effects of aminophylline on clinical recovery and bispectral index in patients anesthetized with total intravenous anaesthesia

Aminophylline, which is clinically used as a bronchodilator, antagonizes the action of adenosine, so it can be used to shorten the recovery time after general anesthesia. Therefore, we wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index [BIS] and clinical recovery in patients anesthetized with total intravenous anesthesia [TIVA]. Ninety two patients who were scheduled for elective inguinal herniorrhaphy were enrolled in this study. All patients were premedicated with midazolam and morphine. Anesthesia was induced with propofol 2.5 mg/kg and remifentanil 2.5 microg/kg without muscle relaxant. For maintenance of anesthesia we used propofol 100 microg/kg/min, remifentanil 0.2 microg/kg/min and 100% oxygen with stable BIS readings in the range 40-60. After skin closure, aminophylline 4 mg/kg was given to Group A and an equivalent volume of normal saline to Group P. BIS values, heart rate, blood pressure, oxygen saturation and End tidal CO2 [ETco2] were determined. Time to eye opening, extubation time and response to command were measured. There were no significant differences in SpO2, ETco2 and anesthesia time. Heart rate and systolic blood pressure were found to be statistically higher [p<0.001] in Group A. Time to eye opening, hand grip and extubation were significantly shorter [p<0.001] in Group A. Bispectral index scores were significantly higher in group A. Injection of aminophylline at emergence time led to significant increase in BIS and shortening recovery time from anesthesia

Effects of short-term renovascular hypertension and type 2 diabetes on cardiac functions in rats

Background: The cardiac effects simultaneously occurring during experimental hypertension and diabetes have rarely been investigated. This study aimed at examining the effects of shortterm renovascular hypertension and type 2 diabetes on cardiac functions

Methods: Five groups [7 each] of male Sprague-Dawley rats, including a control group, a diabetes [induced by Streptozocin and Nicotinamide] group, a renovascular hypertensive [induced by placing Plexiglas clips on the left renal arteries] group, a sham group, and a simultaneously hypertensive-diabetic group, were used. The animals' hearts were used for isolated heart studies, and the indices of cardiac functions and coronary effluent creatine kinase MB were measured. The results were analyzed using One-way Analysis of Variance, followed by the Duncan Multiple Range test

Results: The diabetic group had a significantly lower rate of rise [-29.5%] and decrease [-36.18%] in ventricular pressure, left ventricular developed pressure [-28.8%], and rate pressure product [-35%], and significantly higher creatine kinase MB [+166%] and infarct size [+36.2%] than those of the control group. The hypertensive group had a significantly higher rate of rise [+12.17%] and decrease [+16.2%] in ventricular pressure, left ventricular developed pressure [+16%], and rate pressure product [+24%], and significantly lower creatine kinase MB [-30%] and infarct size [-27%] than those of the sham group. Simultaneously, the diabetic and hypertensive rats had a significantly higher rate of rise [+32%] and decrease [+30.2%] in ventricular pressure, left ventricular developed pressure [+17.2%], and rate pressure product [+22.2%], and significantly lower creatine kinase MB [-24%] and infarct size [-16.2%] than those of the diabetic group

Conclusion: The findings indicated that the simultaneity of hypertension with type 2 diabetes attenuated diabetes-induced cardiac impairment

effect of intraoperative restricted normal saline during orthotopic liver transplantation on amount of administered sodium bicarbonate

Background: Severe metabolic acidosis occurs during orthotopic liver transplantation [OLT] particularly during the anhepatic phase. Although NaHCO[3] is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO[3]

Methods: In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision [T1], 15 min before reperfusion [T2], and 5 min after reperfusion [T3]

Results: There were no significant differences in demographic characteristics of the donors and recipients [P>0.05]. In the restricted normal saline group there was significantly lower central venous pressure [CVP] than in the non-restricted normal saline group [P=0.002]. No significant differences were noted in the other hemodynamic parameters between the two groups [P>0.05]. In the non-restricted normal saline group arterial blood pH [P=0.01] and HCO[3] [P=0.0001] were significantly less than the restricted normal saline group. The NaHCO[3] requirement before reperfusion was significantly more than with the restricted normal saline group [P=0.001]

Conclusion: Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO[3] during the anhepatic phase

Severe acute hyperkalemia during pre- anhepatic stage in cadaveric orthotopic liver transplantation

A serious hazard to patients during orthotopic liver transplantation is hyperkalemia. Although the most frequent and hazardous hyperkalemia occurs immediately after reperfusion of the newly transplanted liver, morbid hyperkalemia could happen in the other phases during orthotopic liver transplantation. However, pre-anhepatic hyperkalemia during orthotopic liver transplantation is rare. This report describes one such patient, who without transfusion, developed severe hyperkalemia during pre-anhepatic phase. The variations in serum potassium concentration of the present case indicate that it is necessary to take care of the changes of serum potassium concentration not only during reperfusion but also during the other phases of the liver transplantation