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Mediastinal irrigation with superoxidized water after open-heart surgery: the safety and pitfalls of cardiovascular surgical application.

Postoperative mediastinal infection after open-heart surgery via median sternotomy is a devastating complication. In this paper, we describe a simple method of irrigating the mediastinum using superoxidized water to prevent perioperative contamination. After mediastinal hemostasis was done, warm superoxidized water of more than 21 was uninterruptedly irrigated for 5 min immediately prior to sternal closure. We have used this method in 25 patients undergoing cardiac surgery, and noted significant perioperative electrocardiographic changes, including ST elevation, without hemodynamic compromise in 15 of these patients.

Cardiac Surgical Procedures↗

Open retroperitoneal irrigation for graft infection after thoracoabdominal aortic aneurysm repair.

A successfully-treated case of graft infection after thoracoabdominal aortic repair is reported. A 61-year-old male underwent graft replacement of a Crawford type IV thoracoabdominal aortic aneurysm and developed graft infection due to methicillin-resistant Staphylococcus aureus. After 35 days' open retroperitoneal irrigation, the culture around the graft turned negative, and omental transposition and skin flap transfer were successfully conducted. The long-term open retroperitoneal irrigation could be conducted without significant complications, and it was very effective in controlling the severe infection.

Aortic Aneurysm, Abdominal↗

Pleural space sterilization using gentian violet irrigation for postbullectomy empyema associated with artificial material infection.

Postoperative empyema associated with artificial material infection involves several treatment problems. We report the successful treatment of a case of post-bullectomy empyema with a small alveolar fistula that was associated with artificial material infection by Streptococcus viridans. In this case, complete empyema space sterilization was obtained by tube drainage and daily pleural irrigation using 0.1% gentian violet solution. This treatment circumvented the need for invasive surgery, including removal of the infected artificial materials and space-filling and/or collapse procedures. Consequently, gentian violet irrigation may be a useful treatment option in selected cases with complicated thoracic empyema.

Adult↗

Comparative toxicity of intraocular irrigating solutions on the corneal endothelium.

Isolated rabbit and human corneas were perfused in vitro with Plasma-lyte 148 solution and with a glutathione bicarbonate Ringer's solution. The corneal swelling rate and ultrastructure were compared to corneas perfused with three commonly used intraocular irrigating solutions. Corneas perfused with Plasma-lyte 148 swelled at a rate of 47 mu/gr and the endothelial cells separated from each other and showed extensive damage after three hours of perfusion. By comparison, corneas perfused with 0.9% NaCl increased in thickness by 98 mu/hr, lactated Ringer's by 39 mu/hr, balanced salt solution by 24 mu/hr, and glutathione bicarbonate Ringer's solution by 4 mu/hr. These results indicate that endothelial cell damage and increased corneal thickness observed during perfusion was related to the incomplete composition of 0.9% NaCl, Plasma-lyte 148, and lactated Ringer's and that endothelial cell damage can be prevented if the intraocular irrigating solution contains concentrations of inorganic and organic constituents that are similar to those in aqueous humor.

Animals↗

Intraocular irrigating solutions and lens clarity.

By in vitro incubation of rhesus monkey lenses at 37degreesC, we determined that solutions superior to intraocular irrigating solutions in common clinical use could be prepared by aspetically adding commerically available solutions of dextrose 5% in water and sodium bicarbonate to either Ringer's injection or Ringer's lactate solutions. While not as effective as glutathione-bicarbonate-Ringer's solution (G-B-R) in maintaining lens clarity, these mixtures can be prepared easily in the operating room (in contrast to G-B-r) and may improve surgical results in procedures requiring prolonged intraocular irrigation.

Animals↗

The effects of intravitreal irrigation during vitrectomy on the electroretinogram.

Intravitreal irrigation with Balanced Salt Solution Plus (BSS Plus) produced less decrease in b-wave amplitude than either normal saline solution or Balanced Salt Solution. BSS Plus was more suitable for intravitreal irrigation because it contained the appropriate bicarbonate, pH, and ionic composition necessary for maintenance of normal retinal electrical activity, and it contained glutathione, which is necessary for maintenance of endothelial cell adenosine triphosphatase and for protection against free radical damage and oxidative stress.

Animals↗

The effect of intraocular irrigating solutions on lens clarity in normal and diabetic rabbits.

