[Comparison of the effects of methadone and morphine on postoperative pain scale following thoracic surgery in opium addict patients]

Post operative pain is cause of suffering in most patients and can cause a lot of problems. Analgesic effects of many narcotics have been widely studied. In this study, the effects of methadone and morphine on postoperative pain scale following thoracic surgery in opium addict patients were assessed. In this clinical trial and double blind study, sixty opium addict patients [ASA I, II], aged 20-65 yr, were randomly allocated into two groups. Thirty minutes before induction of general anesthesia the first group received 0.1 mg/kg methadone and the second group received 0.1 mg/kg morphine. The two groups were assessed and compared in regard to the intensity of pain and meperidine requirement in the first post operative 24 hr. Intensity of post operative pain and meperidine requirement in the methadone group were significantly lower than those in the morphine group [P<0.01]. Administration of 0.1mg/kg methadone as premedication for opium addict patients reduces the post operative pain more than morphine. Therefore, premedication with methadone for opium addict patients undergoing thoracic surgery is recommended

Two-year experience of orthotopic liver transplantation in Afzalipoor Hospital, Kerman, Southeastern Iran

End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation. To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran. From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected. Patients [7 women and 5 men] aged between 14 and 55 years. Indications for the transplantation included HBV infection [n=5], cryptogenic cirrhosis [n=2], Wilson's disease, alcoholism [n=1], HCV infection [n=1], Budd-Chiari syndrome [n=1], and autoimmune hepatitis [n=1]. MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, post-operatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions. We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success

Post-reperfusion syndrome and outcome variables after orthotopic liver transplantation

Post-reperfusion syndrome [PRS] is an important during liver transplantation. We studied the occurrence and severity of PRS in patients who underwent orthotopic liver transplantation [OLT] to investigate how PRS was correlated to clinical variables and outcomes. We retrospectively recorded intra- and peri-operative data for 184 adult patients who received cadaveric OLT during a 3-year period from 2005 to 2008. Patients were divided into two groups according to the severity of PRS: Group 1 [mild or no PRS] comprised 152 patients; and group 2 [significant PRS] consisted of 32 patients. There were no significant differences in demographic and pre-operative data between groups. Group 2 had more total blood loss than group 1 [p=0.036], especially after reperfusion [p=0.023]. Group 2 required more packed red cell transfusions [p=0.005], more fresh frozen plasma [p=0.003] and more platelets [p=0.043] than group 1. Fibrinolysis was more frequent in group 2 [p=0.004]. hospital stay in group 2 was significantly longer than in group 1 [p=0.034], but the frequencies of other outcomes including infection, re-transplantation, dialysis, rejection and extended donor criteria did not differ significantly between groups. Bleeding, blood transfusion and fibrinolysis occurred more often in the group of severe PRS after reperfusion. Although postoperative complications like rejection, infection and the dialysis rate were not significantly different in the two groups, hospital stay was more prolonged in the group with severe PRS