The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various supportive therapeutic strategies in the pre-hospital and pre-operative stages is essential for optimal care. The immediate rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure is now the standard treatment of patients with combined traumatic brain injury (TBI) and hemorrhagic shock (HS). The Fluid in patients with brain trauma and especially in patients with brain injur y is a critical issue. In this context we present a review of the literature about the history, physiology of current Fluid preparations, and a discussion regarding the use of Fluid Therapy in traumatic brain injury and decompressive craniectomy.

Background: Post-operative nausea and vomiting (PONV) following surgical operations requiring general anesthesia are common and distressing. The incidence of PONV may be as high as 70% during the first 24 hrs of tonsillectomy. Objective: This study determines the effects of intraoperative well-hydration on postoperative nausea and vomiting. Methods: 90 ASA I patients with age of 6-12 years scheduled for tonsillectomy under general anesthesia randomly assigned to receive either routine iv Fluid plus intraoperative well-hydration plus 4 ml/kg/h Ringer’s solution (well hydrated group; n=45) and routine iv Fluid requirements (control group; n=45). All study preparations were administered in a doubleblinded fashion. Results: During the first postoperative day, the incidence of nausea and vomiting were significantly lower in the wellhydrated group as compared with control (p<0.05). There was no significant differences between males and females regarding the incidence of nausea and vomiting (p>0.05). Conclusion: The present study showed that well-hydration reduces the incidence of post tonsillectomy nausea and vomiting, and high iv Fluid Therapy is a simple, effective, safe and well-tolerated technique for prevention of postoperative nausea and vomiting.

Background and Aim: Electrolyte disorders in hospitalized children have several causes. One of the most important and common causes is using inappropriate maintenance Intravenous Fluids. This study aimed to investigate the effect and type of maintenance of Intravenous Fluids on the incidence of electrolyte disturbance in hospitalized children. Methods: This research is a prospective cohort study. Non-surgical hospitalized children were divided into two groups based on the type of Intravenous Fluid received (normal saline [0. 9% NaCl] or half saline [0. 45% NaCl]). After matching two groups in terms of age and gender, the incidence of electrolyte disturbances (sodium and potassium) was evaluated in the two groups on the second and third days of the study. Results: A total of 163 patients were included in this study. About 55. 5% of the children were boys, and 44. 5% were girls. The Mean±, SD age of the children was 48. 42±, 36. 35 months, and their mean weight was 19. 49±, 10. 88 kg. Also, 50. 6% of patients were in the half saline group and 49. 4% in the normal saline group. Initially, serum sodium and potassium levels were normal in both groups. On the second and third days of the study, the incidence of serum sodium and potassium disorders was higher in patients who received half saline Fluid, but this higher incidence was not statistically significant (P>0. 05). Conclusion: There is no significant difference between normal saline and half saline in terms of electrolyte disturbance if the patient’, s clinical condition is judged correctly and an appropriate volume of Fluids is prescribed.

Introduction: Olygohydromniosis is a common phenomen in prolonged pregnancies and fetal growth rethardaton. The aim of this study was to determine the effect of maternal hydration with Intravenous (IV) isotonic Fluid, IV hypotonic Fluid, and oral water on amniotic Fluid index (AFI) in women with oligohydramnios. Methods and Material: This study was a clinical trial study, done in the year 2004 in Khoram Abad Asali Hospital. 80 patients with low AFI (less than 5cm) and gestational age over 35 weeks without maternal complications were randomized into four groups (2L/2h IV isotonic Fluid, 21/2h IV hypotonic Fluid, 2L/2horal water, control). Maternal AFI was measured before hydration and 1 hour after hydration. Variables such as maternal age, gestational age, gravity, parity and AFI were gathered by a check list and analyzed with SPSS. Data were compared using paired t-test and Fisher within each group (p<0.05) was considered statistically significant. Results: Eighty patients (n=20/group) completed the study without and maternal adverse effects. The mean increase in AFI after hydration was significantly greater in oral water groups (this pattern increased from 3.6±1 to 6±1.09 (p<0.001), in the IV hypotonic group mean AFI increased from 4.2±0.83 to 5.98±0.94 (p<0.001), in the IV isotonic group mean AFI increased from 4.42±-0.49 to 5.3±-0.7 (p<0.001), in the control group change in AFI was not significant (from 4.01±0.68 to 4.08±0.6).Conclusion: Maternal hydration with oral water, IV hypotonic Fluid and IV Isotonic Fluid increases AFI in oligohydramnios. Maternal hydration with oral water was more effective than other groups.

Background: Outpatient surgery is practiced worldwide. The shortage of nursing and limitations of bed spaces, as well as the popularity of outpatient surgery with patients has encouraged the growth of outpatient surgery and the emphasis on its efficacy. Complications like nausea, vomiting, dizziness, drowsiness may delay ambulating of patients and cause prolonged hospitalization. The present study was conducted with the aim of determining the efficacy of Intravenous Fluid Therapy on adverse events of outpatient surgeries. Materials and methods: We studied 70 patients ASA class I, II who had been candidated for D&C. They were randomized in two groups to receive 20 cc/kg (case group) or 2cc/kh (control group) of ringer solution intraoperatively. A standardized balance anesthesia (fentanyl 1 µg/kg, thiopental sodium 4mg/kg and maintenance of (Halothane 1%, O2, N2O 5%) was used for all patients. The incidence of drowsiness, dizziness, fatigues, nausea, vomiting, and recovery time, obeying orders and obeying exact order were recorded. Finally data were analyzed by SPSS software. Results: Incidence of nausea, vomiting, and drowsiness had significantly decreased in case group (P<0.05), meanwhile, mean time of recovery, obeying orders and obeying exact orders were decreased significantly in case group (P<0.0001). Mean time of eye opening has shown no significant difference between the groups. Conclusion: Intraoperative Fluid replacement seems to be associated with reduced postoperative complications. Thus, this approach is highly recommended on outpatient surgeries.

