Fulminant hepatic failure after simultaneous kidney-pancreas transplantation: a case report / Insuficiência hepática fulminante após transplante simultâneo de rim-pâncreas: um relato de caso

Abstract We describe an unusual case of hyperacute hepatic failure following general anesthesia in a patient receiving a simultaneous kidney-pancreas transplant. Despite an aggressive evaluation of structural, immunological, viral, and toxicological causes, a definitive cause could not be elucidated. The patient required a liver transplant and suffered a protracted hospital course. We discuss the potential causes of fulminant hepatic failure and the perioperative anesthesia management of her subsequent liver transplantation.

Resumo Descrevemos um caso incomum de insuficiência hepática hiperaguda após a anestesia geral em uma paciente que recebeu um transplante simultâneo de rim-pâncreas. Apesar de uma avaliação agressiva das causas estruturais, imunológicas, virais e toxicológicas, uma causa definitiva não pôde ser identificada. A paciente precisou de um transplante de fígado que resultou em prolongamento da internação hospitalar. Discutimos as potenciais causas da insuficiência hepática fulminante e o manejo da anestesia no período perioperatório de seu subsequente transplante de fígado.

Application of oxycodone combined subarachnoid block in the elderly patients with femoral trochanter fracture surgery / 临床麻醉学杂志

Objective To investigate the advantages and disadvantages of oxycodone combined subarachnoid block and intravenous-inhalational anesthesia in elderly patients with femoral trochanter fracturethe surgery.Methods Thirty-four patients undergoing elective surgery with closed reduction and Proximal femoral nail anti-rotation (PFNA) fixation,13 males and 21 females,aged 76-92 years,ASA physical status Ⅱ or Ⅲ,were equally randomized into two groups (n =17 each):group O and group C.Patients in group O received oxycodone combined subarachnoid block.Patients in group C received intravenous-inhalational anesthesia.Patients in group C were not premeditated beforel entering the operation room.After entering the rooms group O was given oxycodone 3-5 mg i.v first,then given ropivacaine in subarachnoid space.All patients were induced with intravenous of sulfentanil 0.2-0.3μg/kg,cisatracurium 0.15 mg/kg,etomidate 0.1-0.2 mg/kg slowly.Anesthesia was maintained by intravenous propofol 3-5 mg· kg-1 · h-1,remifentanyl 0.1-0.3 μg · kg-1 · h-1,sevofrane 0.55％-2％ infusion,intravenous bolus cisatracurium 0.05-0.10 mg/kg.The anesthesia related complications and length of hospital stay were recorded.Results Postoperative nausea and vomiting (PONV) respiratory depression of group O was significantly lower than that of group C [2(11.8％) cases vs 9 (52.9％) cases,P＜0.05],length of hospital stay of group O was significantly shorter than that of group C [(10.4±1.6) d vs (15.8±2.0) d,P＜0.05].Conclusion In the elderly patients with femoral intertrochanteric fracture closed reduction and PFNA internal fixation,oxycodone combined subarachnoid block may improve patients' recovery.

Effects of different anesthesia methods on cognitive function in elderly patients with intracranial tumors at different time points / 实用肿瘤学杂志

