Aminocaproic Acid (amicar) as an alternative to aprotinin (trasylol) in liver transplantation.

INTRODUCTION: This study compared clinical outcomes for a large number of liver transplant patients receiving intraoperative epsilon-aminocaproic acid (EACA), aprotinin, or no antifibrinolytic agent over an 8-year period. PATIENTS AND METHODS: Records for deceased donor liver transplants were reviewed. Data included antifibrinolytic agent, blood loss, early graft function, and postoperative complications. Study groups included low-dose aprotinin, high-dose aprotinin, EACA (25 mg/kg, 1-hour infusion), or no antifibrinolytic agent. RESULTS: Data were included for 1170 consecutive transplants. Groups included low-dose aprotinin (n = 324 [28%]), high-dose aprotinin (n = 308 [26%]), EACA (n = 216 [18%]), or no antifibrinolytic (n = 322 [28%]). EACA had the lowest intraoperative blood loss and required the fewest transfusions of plasma. Patients receiving no agent required the most blood transfusions. Early graft loss was lowest in the EACA group, and 90-day and 1-year patient survival rates were significantly higher for the low-dose aprotinin and EACA groups according to Cox regression. Complications were similar, but there were more episodes of deep vein thrombosis in patients receiving EACA. CONCLUSIONS: These results suggest that transitioning from aprotinin to EACA did not result in worse outcomes. In addition to decreased intraoperative blood loss, a trend toward improved graft and patient survival was seen in patients receiving EACA.

Isoflurane potency in the northern leopard frog Rana pipiens is similar to that in mammalian species and is unaffected by decerebration.

Amphibians are commonly used in biomedical research, including studies of mechanisms of anaesthetic action. There is, however, little published work describing the kinetics of inhaled anaesthetic agents or the potency of isoflurane in amphibians. Ten Northern leopard frogs were exposed to a constant isoflurane concentration of 1.0%, 1.2% or 1.5% atm for 4 h, and their response to a noxious stimulus was tested every 20 min. Each frog was anaesthetized with each concentration in random order and allowed at least 16 h to recover between anaesthetic exposures. Frogs were then pithed and the protocol was repeated. Frogs first displayed immobility during stimulus application at 80 min, and the proportion of animals becoming immobile steadily increased to reach a stable level at 4 h. The 50% effective dose for isoflurane in intact and pithed frogs did not differ, and was 1.15 and 1.25% atm, respectively. The potency of isoflurane in leopard frogs was similar to that reported in mammalian species. Cutaneous uptake of anaesthetic is effective given sufficient time, approximately 4 h in this study. Forebrain structures appear to be unimportant for the immobilizing action of isoflurane in the frog.