We conducted a series of experiments on normal and diabetic rabbits to evaluate the effect of intraocular irrigating solutions on the lens. Lenticular clarity was studied in vivo in eyes undergoing vitreous cavity perfusions with various irrigating solutions. The clarity of isolated lenses incubated in these same solutions was also evaluated. In order to quantitate the cataractous changes observed, we measured the uptake of inulin (tagged with radioactive carbon) by isolated lenses. We found that balanced salt solution (BSS) and BSS Plus maintain excellent lens clarity in normal rabbits; that diabetic lenses are more likely to develop opacification than normal lenses, becoming cataractous when exposed to BSS Plus; and that adding supplemental glucose to BSS Plus allows this solution to maintain excellent lens clarity in diabetic rabbits.

Animals↗

Antibiotic irrigation and the formation of intraabdominal adhesions.

The efficacy of antibiotic peritoneal lavage in the prevention of postoperative infection is controversial. The role of intraperitoneally administered cefazolin and tetracycline in the formation of adhesions was studied in the rodent model. Thirty-two rats were divided into 3 groups. Group 1 underwent midline laparotomy with instillation of 10 ml of normal saline solution. Group 2 and Group 3 underwent the same procedure with instillation of 0.2 percent saline solutions of cefazolin or tetracycline, respectively. Animals were sacrificed after 2 weeks. Intraabdominal adhesions were graded and samples of parietal peritoneum were processed for histologic data. Group 2 and Group 3 had significantly higher adhesion scores compared with Group 1 (p less than 0.001). Histologic appearance of both antibiotic-irrigated groups showed mesothelial thickening with presence of fibroblasts and collagen. Cefazolin and tetracycline irrigation of the abdominal cavity contributes to the formation of peritoneal adhesions in the rat model.

Abdomen↗

Catheter irrigation for treatment of pyogenic closed space infections of the hand.

We studied 29 patients admitted to San Francisco General Hospital with flexor tenosynovitis (6 patients), pyogenic arthritis (17 patients), and deep space infections (6 patients). All patients underwent catheter irrigation of the infected space for at least 48 hours postoperatively. In 23 patients no further operative procedures were required. Infection was controlled without amputation in all patients. Median hospital stay was the same for patients with tenosynovitis, pyogenic arthritis, and deep space infections (8 days). Thirteen of 17 patients followed for at least one month, including 7 of 9 patients with pyogenic arthritis, were found to have regained at least 50% of baseline motion. In this series the outcome of treatment for pyogenic arthritis was comparable to that for tenosynovitis. We believe that catheter irrigation should be considered as a treatment option in pyogenic arthritis. A prospective trial comparing the efficacy of treatment modalities for pyogenic arthritis is indicated.

Adolescent↗

Effectiveness of root canal irrigation.

When root canals are being enlarged, repeated irrigation is mandatory. Under the conditions of this study, the most significant factor in obtaining maximum results in root canal irrigation is the diameter of the canals. The removal of debris seems to be a function of canal diameter rather than the type of solution used.

Contrast Media↗

9-Aminoacridine--its present status and current recommendations for use as a surgical and endodontic irrigant in dentistry.

Evidence is presented to support the use of 9-aminoacridine as a safe and effective surgical irrigant in dentistry. The available literature confirms that 9-aminoacridine is a potent antimicrobial agent, effective against a wide range of microorganisms commonly found in septic wounds and causing minimal tissue irritation. The use of 9-aminoacridine for routine root canal irrigation and as an antiseptic in the management of maxillofacial abscesses is recommended.

Aminacrine↗

The efficacy of several irrigating solutions for endodontics: a scanning electron microscopic study.

The perforated irrigation needle was used to test a high-volume (20 c.c.) final flush of prepared root canals. Three solutions: TEGO 1 percent, NaOCl 5.25 percent, and REDTA were tested. The roots were split longitudinally and were prepared for examination under the scanning electron microscope immediately after preparation and final flushing. In addition, groups were prepared and flushed in the same manner, but after splitting they were soaked in the respective solutions for 3 hours and then examined. The results indicated that the smeared layer is caused by instrumentation, that it is not removed by TEGO or NaOCl, and that it is removed by REDTA. It may be that the smeared layer is a slurry of dentin filings, since REDTA does not remove soft tissue. All solutions produced a canal quite free of debris; however, none of the tested irrigants was completely satisfactory by itself.