Objective The objective of this study was to observed the effect of target control intravenous (TCI) anesthesia and intravenous inhalational anesthesia in the postoperative cognitive function in elderly patients with intracranial tumor at different time points.Methods Seventy patients were divided into the experimental and control groups according to the different methods of intraoperative anesthesia.The experimental group was selected to treat with propofol combined with remifentanil TCI anesthesia,and the control group was treated with intravenous anesthetics combined with inhalation isoflurance.Recovery time of respiration,time of opening eyes,extuation time,orientation recovery time,OAAS score before and after operation,and cognitive function (MMSE)were observed in two groups.Results They were no differences in the recovery time of respiration,time of opening eyes and extubation time in two groups (P ＞ 0.05).The orientation recovery time in the experimental group was 20.4 ± 5.8 min and 23.2 ± 4.3 min in the control group.They had significantly different between experimental and control groups (P ＜ 0.05).The time of extubation,leaving the operating room and after 1 h of extubation,OAAS point for the experimental group was 3.3 ± 0.5,4.2 ± 0.4,4.6 ± 0.6 min,respectively,and 2.3 ± 0.2,3.3± 0.4,3.9 ± 0.3 in the control group,respectively.They were significantly different between the experimental and control groups(P ＜ 0.05).Prior to treatment,there was no significant difference in MMSE score between the two groups(P ＞0.05).MMSE score was 25.0 ±0.4 and 27.9 ± 1.1 in the experimental group after treatment for 24 h and 48 h,respectively.MMSE score in the control group was 23.2 ±0.9 and 25.8 ± 1.3 after treatment for 24 and 48 h,respectively.There had a significant different from two groups (P ＜ 0.05).Conclusion For elderly patients with intracranial tumor surgery,TCI anesthesia with propofol and remifentanil is stable and awake,and the effect on postoperative cognitive function is relatively small.

Comparison of speed of inhalational induction in children with and without congenital heart disease.

Background: Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in‑depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression. Aims: To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions. Setting: Tertiary care hospital. Design: A prospective, single‑center clinical study. Materials and Methods: Ninety‑three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air‑oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End‑tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction. Results: Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed. Conclusion: The time to inhalational induction of anesthesia is significantly prolonged in patients with right‑to‑left shunt, compared to patients without CHD or those with left‑to‑right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD.

Total intravenous anesthesia of propofol-remifentanil for patients of cosmetic surgery / 中华医学美学美容杂志

Objective To explore the effect of propofol-remifentanil total intravenous anesthesia in cosmetic surgery and the controllability of anesthesia.Methods According to the American Society of Anesthesiologists (ASA),levels Ⅰ-Ⅱ hospitalized patients for elective cosmetic surgery (100 cases) were randomly divided into two groups,namely propofol-remifentanil total intravenous anesthesia group (Group T) and combined intravenous inhalational anesthesia group (Group C),50 cases each.Observatory items of patients included intraoperative cardiovascular drug use,body movement,waking-up time,extubation time,leaving time from operation theatre,postoperative adverse reaction,hypoxemia (SpO2＜95％) and anesthesia satisfaction.Results In Group C,waking-up time,extubation time and leaving time from operation theatre were (12.2 ± 3.6),(13.8± 4.6) and (4.6 ±5.8) min,respectively,which were longer than those (6.7±2.6),(7.8±3.3) and (3.3±3.8) min in Group T (P＜0.05).In Group T,intraoperative ephedrine usage (6/50,12.0％) and body moving rates (4/50,8.0％) were higher than those (1/50,2.0％) and (1/50,2.0％) in the Group C (P＜0.05).The Group T had lower incidence of postoperative adverse reactions,including lethargy (2/50,4.0％),irritability (1/50,2.0％),nausea and vomiting (8/50,16.0％),which were lower than those (8/50,16.0％),(7/50,14.0％) and (17/50,34.0％) in the Group C (P＜0.05).The incidence of postoperative chill was similar between the two groups with no statistical significance (P＞0.05).Satisfactory rate with anesthesia was 84.0％ (42/50) in Group T that was higher than 52.0％ (26/50) in Group C (P＜0.05).Conclusions Propofol-remifentanil intravenous anesthesia has definite effects with faster postoperative recovery,less adverse reaction and complications,safety and operablity.

