Hyskon induced pulmonary hemorrhage.

Hyskon, a distension medium composed of dextran 70 in 10% dextrose in water, is often used during hysteroscopic procedures. Coagulopathy and pulmonary edema are the most commonly reported side effects encountered during its use. We present the first case report in which a healthy patient developed pulmonary hemorrhage from Hyskon use. The major side effects of Hyskon are discussed, as are the possible etiologies of the reported complication and the implications for anesthesiologists.

Flushing with autologous blood improves intraoperative hemodynamic stability and early graft function in clinical hepatic transplantation.

Hemodynamic instability and hyperkalemia are common after reperfusion and may cause ischemic damage on the hepatic allograft. Two techniques for flushing hepatic grafts before reperfusion were studied to evaluate their effects on intraoperative hemodynamic and metabolic status and on early graft function in 83 consecutive adult hepatic transplantations. In the first 41 patients (group 1), the hepatic grafts were rinsed with 500 milliliters of lactated Ringer's solution (LR). In the subsequent 42 patients (group 2), in addition to LR rinse, the first 500 milliliters of portal blood to flush and reperfuse the liver were drained through the cannula inserted into the donor vena cava before unclamping the vena cava. After reperfusion, the mean arterial pressure decreased 30 +/- 4 percent in group 1 versus 17 +/- 2 percent in group 2 (p < 0.02), and serum K+ increased by 1.9 +/- 0.2 in group 1 versus 0.8 +/- 0.2 milliequivalents per liter in group 2 (p < 0.01). Hyperkalemic cardiac arrest was only seen in two patients in group 1. The K+ concentration in the first 100 milliliters of discarded blood was found to be 40 +/- 2 milliequivalents per liter. The 500 milliliters of discarded blood contained 8.3 +/- 0.4 milliequivalents, which was correlated with graft liver weight (p < 0.001). Early graft function, as measured by serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, total bilirubin and prothrombin time on postoperative day No. 2, was significantly better in group 2 than in group 1 (p < 0.05). The six-month graft and patient survival rates in group 1 were 66 and 75 percent, versus 90 and 95 percent in group 2 (p < 0.01 and p < 0.02, respectively). Further flushing with 500 milliliters of autologous portal blood resulted in smaller intraoperative shifts in serum K+, greater hemodynamic stability, better graft function and improved graft and patient survival.

Postoperative hypertension: a multicenter, prospective, randomized comparison between intravenous nicardipine and sodium nitroprusside.

OBJECTIVE: To compare the efficacy and safety of iv nicardipine with sodium nitroprusside in the treatment of postoperative hypertension after both cardiac and noncardiac surgery. DESIGN: Multicenter, prospective, randomized, open-label study. SETTING: Six tertiary referral medical centers (recovery rooms and surgical ICUs). PATIENTS: A total of 139 patients with postoperative hypertension: i.v. nicardipine (n = 71), sodium nitroprusside (n = 68). INTERVENTION: Administration of i.v. nicardipine or sodium nitroprusside. MEASUREMENTS: Vital signs (BP, heart rate), hemodynamic variables, medication dosage, total number of dose changes, and time to achieve BP control were recorded. MAIN RESULTS: Both medications were equally effective in reducing BP in both the cardiac and noncardiac surgical groups. Under the conditions of the study, i.v. nicardipine controlled hypertension more rapidly than sodium nitroprusside (i.v. nicardipine 14.0 +/- 1.0 mins and sodium nitroprusside 30.4 +/- 3.5 mins, p = .0029). The total number of dose changes required to achieve therapeutic BP response was significantly less in the i.v. nicardipine-treated patients (i.v. nicardipine 1.5 +/- 0.2 vs. sodium nitroprusside 5.1 +/- 1.4, p < .05). Adverse effects were observed with both drugs (i.v. nicardipine 7% [5/71] and sodium nitroprusside 18% [12/68] [NS]). CONCLUSIONS: Intravenous nicardipine is as effective as sodium nitroprusside in the therapy of postoperative hypertension. Specific advantages have been identified. The use of i.v. nicardipine should be considered in the therapy of postoperative hypertension.

Comparative hemodynamic effects of labetalol and hydralazine in the treatment of postoperative hypertension.

The antihypertensive efficacy and safety of IV labetalol were evaluated and compared with the efficacy and safety of IV hydralazine in the treatment of postoperative hypertension. Twenty patients undergoing major noncardiac surgery were entered into the study. Patients were randomized and treated for postoperative hypertension with either labetalol (n = 10) or hydralazine (n = 10). Labetalol and hydralazine both produced significant reductions in arterial blood pressure (p less than 0.001) within 10 minutes, which lasted at least 2 hours. In addition, labetalol produced a significant reduction in the heart rate and rate-pressure product without creating any adverse effects. In contrast, hydralazine produced significant sinus tachycardia requiring IV propranolol in three patients, two of whom developed transient ST segment depression. These results indicate that labetalol is safe and effective for the control of postoperative hypertension, especially in those patients who are least able to tolerate tachycardia.

Thrombocytopenia following peritonitis in surgical patients. A prospective study.

Thrombocytopenia is commonly found in patients with serious infection. To investigate this phenomenon, 14 consecutive patients (68 +/- 10 years) who underwent laparotomy for bowel perforation and culture-proven peritonitis were prospectively studied. Ten noninfected laparotomy patients served as a control group. None of the 10 control patients developed thrombocytopenia. Of the infected group, 12 of 14 patients (85%) developed thrombocytopenia (less than 100,000/mm3). One patient (9%) developed disseminated intravascular coagulation (DIC). Of the remaining 11 patients with thrombocytopenia, platelet counts fell from preoperative level of 350,000 +/- 166,000 to 54,000 +/- 30,000 (p less than 0.001) and reached this nadir 4.3 +/- 2 days after surgery. There was no statistically significant difference in prothrombin time, partial thromboplastin time, or fibrinogen levels before versus after operation in this group. Bleeding times in seven patients were 5.5 +/- 2 minutes, and bone marrow examination in five patients with platelet counts of less than 50,000/mm3 revealed normal or increased megakaryocytes. No patient in this group bled, had medications held, or received platelet transfusions. Platelet counts increased greater than 100,000/mm3 at a mean of 8.9 +/- 4.1 days after operation. It is concluded that thrombocytopenia is common following surgery for intra-abdominal infection, is not usually associated with DIC, clinical bleeding, or coagulation abnormalities, does not commonly result from bone marrow suppression, and is transient and does not require routine platelet transfusions.

Use of constant-infusion verapamil for the treatment of postoperative supraventricular tachycardia.

The effects of constant-infusion verapamil were studied in ten postoperative ICU patients who developed supraventricular tachycardia (atrial fibrillation) with rapid ventricular response rates. A 5-mg iv bolus dose of verapamil was followed by a 5-mg/h infusion that continued for 8 h. Ventricular rates were significantly (p less than .005) reduced from a pretreatment mean of 156 +/- 14 (SD) to 104 +/- 9 beat/min on constant-infusion therapy. This therapy was well tolerated without observed side-effects. Moreover, constant-infusion verapamil might avoid the hypotension and wide range of ventricular rates frequently encountered with repeated bolus doses of verapamil.