Dentin↗

Carbon dioxide gas replacement of chronic subdural hematoma using single burr-hole irrigation.

In order to achieve complete irrigation, reduce air in the hematoma cavity, and obtain rapid reduction of the cavity without drainage, we use burr-hole evacuation of the hematoma followed by irrigation using physiologic saline solution and replacement of the hematoma with carbon dioxide (CO2) gas. We have treated 19 cases between the ages of 41 and 84. With the exception of one case with dementia of 5 years' duration, all cases were asymptomatic postoperatively. Computed tomography (CT) scans obtained immediately postoperatively showed the gas to fill the hematoma cavity, but on the following day, the gas and the hematoma cavity had nearly disappeared. There was no surgical mortality nor morbidity and there were no side effects of the CO2 gas. Recurrence was found in one case (5.3%). By filling the hematoma cavity with CO2, disappearance of the cavity is rapid and drainage is not needed. Moreover, this technique implies no restrictions on postoperative motility, and is thus suitable for elderly patients.

Adult↗

An experimental evaluation of antiseptic wound irrigation.

An experimental wound infection model was used to assess the value of four proprietary antiseptics applied topically in preventing the development of wound sepsis. Irrigation of wounds with either saline or noxytiolin 15 min after contamination with Staphylococcus aureus did not reduce either the incidence or degree of infection. Benzalkonium chloride and, to a lesser degree, povidone-iodine significantly reduced the infection rate, but were inferior to chlorhexidine gluconate which eliminated all overt signs of infection. The rate of healing of the chlorhexidine-treated, contaminated wounds was found to be no different from control non-infected wounds. When irrigation was carried out 45 min before wounds were contaminated, chlorhexidine was the only treatment which reduced the rate of infection (P less than 0.001). It is concluded that the superior activity of chlorhexidine in this model is a good indication that it should be a highly effective agent in the prevention of staphylococcal wound infection, and that this is probably due to a combination of bactericidal and persistent action together with low toxicity.

Animals↗

Non-toxic antiseptic irrigation with chlorhexidine in experimental revascularization in the rat.

The effect of different wound irrigation fluids upon femoral arteries and veins was investigated in the rat, using microsurgical techniques. Toxicity was evaluated by microscopical observation after selective staining of histological slides. Povidone-iodine, 10%, proved to be a very irritant solution, provoking an attack on the vascular endothelium and secondary thrombosis. Chlorhexidine at 0.05%, 0.02% and 0.001% was found by contrast to have a very low toxicity which was comparable to physiological saline. Experimental investigation of antiseptic solutions should not only include the determination of the antibacterial effect, but also the potential for cell toxicity, using an irrigation technique.

Animals↗

Closed continuous irrigation as a treatment for infection in the hand.

A method of closed irrigation has been devised to treat infections in the hand. After adequate débridement, two tubes are placed in the infected area, an inlet tube and an outlet tube. For a small infection, one tube serves both purposes. The wound is closed completely. Irrigation with saline and antibiotic solution is continued for 1 week, extended up to 3 weeks in cases of severe infection. This method has been applied in 31 cases including pyogenic tenosynovitis, tuberculous tenosynovitis, pyogenic arthritis, osteomyelitis, bite injury, crush injury and amputation stump infection. Infection healed primarily in 29 cases. Further surgery was needed in two cases which healed finally.

Adolescent↗

Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem.

Gastrointestinal drug smuggling is a common problem in many major cities. Though the majority of cases never require medical attention, the "body-packer" frequently presents with life-threatening symptoms of intoxication, including seizures and cardiorespiratory collapse, as well as mechanical obstruction from the ingested drug packets. The risk to asymptomatic smugglers may vary with packaging materials, and remains unknown. Lack of controlled studies, and variations in packaging materials and clinical outcomes have prevented formulation of a consistent management strategy. Current recommendations for asymptomatic body-packers vary from immediate surgical removal, to use of laxatives, to observation. The authors present the first reported case of an asymptomatic cocaine body-packer treated with whole bowel irrigation with polyethylene glycol electrolyte lavage solution. This strategy was safe, well tolerated, resulted in the rapid elimination of drug packets from the gastrointestinal tract, and facilitated assessment by contrast radiography. The potential benefits and limitations for the use of whole bowel irrigation in this difficult problem are discussed.

Adult↗