RESUMEN
Living donor liver transplantation reduces time and mortality on the waiting list. Bleeding is a serious complication; however, "overcorrection" of coagulopathy may lead to hepatic artery thrombosis. We report a case where desmopressin (DDAVP) was used in the management of persistent postreperfusion bleeding (44 red blood cell units transfused). After 1 dose of DDAVP, bleeding improved significantly and the recipient had an unremarkable recovery. DDAVP should be considered for persisting bleeding after correcting common coagulation abnormalities where complexity of the anastomosis may preclude the use of more aggressive procoagulant drugs in liver transplantation.
Asunto(s)
Desamino Arginina Vasopresina/uso terapéutico , Hemostáticos/uso terapéutico , Trasplante de Hígado/efectos adversos , Hemorragia Posoperatoria/tratamiento farmacológico , Daño por Reperfusión/tratamiento farmacológico , Humanos , Hígado/irrigación sanguínea , Hígado/efectos de los fármacos , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Daño por Reperfusión/etiologíaRESUMEN
A 34-yr-old man with hepatic haemangiomatosis presented for orthotopic liver transplantation. His massively distended abdomen caused thoracic compression and severe restrictive lung disease. Respiratory failure was the principal indication for transplantation. Increased airway pressures, pulmonary hypertension, systemic hypotension caused by aorto-caval compression, and blood loss, complicated the intra-operative anaesthetic management. Weaning from mechanical ventilation was impaired by acute and chronic metabolic alkalosis, and diaphragmatic laxity.
Asunto(s)
Hemangioma/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Insuficiencia Respiratoria/etiología , Adulto , Estudios de Seguimiento , Hemangioma/complicaciones , Humanos , Neoplasias Hepáticas/complicaciones , MasculinoAsunto(s)
Anestésicos por Inhalación/efectos adversos , Hidrocarburo de Aril Hidroxilasas , Autoanticuerpos/sangre , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Sistema Enzimático del Citocromo P-450/inmunología , Isoflurano/efectos adversos , Oxigenasas de Función Mixta/inmunología , Enfermedad Hepática Inducida por Sustancias y Drogas/inmunología , Citocromo P-450 CYP2A6 , Ensayo de Inmunoadsorción Enzimática , Resultado Fatal , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. Reports that were supportive of this technique were based on nonrandomized observational studies with significant selective bias. At the present time, most centers do not routinely offer prophylactic blood patches, and those that do report a variable success rate. A recent case study of permanent neurologic deficit after prophylactic epidural blood patch has also raised some concern about the safety of this prophylactic technique.
Asunto(s)
Parche de Sangre Epidural , Cefalea/prevención & control , Humanos , Resultado del TratamientoRESUMEN
Minute ventilation-sensing pacemakers enable the paced heart to respond to an increased workload. Two patients with such a pacemaker developed pacemaker-driven tachycardia when connected to an electrocardiogram (ECG) monitor also capable of documenting ventilatory frequency and ECG lead disconnection. This tachycardia stopped when the ECG leads were removed. These pacemakers and monitors emit a low-amplitude electrical current and measure the resultant impedence signal across the chest. When patients are connected to the monitor the pacemaker sensor summates both impedence signals and the paced heart rate is increased as a result.
Asunto(s)
Marcapaso Artificial/efectos adversos , Pletismografía de Impedancia/efectos adversos , Taquicardia/etiología , Anciano , Falla de Equipo , Humanos , MasculinoRESUMEN
The profound analgesic properties of intrathecal narcotics without motor blockade make them an excellent choice for pain relief during the first stage of labor. Recent studies have attempted to define more clearly the pharmacology of commonly used agents. In this review we shall outline some of these advances and discuss their impact on labor.
RESUMEN
We describe two cases where we attempted to reduce the adverse effects of inadvertent spinal anaesthesia by aspirating local anaesthetic-contaminated cerebrospinal fluid (CSF). Analysis of this CSF for its local anaesthetic concentration revealed that we were able to recover 51% and 39% of the administered lignocaine. It is suggested that such aspiration may be a helpful additional measure to the supportive management of this complication.
Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Raquidea , Anestésicos Locales/líquido cefalorraquídeo , Lidocaína/líquido cefalorraquídeo , Adulto , Anciano , Anestesia Obstétrica/efectos adversos , Cesárea , Femenino , Humanos , Embarazo , SucciónRESUMEN
We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. The epidural space was located easily with the loss-of-resistance technique using 3 ml of air. A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.
