RESUMEN
Our study showed a statistically significant incidence of pulmonary edema in mice receiving amiodarone and 100% oxygen. This finding, together with a variety of clinical reports, indicates that in patients receiving amiodarone therapy, FiO2 should be maintained at the lowest possible level, consistent with adequate oxygenation.
Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Pulmón/metabolismo , Oxígeno/metabolismo , Edema Pulmonar/inducido químicamente , Vasodilatadores/efectos adversos , Animales , Masculino , Ratones , Ratones Endogámicos , Edema Pulmonar/metabolismo , RespiraciónRESUMEN
The major causes of liver graft failure are acute rejection, technical failure, and primary nonfunction (PNF). This study was undertaken to determine whether delayed return of neuromuscular function correlates with allograft primary dysfunction in humans given vecuronium. Twenty-two adult patients undergoing orthotopic liver transplantation were given an initial dose of vecuronium, 0.1 mg/kg intravenously (i.v.). All patients recovered from vecuronium-induced neuromuscular block prior to explantation. No additional neuromuscular blocker was given until the liver graft was implanted and reperfused. Fifteen minutes after reperfusion another 0.1 mg/kg vecuronium was given IV and recovery time from attaining complete neuromuscular block to return of the fourth twitch of a train-of-four was recorded. Patients were divided into three groups according to postoperative liver function. Group I consisted of 17 patients with immediate normal liver graft function. Group II consisted of four patients with primary dysfunction (PDF) [peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) > 2000 U/L, prothrombin time > 16 s, and poor quality and quantity of bile within 3 days postoperatively] which eventually recovered normal function. Group III consisted of one patient with PNF (uncorrectable coagulopathy, severe metabolic acidosis, rising AST and ALT, and minimal or no bile output), whose graft never recovered. Recovery time in Groups II and III was prolonged compared to Group I (P < 0.05). Recovery time in Group III was prolonged compared to Group II (P < 0.05). A test based on these results using a recovery time of > 135 min as a predictor of PDF has a sensitivity and specificity of 80% and 76%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Rechazo de Injerto/diagnóstico , Trasplante de Hígado , Bloqueo Nervioso , Bromuro de Vecuronio/administración & dosificación , Adulto , Anciano , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Femenino , Humanos , Hígado/fisiología , Masculino , Persona de Mediana Edad , Reperfusión , Sensibilidad y Especificidad , Factores de Tiempo , Bromuro de Vecuronio/farmacocinéticaAsunto(s)
Ecocardiografía , Trasplante de Corazón/fisiología , Función Ventricular Derecha/fisiología , Cardiomiopatía Dilatada/cirugía , Dilatación Patológica/diagnóstico por imagen , Ecocardiografía/métodos , Embolia Aérea/diagnóstico por imagen , Esófago , Cardiopatías/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patients undergoing orthotopic liver transplantation (OLT) are susceptible to massive blood loss and require transfusion. Possible reasons for increased transfusion demands include platelet abnormalities, thrombocytopenia secondary to hypersplenism, clotting factor deficiencies, fibrinolysis, increased surgical blood loss associated with portal hypertension and previous surgical procedures, and hypothermia. The purpose of this study was to review trends in blood product usage during our first 6 years of experience performing OLT.