Influence of acepromazine on the cardiovascular actions of dobutamine in isoflurane-anesthetized horses / Influência da acepromazina sobre os efeitos cardiovasculares da dobutamina em cavalos anestesiados com isofluorano

The influence of acepromazine (ACP) on the effectiveness of dobutamine (DBT) in increasing blood pressure during isoflurane (ISO) anesthesia was evaluated in six horses. On separate occasions, the horses were randomly assigned to receive NaCl 0.9 percent (Control), ACP 0.025mg kg-1 and ACP 0.05mg kg-1. The experimental treatment was administered prior to induction of anesthesia. Maintenance of anesthesia was performed under conditions of normocapnia with ISO in oxygen. Dobutamine was administered at progressively increasing infusion rates until mean arterial pressure (MAP) reached 70mmHg or until a maximum infusion rate of 5.0µg kg-1 min-1. Compared with baseline, DBT increased heart rate, systolic, diastolic and mean blood pressures in all treatments. However, these variables did not differ among treatments. The target MAP (70mmHg) was not reached in 2/6, 2/5 and 0/6 horses in the Control, ACP0.025 and ACP0.05 treatments, respectively. The mean dose of DBT to achieve target MAP was 3.5±1.8, 3.7±1.6 and 2.7±1.4µg kg-1 min-1 in the Control, ACP0.025 and ACP0.05 treatments, respectively (P>0.05). Under the conditions of this study, premedication with ACP does not interfere with the effectiveness of DBT in increasing blood pressure in horses anesthetized with ISO.

A influência da acepromazina (ACP) sobre a capacidade da dobutamina (DBT) em elevar a pressão arterial durante a anestesia com isofluorano (ISO) foi avaliada em seis equinos. Em ocasiões diferentes, os animais receberam aleatoriamente NaCl 0,9 por cento (Controle), ACP 0,025mg kg-1 e ACP 0,05mg kg-1. O tratamento experimental foi administrado previamente à indução da anestesia. A manutenção da anestesia foi realizada em condições de normocapnia com ISO em oxigênio. A administração de DBT foi iniciada em doses progressivamente crescentes até que o valor de pressão arterial média (PAM) atingisse 70mmHg ou até a dose máxima de 5,0µg kg-1 min-1. Comparado ao basal, a administração da DBT resultou em elevação na frequência cardíaca e pressões arteriais sistólica, diastólica e média em todos os tratamentos. Porém, não houve diferença entre os tratamentos nessas variáveis. A PAM alvo (70mmHg) não foi atingida em 2/6, 2/5 e 0/6 animais dos tratamentos Controle, ACP0.025 e ACP0.05, respectivamente. A dose média de DBT para a PAM alvo foi de 3,5±1,8; 3,7±1,6 e 2,7±1,4µg kg-1 min-1 no Controle, ACP0.025 e ACP0.05, respectivamente (P>0,05). Nas condições deste estudo, o pré-tratamento com ACP não interfere na eficácia da DBT em elevar a pressão arterial de cavalos anestesiados com ISO.

Effect of bronchodilator on bronchial mucus transport velocity during inhalational anesthesia

BACKGROUND: Volatile-based anesthesia resulted in a significantly reduced cilia beat frequency. This study was to evaluate the effect of bronchodilator on bronchial mucus transport (BMT) distance measured with a bronchoscope during Inhalational anesthesia. METHODS: Twenty-four adult patients undergoing elective orthopedic surgery under inhalation anesthesia using sevoflurane and nitrous oxide were included. Twenty minutes after tracheal intubation, they were manually inspired without nebulization of salbutamol (control group: n = 12) or with nebulization of salbutamol(salbutamol group: n = 12). And then a single drop of 0.02 ml methylene blue was applied to the posterior mucosal surface of the right main bronchus 5 cm away from the carina under the bronchoscope. The distance of dye movement was measured 5 min after its application. RESULTS: BMT distance and velocity of methylene blue during 5min were 6.2 +/- 3.1 mm and 1.2 +/- 0.6 mm/min in control group, and 23.3 +/- 16.6 mm and 4.7 +/- 3.3 mm/min in salbutamol group, respectively. BMT distance and velocity of methylene blue in salbutamol group were longer and faster than those in control group(P < 0.05). CONCLUSIONS: Salbutamol facilitates the transport of bronchial secretion under sevoflurane-based inhalational anesthesia in term of BMT velocity.