Early and late outcome after elective cardiac surgery in patients with cirrhosis.

BACKGROUND: A prospective study was performed to evaluate the early and late outcome after elective cardiac surgery in patients with cirrhosis. METHODS: All patients who underwent elective cardiac surgery between 1995 and 1997, and were suspected of having a history of cirrhosis, were followed in the intensive care unit (ICU), during hospitalization and after hospital discharge. All patients received high doses of aprotinin during surgery. RESULTS: Ten patients of Child-Pugh class A and 2 patients of Child-Pugh class B were studied. All patients had signs of portal hypertension, and 11 of 12 patients had thrombocytopenia. In the first 24 h after operation, the median chest tube output was 810 mL (range 350 to 1,500 mL). Median ICU and hospital stays were 3 and 15 days, respectively (range 2 to 10 and 7 to 36 days, respectively). Seven patients experienced postoperative morbidity and 7 patients had significant complications after their hospital discharge. One death occurred in the ICU. Two deaths occurred after hospital discharge and were related to further hepatic damage. CONCLUSIONS: These results suggest that, in patients with mild or moderate cirrhosis, the incidence of significant complications was high after elective cardiac surgery, increasing the length of stay in ICU and overall hospitalization time and compromising the health status, even well after the operation.

[Anesthesia in interventional bronchoscopy]. / Principes de l'anesthésie en bronchoscopie interventionnelle.

Interventional rigid bronchoscopy requires the same careful anesthetic management as any type of surgery. Furthermore, access to airways for both endoscopist and anaesthetist raises difficult problems. Hypoventilation with its consequences is a major risk, especially for patients with impaired ventilatory capacity. General anesthesia warrants controlled or assisted mechanical ventilation, without precise spirometric monitoring because of air leakage. Discussion of indications between both operators is needed. Careful preoperative evaluation is required. Ultra short intravenous anesthetic agents are chosen for a rapid recovery of consciousness and ventilation. Ventilation is generally manually assisted or delivered by high frequency jet ventilation. Flexible fiberoptic bronchoscopy is systematically performed before extubation. Interventional rigid bronchoscopy is ideally performed in an operating room or an adjacent area or in an intensive care unit in case of complication. Postoperative supervising in a recovery room is mandatory.

[Acute necrotizing enterocolitis during a prolonged treatment with neuroleptics]. / Entérocolite aiguë nécrosante au cours d'un traitement prolongé par neuroleptiques.

A 32-year old man treated for several years with phenothiazine for chronic psychosis developed acute necrotizing colitis. The causal relationship with neuroleptics was reinforced by the absence of any other treatment and by histological findings including extensive mucosal necrosis without stenotic lesion and without mesenteric vessels alteration. The patient required emergency total colectomy and was discharged after 7 weeks of hospitalisation in the intensive care unit.