Low central venous pressure anaesethesia in major hepatic resection

Blood loss and transfusion requirements are major determinants of morbidity and mortality following liver resection. This study evaluates the association of low central venous pressure [LCVP] with blood loss and blood transfusion during liver resection. Thirty consecutive hepatic resections were studied prospectively concerning CVP, volume of blood loss and volume of blood transfusion and renal outcome. Data were analyzed for those with a CVP 5 mmHg. A muitivariate analysis assessed potential confounding factors in the comparison. The mean blood loss in patients with a CVP of 5 mmHg or less was < 500 ml and that in those with a CVP > 5 mmHg was > 2000 ml. [p <0.0001]. Only two patients with a CVP of 5 mmHg required transfusion. No incidences of air embolism or permanent renal shutdown have been reported. In conclusion: The volume of blood loss and blood transfusion during liver resection correlates with the CVP during parenchyma! transection. Lowering the CVP to less than 5 mmHg is a simple and effective technique to reduce blood loss during liver resection and delete the need for blood transfusion with its hazards

Effect of albumin administration prior to graft reperfusion on the severity of reperfusion syndrome during living related liver transplantation

A prospective randomized study to evaluate the effect of intra-operative use of Albumin [20%] infusion prior to graft reperfusion on the severity of reperfusion syndrome during living donor liver transplantation Twenty patients were included with Child-Pughs C classification [ESLD]. Samples and measurements were taken pnor to reperfusion, during and after reperfusion of the donor liver graft. I. V fluids, blood and blood products were used to adjust a Hb level at [8-10 gm/dl] and Hct between 24-28% for better graft function and survival The reperfusion syndrome was severe as regard the decrease in MABP in No Albumin group [MABP = 48.2 +/- 7.23 mmHg] compared to Albumin group [MABP = 63.45 +/- 6.96 mmHg]. [P=00002] CVP was highly significant increased in Albumin group during reperfusion compared to No Albumin group [p = 0.0002]. Also. CVP correlated positively with S albumin level [r = 0.81. p = 0.002] dunng reperfusion syndrome. Patients of No Albumin group needed more motropic support than patients of Albumin group. In conclusion Albumin 20% in a dose of 1.5 ml/kg causes volume retention and expansion of intravascuiar volume which was a beneficial effect in liver transplant surgery to elevate the CVP prior to graft reperfusion and hence decreasing the severity of reperfusion syndrome and also elevating the already low serum albumin level and oncotic pressure

Intrathecal meperidine with isobaric lidocaine versus intrathecal hyperbaric bupivacaine for transurethral resection of the prostant [TURP]

We administered subarachnoid block, at L 2-3 or L 3-4 interspace in two groups of patients, 20 patients each according to the analgesic used. Group A received 15 mg 0.5% hyperbaric bupivacaine and group B received 60 mg 2% lidocaine with 20 mg meperidine. Patients were observed until anaesthesia descended to less than sacral [S1], criteria of spinal anaesthesia as well as haemodynamic changes have been evaluated. There was significant difference between bupivacaine [group A] and lidocaine meperidine [group B] in all criteria of induction and recovery of spinal block. Time to T10 block was 6.1 ["2.2] min. in group A, versus 3.2 ["1.1] min. in group B, Time of full motor block was 14.2 ["4.1] min. in group A, versus 9.2["2.7] min. in group B, duration of motor block was 182["29.1] min. in group A versus 122["23.3] in group B, and duration of sensory block to S1 was 320["30.3] min. in group A, versus 195["22.3] min. in group B. Regarding haemodynamic changes heart rate showed significant decrease during recovery in group A patients. Pruritis and respiratory depression were recorded only in group B, but they were very mild and need no treatment. We concluded that, the use of lidocaine in moderate dose with 20 mg meperidine intrathecally represented an excellent alternative to intrathecal hyperbaric bupivacaine for TURP Surgery in elderly patients

Aprotinin versus tranexamic acid in cirrhotic patients undergoing hepatic surgery

Patients with liver cirrhosis have complex hemostatic dysfunction characterized by impaired clotting factor synthesis, thrombocytopenia and accelerated fibrinolysis. Pharmacological management has been advocated to decrease bleeding and transfusions during major hepatic surgery, with the use of either aprotinin or tranexamic acid. In the present study, aprotinin was given in moderate doses to 10 patients and tranexmaic acid was given to another 10 patients compared with control group. Hemostasis was significantly better preserved after aprotinin treatment [blood loss of 373 ml in the aprotinin group, 524 ml in tranexamic acid group versus 956 ml in the control group]. Platelets were better preserved in aprotinin and tranexamic acid groups. Fibrinolysis was significantly reduced in aprotinin and tranexamic acid groups, where fibrinogen level was significantly reduced in the control group [206.8 mg/dl, 184 mg/dl at 4 and 6 hours intraoperatively] and FDPs were significantly increased in the control group [FDPs changed from 4.8 micro g/dl to 26 micro g/dl during surgery]. We conclude that prophylactic use of either aprotinin [in moderate doses] or tranexamic acid is equivocal and is mandatory in the operative management of hepatic resection