Subject(s)
Intraoperative Complications/therapy , Practice Guidelines as Topic , Scoliosis/surgery , Spinal Cord Injuries/therapy , Spinal Fusion/adverse effects , Adolescent , Adult , Algorithms , Child , Combined Modality Therapy , Contraindications , Drainage , Humans , Hypothermia, Induced , Internal Fixators/adverse effects , Intracranial Hypertension/etiology , Intracranial Hypertension/prevention & control , Intracranial Hypertension/surgery , Intraoperative Complications/drug therapy , Intraoperative Complications/etiology , Intraoperative Complications/prevention & control , Ischemia/etiology , Ischemia/prevention & control , Ischemia/therapy , Methylprednisolone/therapeutic use , Monitoring, Intraoperative/methods , Monitoring, Intraoperative/statistics & numerical data , Neuroprotective Agents/therapeutic use , Spinal Cord/blood supply , Spinal Cord Injuries/drug therapy , Spinal Cord Injuries/etiology , Spinal Cord Injuries/prevention & controlABSTRACT
Intestinal transplantation is becoming more firmly established as a treatment for intestinal failure in patients whose home parenteral nutrition regimens have caused serious side effects. Outcomes have improved spectacularly over recent years thanks to the refinement of surgical techniques and the introduction of new immunosuppressants, and also to greater experience in anesthetic and postoperative management of intestinal transplant patients. The main causes of high morbidity and mortality continue to be sepsis and acute rejection of the graft. Both graft and patient survival have improved with the advent of the immunosuppressant regimens based on Tacrolimus, although survival rates are still far below those reported for other solid organ transplants. The first intestinal transplant performed in Spain took place in July 2002 in our hospital and the results were promising. Given this new challenge for anesthesiologists, we decided to review current trends in the perioperative management of patients receiving isolated intestinal transplants, the main complications that arise, treatment strategies, and future prospects.
Subject(s)
Intestines/transplantation , Adenomatous Polyposis Coli/surgery , Adult , Anesthesia, General , Donor Selection , Female , Forecasting , Graft Rejection , Graft Survival , Humans , Immunosuppression Therapy/methods , Monitoring, Intraoperative , Parenteral Nutrition, Total , Postoperative Complications , Tissue and Organ Procurement , Treatment OutcomeSubject(s)
Heart Defects, Congenital/physiopathology , Hypertension, Pulmonary/drug therapy , Pulmonary Circulation/physiology , Adrenergic alpha-Antagonists/therapeutic use , Adrenergic beta-Agonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , Heart Defects, Congenital/drug therapy , Humans , Infant, Newborn , Ischemia/physiopathology , Ketanserin/therapeutic use , Lung/blood supply , Nitric Oxide/therapeutic use , Oxygen/therapeutic use , Phosphodiesterase Inhibitors/therapeutic use , Prostaglandins/adverse effects , Prostaglandins/metabolism , Prostaglandins/therapeutic use , Prostaglandins E/therapeutic use , Vasodilator Agents/therapeutic useABSTRACT
Syncope or near-syncope can be the manifestation of a benign problem or a symptom of a life-threatening disease. Vasovagal syncope accounting for almost 70 per cent of cases. We identified 5 young patients who were presented to us with syncope or near-syncope. Diagnostic test, such as electrocardiogram, Holter monitoring and electrophysiological study identified only markers of hypervagotonia. We treated them with oral propantheline. By the time of follow up (20 months) none had recurrent episodes of syncope. Propantheline can be useful in patients with symptomatic vagotonia.
