ABSTRACT
Hydroxyethyl starchs [HES] have the advantage of a higher plasma-expanding effect and an infrequent incidence of allergic reactions, but they have more pronounced effects on emostasis. A new HES with a lower in vivo molecular weight [HES 130/0.4] has been introduced
The aim of this study was to compare the effect of hypervolemic haemodilution of the ecently available low molecular weight hydroxyethyl starch 130/04 and albumin 5% on the hemostatic function, renal function and blood loss during laparotomy for abdominal tumor excision Forty six children with age range between 3 and 5 years were enrolled in the study. Patients were randomly allocated after induction into two groups ; Group I patients received either 6% HES 130/0.4 as a hypervolemic hemodilution with a dose of 25 ml/kg over one hour oreoperativly. Group II [control group] patients received Albumin 500 as a hypervolemic hemodilution with a dose of 25 ml/kg
Measurements: hemoglobin and hematocrit, PT, partial thromboplastin time [PTT], platelet count, serum creatinine, urine out put were measured. Blood losses at the end of surgery were calculated using the equations developed by Mercuriali and lnghilIeri, considering sex, preoperative body weight and hemotocrit and volume of blood transfusion
Results: The mean intra-operative blood loss in group I was 362.8 +/- 4.5 ml, whereas it was 374.1 +/- 3.2 ml in group II, there was no statistically significant differences in the mean blood loss in both groups .There was no statistically significant difference in all other measurements in both groups
Conclusion: The new low molecular weight hydroxyethyl starch 130/0.4 up to 25 ml/kg hypervolemic hemodilution have similar blood loss without effect on hemostatsis and renal function similar to albumin 5% during laparotomy for abdominal tumor Excision in Pediatrics abdominal tumor excision in pediatrics
ABSTRACT
Background: Liver transplantation is the accepted standard of care for patients with End Stage Liver Disease [ESLD]. Since the liver transplant programme restarted in King Faisal Specialist Hospital and Research centre in 2001 and results have been improving. We review the overall results of liver transplantation over the last 6 years
Patients and Methods: Characteristic of patient population: Data retrospectively reviewed between April 2001 to January 2007 years, our center performed 122 liver transplantations, 77 from deceased donors [DDL T], and 45 from living donors [LDLT], in 118 patients 4 cases were retransplanted. Perioperative Management: All patients were evaluated preoperatively according to the institute protocol. All patients received general anesthesia according to our protocol. Swan Ganzcatheterization and Rapid Infusion System [RIS] only used when clinically indicated most of the patients were assisted by mechanical ventilation in Medical Surgical Intensive Care Unit [MSICU] postoperatively. Fluid therapy and vasoactive agents were managed according to haemodynamic parameters
Results: The patients were 68 male and 54 female. Their median age was 43 years, ranging from 2 to 63 years. 111 patients were adult and 11 patients were pediatrics. In DDLT the median operating and anesthesia time were 8 hours [range 4-19], and 9 hours [range 5-20] respectively, median MSICU discharge time 15 hours [range 9-85] and hospital stay was 13 days [range, 6-183]. After a median fol/ow-up period of 760 days [range, 2-2085], the overall patient and graft survival rates was 86%. Deaths were due to primary non-function in 4 patients, central pontine myelinolysis in one patient, chronic rejection in one patient, recurrent malignancy in 2 patients, and recurrent HCV infection in 3 patients. In the LDLT group; median operating and Anesthesia time were 11 hours [range, 7-17] and 12 [range 818] respectively. Median MSICU discharge time was 16 hours [range 4-76] and median hospital stay was 15 days [range, 7-127]. After follow-up period of 685 days [range, 26-1540], the overall patient and graft survival rates were 90% and 80% respectively. Graft failure and deaths were due to hepatic anery thrombosis in 2 cases, biliaIy complication in one patient, uncontrollable bleeding in one patient, portal vein thrombosis in 2 cases, and smalI-for-size-syndrome in 3 patients. Four patients were successfully retransplanted using cadaveric organs. The median intraoperative packed red blood cells [PRBCs] transfused was 6 units [range 0-40] and 4 units [range 0-65] in DDLT and LDLT groups respectively
Conclusions: Both DDLT and LDLT are being successfully performed at KFSH and RC with good outcomes. Our early experience indicates higher rate of biliary and vascular complications in the LDLT group. Intraoperative Packed Red cells, blood products, fluid replacement and estimated blood loss in both groups were matching the international centers results