effect of pentoxifylline on hepatocyte growth factor and liver functions in cirrhotic patients undergoing splenectomy and decongestion

High morbidity and mortality rates in cirrhotic patients undergoing intraabdominal surgery underscore the need for identifying a therapy that will decrease postoperative hepatic dysfunction and enhance hepatic regenerative activity. Perioperative administration of pentoxifylline [PTX] is suggested to decrease liver fibrosis and enhance hepatic regenerative activity in cirrhotic patients. Hepatocyte growth factor [HGF] is hepatocyte mitogen, that is suggested to play a role in liver regeneration during injury. The aim of this study is to investigate the value of perioperative administration of PTX on reducing liver injury as reflected by changes in serum level of hepatocyte growth factor [HGF], and standard liver functions in cirrhotic patients undergoing Splenectomy and decongestion. 20 adult patients with cirrhotic liver were randomly allocated into two equal groups. Patients in the first group [PTX Gp], received 300 mg i.v. PTX before induction of general anesthesia followed by 100 mg /h PTX in 500 ml glucose 5% infused in 10 hours. Patients in the second group [control Gp], received 15ml i.v. glucose 5% solution before induction of general anesthesia followed by 500 ml glucose 5% infused in 10 hours. All patients' were Child class A. Hepatocyte growth factor increased significantly at postoperative time when it was compared with preoperative value in control group. Liver enzymes SGOT, SGPT, prothrombin activity, total bilirubin, serum albumin, blood urea and creatinine did not significantly change in the studied groups when postoperative values were compared with preoperative ones or when the studied groups were compared with each other. White blood count and platelets increased significantly postoperatively compared with preoperative values in the studied groups. The current study suggested that perioperative administration of PTX could produce hepatocyte protection during intra-abdominal surgery as hepatocyte growth factor did not significantly increase at postoperative time in PTX group meanwhile, it increased significantly at postoperative time compared to preoperative value in control group. It did not influence liver or kidney functions, as SGOT, SGPT, prothrombin activity, serum albumin, total bilirubin as well as blood urea and creatinine did not significantly change postoperatively compared with preoperative values in both studied groups

effect of thoracic paravertebral block on respiratory muscle strength, lung volumes and capacities, and arterial blood gases

Thoracic paravertebraI block has been advocated as a useful technique for breast surgery, this study was carried out on thirty adult female patients ASA I to evaluate the effect of ropivacaine thoracic paravertebral block on respiratory muscle strength, lung volumes and capacities and blood gases. Patients were scheduled for minor breast surgery. Respiratory functions and arterial blood gases were assessed before and after the block. Respiratory rate and oxygen saturation were assessed before and every 10 min intraoperative. The results of this study showed that, there was no significant change in vital capacity, in respiratory rate, in oxygen saturation and in arterial blood gases after the block compared with before the block. There was a significant decrease in forced vital capacity [FVC], in forced expiratory volume in one second [FEVI], in maximum inspiratory pressures [PI max], and in maximum expiratory pressure [PE max] after the block compared with the values before the block. In conclusion, single injection ropivacaine paravertebral block is an adequate anesthetic technique for minor breast surgery. It produced good efficient sensory block and extended post operative analgesia up to 150 +/- 19.97min from the onset of the block. Although it significantly decreased effort dependent respiratory functions, it produced mild respiratory muscle weakness that did not influence arterial blood gases, oxygen saturation or respiratory rate. It is recommended to use ropivacaine thoracic paravertebral block in minor breast surgery as a suitable ulternative to general anesthesia

Comparison of intrathecal ropivacaine and in combination with fentanyl, clonidine or midazolam for minor surgery

Sixty adult ASA I and II patients scheduled for lower abdominal surgery were studied. Patients were randomly assigned to receive intrathecal 15 mg ropivacaine GII [n=15] or ropivacaine plus 25 micro g fentanyl GI [n=15] or ropivacaine plus 75 micro g c/onidine GIII [n=15] or ropivacaine plus Img midazolam GIV [n=15].The addition of fentanyl to ropivacaine in GII did not significantly affect pulse rate, while the addition of clondine and midazolam in GIII and in GIV significantly decreased PR. The MABP decreased significantly intra-operatively in the four studied groups. The addition of clonidine decreased MABP significantly in GIII compared to GI The addition of fentamyl clonidine or midazolam to ropivacaine did not influence the onset of sensory block, but they increased sensory level significantly. The duration of analgesia was significantly prolonged in GII and in GIII Midazolam in GIV did not significantly prolong the duration of analgesia in our study. The onset of motor block was delayed significantly and the duration of the block was significantly shorter in GII compared to GI. Clonidine and midazolam in GIII and GIV increased the degree of motor block without increasing the duration. The analgesic consumption was significantly less in GII and in GIII while there was no significant change in GIV compared to GI. The incidence of complications was nil in GII and in GIII. In GI one case complained of shivering, however, one case had a post-operative headache in GIV