl was superior in its antimicrobial abilities compared with other irrigants used. A reduced concentration of NaOCl (0.5%) resulted in significantly decreased antimicrobial effects. When compared with 21% alcohol, 0.5% NaOCl and 2% chlorhexidine, paramonochlorophenol (cresophene) showed a greater antimicrobial effect.

Analysis of Variance↗
PubMed2000

Effectiveness of 1 mol L-1 citric acid and 15% EDTA irrigation on smear layer removal.

AIM: The aim of this study was to evaluate in vitro the cleansing and smear layer removal capability of alternate canal irrigation with citric acid and NaOCl. METHODOLOGY: Eighty-one teeth were divided into three groups on the basis of the type of instrumentation, namely, manual stainless steel, Ni-Ti mechanized ProFile .04 taper or MACXim. The groups were further divided on the basis of irrigation protocol: 5% NaOCl alone, NaOCl alternated with 1 mol L-1 citric acid solution or a combination of 15% EDTA and Cetrimide solution. After longitudinal sectioning, dentinal walls were microphotographed with scanning electron microscopy at x300 and x1000 magnifications. Qualitative and quantitative cleansing level evaluations were performed using computerized image analysis software. Data were statistically evaluated using Kruskal-Wallis analysis and t-test. RESULTS: Qualitative evaluation at x300 and x1000 showed no statistically significant differences in cleansing ability between citric acid, EDTA and NaOCl groups. Quantitative evaluation of smear layer removal, measured as open tubules/total dentinal surface ratio, showed that 1 mol L-1 citric acid solution was comparable to EDTA (11.97% vs. 10.36%) (NS); in samples treated with ProFile .04 taper instruments citric acid was most effective (16.17%), whilst in the group treated with manual instrumentation EDTA and Cetrimide were the most effective (11.94%). Specimens irrigated with 5% NaOCl demonstrated significantly more cleansing than those obtained in the other two groups (P < 0.001). CONCLUSIONS: 1 mol L-1 citric acid solution was as effective in removing smear layer as EDTA, but was superior in specimens treated with ProFile .04 taper instruments.

Cetrimonium↗
PubMed2002

Influence of irrigants on the coronal microleakage of laterally condensed gutta-percha root fillings.

AIM: To assess in vitro coronal microleakage in extracted human teeth after root-canal treatment, using different endodontic irrigants. METHODOLOGY: Fifty teeth with single root canals were prepared and filled using the lateral condensation of gutta-percha and Endométhasone sealer. Canal preparation consisted of initial shaping of the coronal two-thirds with Gates-Glidden burs size 2 and 3, followed by preparation of the apical stop and step-back flaring with manual files. Each group (n = 10) was irrigated with the following solutions: I--1% NaOCl, II--1% NaOCl + 17% EDTA, III--2% chlorhexidine gel, IV--2% chlorhexidine gel + 1% NaOCl, and V--distilled water. After root-canal filling, the teeth were incubated at 37 degrees C for 10 days followed by 10 days immersion in human saliva and an additional 10 days in India ink. The teeth were cleared and maximum dye penetration was determined digitally in millimetres. Statistical analysis was carried out using the Kruskal-Wallis test. RESULTS: Least leakage occurred with 1% NaOCl + 17% EDTA (2.62 mm) and 2% chlorhexidine gel (2.78 mm) (P > 0.05). NaOCl (3.51 mm), distilled water (6.10 mm) and 2% chlorhexidine gel + 1% NaOCl (9.36 mm) gave increased leakage with a significant difference compared to NaOCl + 17% EDTA and 2% chlorhexidine gel, and compared to one another (P < 0.05). CONCLUSIONS: Under the condition of this study, irrigation method during root-canal treatment influenced coronal microleakage. NaOCl + EDTA and chlorhexidine gel allowed better sealing following root filling.

Administration, Topical↗
PubMed2003

Scanning electron microscopic study of the cleaning ability of chlorhexidine as a root-canal irrigant.

AIM: To evaluate in vitro the cleaning of root-canal walls after irrigation with different irrigants. METHODOLOGY: A total of 36 recently extracted human teeth were divided into four experimental groups according to the irrigating solution used: saline; 2% chlorhexidine; 2.5% sodium hypochlorite; and 2.5% sodium hypochlorite + EDTA. The cleaning of the apical, middle and coronal thirds of the root canals was evaluated by scanning electron microscope examination using a 4-point scoring system. RESULTS: The best cleaning was obtained using 2.5% sodium hypochlorite and EDTA, followed by 2.5% sodium hypochlorite only (P < 0.05), whose cleaning was similar to chlorhexidine only in the cervical third. Cleaning by saline and 2% chlorhexidine was worse than the other two groups and was similar in all thirds. Better cleaning was found in the cervical and middle thirds for all groups with the worst results in the apical third. CONCLUSIONS: The apical third of the root canals was not cleaned as well as the middle and coronal thirds. Cleaning by chlorhexidine and saline was inferior compared to the cleaning by sodium hypochlorite with and without EDTA.

Analysis of Variance↗
PubMed2003

Effect of different irrigation solutions and calcium hydroxide on bacterial LPS.

AIM: To evaluate the effect of biomechanical preparation with different irrigating solutions and calcium hydroxide dressing in dog root canals containing bacterial endotoxin (lipopolysaccharides; LPS). METHODOLOGY: One hundred and forty premolar roots from seven dogs were filled with Escherichia coli LPS for 10 days (three roots were lost during histological processing). The following irrigating solutions were used for biomechanical preparation: 1% (group I, n = 20), 2.5% (group II, n = 19) and 5% sodium hypochlorite (group III, n = 19), 2% chlorhexidine digluconate (group IV, n = 20) and physiological saline solution (group V, n = 19). In group VI (n = 20), the LPS solution was maintained in the root canal during the entire experiment and in group VII (n = 20), after biomechanical preparation with saline solution, the root canals were filled with a calcium hydroxide dressing (Calen; control). After 60 days, the animals were sacrificed and the following parameters of periapical disease were evaluated: (a) inflammatory infiltrate, (b) periodontal ligament thickness, (c) cementum resorption and (d) bone resorption. Scores were given and data were analysed statistically with the Kruskal-Wallis and Dunn tests (P < 0.05). RESULTS: Histopathological evaluation showed that groups I-VI had more inflammatory infiltrate, greater periodontal ligament thickening and greater cementum and bone resorption (P < 0.05) compared to group VII, which received the calcium hydroxide intracanal dressing. CONCLUSIONS: Biomechanical preparation with the irrigating solutions did not inactivate the effects of the endotoxin but the calcium hydroxide intracanal dressing did appear to inactivate the effects induced by the endotoxin in vivo.

Alveolar Bone Loss↗
PubMed1996

Haemodynamic effects of irrigating fluids studied by Doppler ultrasonography in volunteers.

OBJECTIVE: To study whether moderate amounts of irrigating fluids induce cardiac stress when infused into healthy volunteers, giving special attention to solutions containing ethanol as a tracer of absorption. SUBJECTS AND METHODS: Over a period of 20 min, 15 mL/kg of glycine (1% or 1.5%) or 3% mannitol (all containing 1% ethanol) or sorbitol 2%-mannitol 1% (with no ethanol) were infused intravenously into 10 healthy male volunteers. The central haemodynamic responses were studied using Doppler ultrasonography. RESULTS: Specific and general haemodynamic responses were observed. After infusing glycine there was a reduction of the heart rate and in cardiac output and an elevation of mean arterial pressure, indicating an increase in systemic resistance. There was no improvement when the glycine content was reduced from 1.5% to 1.0%. Furthermore, infusion of all irrigating fluids was associated with a decrease in cardiac output 30 min after the infusion. Almost identical breath-ethanol curves were obtained with the three fluids containing ethanol and all of them caused slight hypoglycaemia. There was no evidence of ethanol-induced tachycardia. CONCLUSIONS: Irrigating fluids containing glycine and ethanol have a specific haemodynamic effect not occurring with solutions containing mannitol or sorbitol.

Adult↗
PubMed1997

A randomized controlled trial evaluating the use of sterile water as an irrigation fluid during transurethral electrovaporization of the prostate.

OBJECTIVE: To compare the safety of sterile water and glycine when used as bladder irrigation during transurethral electrovaporization of the prostate (TUVP) in a randomized controlled trial. PATIENTS AND METHODS: The study comprised 50 consecutive patients admitted for transurethral prostatic surgery who were randomly allocated to receive bladder irrigation with either sterile water or 1.5% glycine during TUVP. After surgery, serum electrolytes and the presence of free plasma haemoglobin (suggesting haemolysis) were determined and the patients observed for clinical evidence of the transurethral resection (TUR) syndrome. RESULTS: There was no significant difference in the level of free plasma haemoglobin between the groups and no difference in serum sodium levels. None of the patients developed any signs of the TUR syndrome. CONCLUSIONS: Water is a safe irrigant for use during TUVP and has several advantages over 1.5% glycine.

Aged↗
PubMed2000

The control of haemolysis during transurethral resection of the prostate when water is used for irrigation: monitoring absorption by the ethanol method.

OBJECTIVE: To determine whether the addition of ethanol to water for irrigation during transurethral resection of the prostate (TURP) and monitoring breath ethanol could be used to detect irrigant absorption and to limit free plasma haemoglobin in cases of absorption. PATIENTS AND METHODS: One hundred patients (46 in Piteå, Sweden and 54 in Uong bi, Vietnam) underwent surgery for benign prostatic hyperplasia (BPH) under an intermittent irrigation technique using water containing 2% ethanol. An expired breath alcohol meter was used to monitor ethanol in the patients' breath every 5 min. Blood samples taken after TURP were assessed for free haemoglobin in 99 patients, and other markers of haemolysis were also evaluated in the Swedish group. RESULTS: Thirty-two patients had detectable ethanol in their breath. There was a close correlation between the maximum ethanol reading during surgery and the level of free plasma haemoglobin after TURP (r = 0.90, P < 0.001). There was no correlation between the duration of TURP and the free haemoglobin level. CONCLUSION: Monitoring breath ethanol during TURP assesses absorption and so can help to keep control of haemolysis. It is suggested that the value on the alcohol meter should not be allowed to exceed 0.15 (corresponding to a blood ethanol level of 0.15 per thousand), which should maintain the free plasma haemoglobin level at < 1.0 g/L after TURP. Restricting the operative duration per se is not a reliable safety measure.

Absorption↗