Introduction: The administration of crystalloid Fluids is considered as the first line treatment in management of trauma patients. Infusion of Intravenous Fluids leads to various changes in hemodynamic, metabolic and coagulation profiles of these patients. The present study attempted to survey some of these changes in patients with mild severity trauma following normal saline infusion.Methods: This study comprised 84 trauma patients with injury of mild severity in Shahid Rajaei Hospital, Shiraz, Iran, during 2010-2011. The coagulation and metabolic values of each patient were measured before and one and six hours after infusion of one liter normal saline. Then, the values of mentioned parameters on one and six hours after infusion were compared with baseline measures using repeated measures analysis of variance.Results: Eighty four patients included in the present study (76% male). Hemoglobin (Hb) (df: 2; F=32.7; p<0.001), hematocrit (Hct) (df: 2; F=30.7; p<0.001), white blood cells (WBC) (df: 2; F=10.6; p<0.001), and platelet count (df: 2; F=4.5; p=0.01) showed the decreasing pattern following infusion of one liter of normal saline. Coagulation markers were not affected during the time of study (p>0.05). The values of blood urea nitrogen (BUN) showed statistically significant decreasing pattern (df: 2; F=5.6; p=0.007). Pressure of carbon dioxide (PCO2) (df: 2; F=6.4; p=0.002), bicarbonate (HCO3) (df: 2; F=7.0; p=0.001), and base excess (BE) (df: 2; F=3.3; p=0.04) values showed a significant deteriorating changes following hydration Therapy.Conclusion: It seems that, the infusion of one liter normal saline during one hour will cause a statistically significant decrease in Hb, Hct, WBC, platelet, BUN, BE, HCO3, and PCO2 in trauma patients with mild severity of injury and stable condition. The changes in, coagulation profiles, pH, PvO2, and electrolytes were not statistically remarkable.

Background & Aim: Hypothermia is a main side effect during surgery in which blood pressure, heart rate, intra cranial pressure, oxygen consumption, pain and discomfort increase. The rate of cesarean section in Iran is three times more than global standard. This study aimed to investigate effect of pre-warmed Intravenous Fluid Therapy on prevention of shivering after general anesthesia in cesarean section.Methods & Materials: A total of 62 women undergoing general anesthesia for elective cesarean section were randomly allocated into two intervention and control groups. In the intervention group, patients received pre-warmed serum (37oC) and in the control group, patients received serum at room temperature (25.5oC). The postoperative shivering and some homodynamic parameters of the participants were assessed in recovery room.Results: The mean of body temperature in the intervention and control groups were 35.9oC±0.48 and 35.42oC±0.6, respectively (P<0.05). The incidence of post operative shivering in the intervention and control groups were 13% and 35%, respectively (P<0.05).Conclusion: Infusion of pre-warmed serum (37oC) would prevent postoperative shivering and could improve nursing care for women underwent general anesthesia in cesarean section.

BACKGROUND: Treatment of hemorrhagic shock is the major problem in emergency surgery. Fluid Therapy is one of the first steps but, the conflict has been over the temperature used for the Fluid injected to the patient. The aim of this study was to determine the effect of Fluid temperature in Intravenous Fluid resuscitation of hemorrhagic shock. METHODS: In this experimental study, 3 groups of 10 rabbits underwent  emorrhagic shock class III (mean arterial pressure = 40 mmHg) by catheter on femoral artery. Within 25 minutes, ringer lactate solutes with controlled temperatures of 15°C, 25°C and 37°C were injected through femoral venous line. They were followed for 72 hours. RESULTS: In the lowest, middle and the highest Fluid temperature group, mortality rate was 90%, 10% and 40%, respectively. Statistically significant difference was seen between the 15°C and 25°C resuscitation groups (P<0.001). CONCLUSIONS: Our findings showed possible benefit of room temperature as the optimal Fluid temperature for Fluid resuscitation in hemorrhagic shock.

Background: Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of Fluid Therapy post-operatively. We compared half-saline vs. normal saline and 1/3–2/3 Intravenous Fluid replacement after renal transplantation.Methods: We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients (Case) received half saline, and group B patients (Control) received normal saline and 1/3–2/3 Intravenous Fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day.Results: There were 34 and 36 eligible patients in the case and control groups, respectively. The mean±SD 6-hour urine output in the first 5 days after surgery was 2586±725 mL in the control group and 2764±758 mL in the case group (p=0.31). The mean±SD serum creatinine level at the end of the 5th post-operative day was 1.3±0.5 and 1.4±0.7 mg/dL in the case and control groups, respectively (p=0.56). Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day (p=0.558). The mean±SD time to creatinine level<1.5 mg/dL was 1.3±1 days in the control group and 1.7±0.8 days in the case group (p=0.635). Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group (p=0.318). The incidence of hyponatremia in the control group was 11% (4 of 36 patients) vs no patients in the case group (p=0.115).Conclusion: Either half-saline or normal saline and 1/3–2/3 Intravenous solution can be safely used as Fluid replacement Therapy after kidney transplantation.