Perioperative evaluation of patients with liver cirrhosis

This work studied 30 patients of both sexes aged between 30-73 years, weighing between 66-95 kg undergoing upper abdominal surgical procedures under general anesthesia. The patients were randomly assigned into three categories according to Child-Pugh and Moemen classification. PT prolonged, serum creatinine and albumin level were measured compared before and after preparation. Intraoperative hemodynamics, morbidity and mortality were evaluated. In this study, it was observed that the PT prolonged and serum creatinine were decreased and albumin level was increased after preparation as compared to baseline value. Although hemodynamic changes during operation were sometimes statistically significant, this was of no clinical importance. Comparison of Child-Pugh and Moemen scores and classifications by statistical study showed a significant positive correlation between them. In the present study, the morbidity was reported by 30% in all patients within 30 days after operation. The overall mortality rate was 6.6% within 30 days after operation

Daily interruption of intravenous sedative infusions for patients with acute respiratory failure in intensive care unit

Objective is to determine whether daily interruption of sedative infusions would decrease the duration of mechanical ventilation and the length of stay in the intensive care. A prospective, randomized, controlled trial. Setting: Intensive care unit in El-Minia University Hospital. Forty-five adult patients presenting with respiratory failure [acute exacerbation of chronic obstructive pulmonary disease] who were receiving mechanical ventilation and continuous infusion of sedative drugs. In the intervention group, the sedative infusions were interrupted until the patients were awake, on a daily basis; in the control group, the infusions were interrupted only at the discretion of the clinicians in the intensive care unit according to the condition of the patient The mean duration of mechanical ventilation was 4.6 +/- 1.2 days in the intervention group, as compared with 7.3 +/- 1.5 days in the control group, and the length of study in the intensive care unit was 5.8 +/- 2.2 days as compared with 9.4 +/- 2.6 days respectively. The wake up time was significantly shorter in patients who received propofol infusion [of both groups] as compared with patients who received midazolam. The triglycerides level were significantly higher in patients who received propofol sedation [of both group] with insignificant changes in patients who received midazolam Adverse events [e.g. removal of the endotracheal tube by the patient] occurred in two patients of the intervention group and three patients in the control group. The daily interruption of sedative drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit