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1.
Eur Rev Med Pharmacol Sci ; 26(21): 8112-8117, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36394761

RESUMO

OBJECTIVE: In this study, we aimed at evaluating the impact of HA330 hemoperfusion adsorbent application on inflammatory markers and end-organ damage markers in patients with sepsis/septic shock. PATIENTS AND METHODS: Patients who were diagnosed with sepsis/septic shock and treated with HA330 hemoperfusion adsorbent in addition to the standard treatment were included in this retrospective study conducted at Inonu University Turgut Ozal Medical Center between January 1, 2019 and January 1, 2021. RESULTS: A total of 150 patients were included in the study. The mean±SD age of the patients was 51.9±17.7 years. 102 patients (68%) were in septic shock. Mean±SD APACHE II scores were 15.3±4.8. The need for mechanical ventilation was noted in 64 patients (42.7%). WBC, neutrophil count, hemoglobin, platelet count, BUN, creatinine, AST, ALT, CRP and procalcitonin levels were measured before and after the procedure. Overall, 104 patients (69.3%) died median (min-max) 2.5 (1-114) days after the cytokine adsorption, while 46 patients (30.7%) recovered from sepsis and were discharged. The increase in BUN levels and decrease in platelet count after the procedure were statistically significant (p≤0.001, 0.041, respectively) in the overall study population. The laboratory findings in 46 survivors indicated significantly decreased AST and ALT levels after cytokine adsorption compared to baseline pre-treatment levels. WBC, neutrophil count, CRP, procalcitonin, BUN and creatinine values were also decreased after cytokine adsorption in survivors, whereas the change was not statistically significant. There was also a non-significant tendency for an increase in platelet count and hemoglobin levels after cytokine adsorption compared to pre-treatment values in these patients. CONCLUSIONS: Although no effect of HA330 hemoperfusion application on inflammatory markers and end-organ damage markers was demonstrated in our study, we used the HA330 hemoperfusion adsorbent method as a last resort in terminal patients with a mortality rate of approximately 90% and for whom antibiotic treatment did not benefit. Therefore, multicenter, prospective studies are needed to clarify the effect of early HA330 hemoperfusion use in the treatment of sepsis.


Assuntos
Hemoperfusão , Sepse , Choque Séptico , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Hemoperfusão/métodos , Estudos Retrospectivos , Choque Séptico/diagnóstico , Choque Séptico/terapia , Pró-Calcitonina , Creatinina , Sepse/diagnóstico , Sepse/terapia , Biomarcadores , Citocinas
2.
Transplant Proc ; 51(4): 1180-1183, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101195

RESUMO

OBJECTIVE: Ischemia-reperfusion (IR) injury is associated with various clinical conditions, such as myocardial infarction, shock, and surgery under vascular occlusion. We aimed to investigate the protective and therapeutic effects of apocynin (AP) on liver injury induced by IR in an in vivo rat model. METHODS: Thirty-two rats were randomly divided into 4 experimental groups with n = 8 in each group: sham, IR, AP, and IR + AP. AP (20 mg/kg) was intraperitoneally administered to rats in the AP and IR + AP groups for 30 minutes before 60 minutes of ischemia and followed by 60 minutes of reperfusion. All rats were killed on the same day to evaluate tissue levels of oxidants and antioxidants (catalase, malondialdehyde, myeloperoxidase, superoxidedismutase (SOD), and total glutathione). RESULTS: IR decreased SOD levels in IR group when compared with the sham group. AP supplementation to IR group significantly ameliorated SOD levels (P < .05). Also, IR caused elevation of myeloperoxidase production when compared with the sham group, whereas AP treatment prevented these hazardous effects (P < .05). However, plasma total glutathione, catalase, and malondialdehyde levels did not differ between the AP + IR and the IR rats. CONCLUSION: The main finding of the present study was that AP may be protective against liver IR injury. Our results suggested that AP pretreatment suppressed oxidative stress and increased antioxidant levels in an rat model of liver IR.


Assuntos
Acetofenonas/farmacologia , Antioxidantes/farmacologia , Fígado/efeitos dos fármacos , Traumatismo por Reperfusão/patologia , Animais , Feminino , Fígado/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/prevenção & controle
3.
Transplant Proc ; 50(10): 3135-3143, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577179

RESUMO

OBJECTIVE: We aimed to investigate the protective and therapeutic effects of dexpanthenol (DXP) on liver injuries induced by ischemia-reperfusion (IR) in an in vivo rat model. METHODS: Thirty-two rats were randomly divided into 4 experimental groups (n = 8 in each group: Sham, IR, DXP, and DXP+IR. DXP (500 mg/kg) was intraperitoneally administered for 30 min before 60 min of ischemia, followed by 60 min of reperfusion to rats in the DXP and DXP+IR groups. All rats were euthanized on day 10 to evaluate immunohistopathological changes as well as tissue levels of oxidants and antioxidants. RESULTS: IR decreased total glutathione (tGSH) levels in IR group when compared to the Sham group. DXP supplementation to IR group significantly ameliorated tGSH levels (P < .05). IR also elevated myeloperoxidase production compared to the Sham group, whereas DXP treatment prevented these hazardous effects. However, plasma superoxidedismutase, catalase, and malondialdehyde levels did not differ between the DXP+IR than the IR rats. Histologic tissue damage was reduced in the DXP and DXP+IR group. CONCLUSION: Liver IR is an inevitable problem during liver surgery. Our results suggested that DXP pretreatment suppressed oxidative stress and increased antioxidant levels in a rat model of liver IR.


Assuntos
Fígado/lesões , Ácido Pantotênico/análogos & derivados , Traumatismo por Reperfusão/prevenção & controle , Complexo Vitamínico B/uso terapêutico , Animais , Antioxidantes/metabolismo , Catalase/metabolismo , Modelos Animais de Doenças , Feminino , Glutationa/metabolismo , Glutationa Peroxidase/metabolismo , Fígado/patologia , Malondialdeído/sangue , Estresse Oxidativo/efeitos dos fármacos , Ácido Pantotênico/uso terapêutico , Peroxidase , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia
4.
Transplant Proc ; 47(4): 1190-3, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26036551

RESUMO

INTRODUCTION: The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients. METHODS: ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy. RESULTS: The positive end-expiratory pressure (PEEP) was 0 cm H20 in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P < .05). CONCLUSIONS: Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.


Assuntos
Corantes/metabolismo , Verde de Indocianina/metabolismo , Transplante de Fígado , Fígado/metabolismo , Doadores Vivos , Respiração com Pressão Positiva/métodos , Adulto , Alanina Transaminase/sangue , Anestesia Geral/métodos , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos , Feminino , Hemodinâmica , Hepatectomia/métodos , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Albumina Sérica/metabolismo , Adulto Jovem
5.
Transplant Proc ; 47(4): 1204-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26036554

RESUMO

The aim of this study was the compare the donor patients who received intravenous (IV) morphine with patient-controlled analgesia (PCA) or epidural morphine during the early postoperative period who underwent liver transplantation. Forty patients were included in the study and randomly divided into 2 groups in a double-blinded manner. They were given IV morphine 5 mg (Group C), or epidural anesthesia adding morphine (2 mg; Group E) by epidural anesthesia technique starting 15 minutes before the estimated time of completion of surgery. All of the patients received PCA with IV morphine (Group C; PCA device was set to deliver 1 mg morphine with a lockout of 15 minutes and a 4-hour limit of 20 mg, and no continuous infusion) or epidural morphine (Group E; patient-controlled epidural analgesia [PCEA] device was set to deliver 0.5 mg morphine with a lockout of 30 minutes and a 4-hour limit of 10 mg, and no continuous infusion) and were followed up for 24 hours, and pain scores were evaluated by study nurses who were blinded to the study protocol. The visual analogue scale (VAS) scores at rest and at movement and morphine consumption at 12 and 24 hours after operation evaluation time points were significantly higher in Group E than those in Group C (P < .05). Furthermore, total morphine consumption in Group C was significantly higher than that in Group E (P < .05). Epidural morphine via PCEA was associated with decreased postoperative VAS scores and morphine consumption. These findings may be beneficial for managing postoperative analgesia protocols in liver transplant donor patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Hepatectomia , Transplante de Fígado , Doadores Vivos , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Intravenosa , Adulto , Analgesia Epidural/métodos , Analgesia Controlada pelo Paciente/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
6.
Transplant Proc ; 47(5): 1462-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26093743

RESUMO

BACKGROUND: Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Our aim in this study was to compare thoracic epidural anesthesia and general anesthesia effects on liver blood flow by means of liver function tests and indocyanine green and compared with living-donor liver transplantation. METHODS: Subjects were divided into 2 equal groups: the control group (group I) and the epidural block group (group II, closed envelope method). In group II patients, the epidural catheter was inserted at the T6-8 level. In all patients, anesthesia was standardized with the use of lidocaine, fentanyl, and thiopental. Indocyanine green clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), and at postoperative 24 and 72 hours were recorded. Simultaneously, hemoglobin, hematocrit, platelet count, prothrombin time (PT), international normalized ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate transaminase, and alanine transaminase values were analyzed. RESULTS: Plasma disappearance rate (PDR) and retention at 15 minutes (R15) of indocyanine green were not statistically significant difference between groups (P > .05). Intragroup comparison of PDR and R15 values at times T1, T2, T3, and T4 showed that the values at T0 were statistically significant (P < .05). PT and INR values were significantly different for all times within each group (P < .05). It was concluded that the use of thoracic epidural anesthesia has no effect on global liver function and liver-related liability tests in patients undergoing elective liver donor surgery.


Assuntos
Anestesia Epidural/métodos , Verde de Indocianina/farmacocinética , Circulação Hepática/fisiologia , Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Adulto , Corantes/farmacocinética , Método Duplo-Cego , Feminino , Humanos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Vértebras Torácicas
7.
Transplant Proc ; 47(2): 469-72, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25769593

RESUMO

BACKGROUND: The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy. METHODS: A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study. The patients were randomly divided into 2 groups: propofol and isoflurane. Plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured before surgery (t0) and after surgery (t1). RESULTS: There were no statistically significant differences in demographic features, anesthesia, and times of surgery between the groups (P > .05). Plasma TAC levels at t0 and t1 were significantly lower in the propofol group than in the isoflurane group (P < .05). OSI at t1 was significantly higher in the propofol group than in the isoflurane group (P < .05). MDA levels were significantly higher in the propofol group than in the isoflurane group at t0 (P < .05). MDA levels level were significantly higher in the isoflurane group than in the propofol group at t1 (P < .05). CONCLUSIONS: Propofol may have protective effects against IR injury caused by the Pringle maneuver during donor hepatectomy in living-donor transplantations. However, the effectiveness of propofol for clinical use needs to be investigated further.


Assuntos
Antioxidantes/farmacologia , Hepatectomia/efeitos adversos , Isoflurano/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Propofol/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Coleta de Tecidos e Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Anestesia/métodos , Antioxidantes/uso terapêutico , Biomarcadores/sangue , Feminino , Hepatectomia/métodos , Humanos , Isoflurano/uso terapêutico , Transplante de Fígado , Doadores Vivos , Masculino , Malondialdeído/sangue , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Propofol/uso terapêutico , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo , Superóxido Dismutase/sangue , Coleta de Tecidos e Órgãos/métodos , Adulto Jovem
8.
Anaesth Intensive Care ; 41(4): 501-4, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23808510

RESUMO

The aim of this study was to determine whether pretreatment with alkalinised lignocaine reduced the incidence and severity of pain during propofol injection. This prospective, randomised, double-blind study included 300 adult, American Society of Anesthesiologists physcial status I to II patients undergoing elective surgery. Patients were randomly allocated to one of three groups: Group L received 0.05 ml/kg of 1% lignocaine (5 ml normal saline + 5 ml 2% lignocaine), Group A received 0.05 ml/kg alkalinised lignocaine (5 ml 2% lignocaine + 1 ml 8.4% NaHCO3 + 4 ml normal saline), and Group S, the control group, was given the same amount of normal saline (NaCl 0.9%). All drugs were given as a bolus over 20 seconds before propofol administration. A blinded researcher assessed the patient's pain level using a four-point scale. The pain score [median (range)] and the incidence of pain in Group A (6%) was significantly lower than in groups L (41%) and S (88%, P <0.001). In addition, the pain score and the incidence of pain were found to be significantly different between Group L and Group S (P <0.001). The incidence of moderate and severe pain were greater in Group S when compared with groups A and L (P <0.001). Intravenous pretreatment with alkalinised lignocaine appears to be effective in reducing the pain during propofol injection.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/química , Anestésicos Locais/uso terapêutico , Injeções Intravenosas/efeitos adversos , Lidocaína/química , Lidocaína/uso terapêutico , Dor/prevenção & controle , Propofol/administração & dosagem , Propofol/efeitos adversos , Adolescente , Adulto , Álcalis , Método Duplo-Cego , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Bicarbonato de Sódio/química , Adulto Jovem
9.
Transplant Proc ; 45(6): 2277-82, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23742834

RESUMO

The aims of this study were to determine the frequency of preoperative iron deficiency in adult living donor liver transplantation patients and to investigate its relationship with the need for intraoperative transfusion. Between September 1, 2011, and June 1, 2012, 103 patients scheduled for liver transplantation were included in this prospective study. Patients were divided into 2 groups according to baseline iron status: an iron-deficient group and a non deficient (normal iron profile) group. Iron deficiency was assessed on the basis of several parameters, including transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein, and peripheral blood smear. Preoperative iron deficiency was diagnosed in 62 patients. Preoperative iron deficiency was associated with low preoperative hemoglobin levels (P = .01) and a high rate of intraoperative transfusion (P < .0001). Preoperative iron deficiency is prognostic factor for predicting intraoperative transfusion requirements. These findings have important implications for transfusion practices for liver transplant recipients.


Assuntos
Anemia Ferropriva/complicações , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Transplante de Fígado/efeitos adversos , Adolescente , Adulto , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Transplant Proc ; 45(3): 966-70, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23622600

RESUMO

We compared postoperative hepatic and renal functions and coagulation profiles in living donors undergoing right hepatectomy under isoflurane (n = 40) versus propofol (n = 40) anesthesia. After induction, anesthesia was maintained with isoflurane/air-O2 (group I) or propofol/air-O2 (group P) in addition to remifentanil and atracurium infusion in both groups. Aspartate aminotransferase, alanine aminotransferase, international normalized ratio (INR), activated partial thromboplastin time (aPTT), albumin, total bilirubin, blood urea nitrogen, creatinine, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were measured in the preoperative period, after end of the operation, and on the first, third, fifth and seventh postoperative days (PODs). INR was significantly increased on POD 3 and aPTT on POD 5 in group I compared with group P (P < .05). Albumin level was significantly lower in Group I on POD 1 and 3 (P < .05). GFR was significantly lower on POD 1 in the group I compared with group P (P < .05). The postoperative coagulation, GFR, and albumin values were superior following administration of propofol than isoflurane in donors who underwent living hepatectomy; however, both approaches were clinically safe, with no significant clinical difference.


Assuntos
Coagulação Sanguínea , Hepatectomia , Isoflurano/farmacologia , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Doadores Vivos , Propofol/farmacologia , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Rim/fisiopatologia , Fígado/fisiopatologia
11.
Transplant Proc ; 45(3): 978-81, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23622603

RESUMO

Liver transplant (LT) recipients often display iron deficiency preoperatively, which significantly increases the quantity of blood that needs to be transfused intraoperatively, A risk factor for a prolonged intensive care unit (ICU) stay. The aim of this retrospective study was to determine whether there was a clinically significant association between iron deficiency and the length of ICU stay, among 153 patients scheduled for OLT from September 2011 to June 2012. Patients were divided into 2 groups according to their baseline iron status: iron- deficient (ID) and non-ID (normal iron profile) cohorts. Iron deficiency was assessed on the basis of several parameters; transferrin saturation as well as serum iron, ferritin, soluble transferrin receptor, and C-reactive protein levels. We retrospectively analyzed the data regarding demographic and clinical features, preoperative laboratory values, intraoperative transfusions, and length of ICU stay. Patient demographic features and preoperative values were similar between the groups. Preoperative iron deficiency, which was diagnosed in 72 patients (58.6%), was associated with a greater intraoperative use of fresh frozen plasma and red blood cell transfusions (P = .0001). The median length of ICU stay after LT was longer among the ID versus the non-ID group (5 and 3 days per patient, respectively; P = .0001). Therefore, we have suggested that preoperative iron deficiency may be a prognostic factor for the length of ICU stay after LT.


Assuntos
Anemia Ferropriva/fisiopatologia , Unidades de Terapia Intensiva , Tempo de Internação , Transplante de Fígado , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Transplant Proc ; 45(2): 487-91, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23498783

RESUMO

AIM: Ischemia/reperfusion (IR) injury (IRI) in liver transplant patients may negatively affect graft function. Although ß-glucan protects kidneys against IRI, its effect on the liver is unknown. This study sought to investigate ß-glucan effects on oxidative damage to the liver after IRI in rats. MATERIALS AND METHODS: Thirty-two rats were randomly divided into 4 experimental groups n = 8 in each group: sham, IR, ß-glucan and IR + ß-glucan. ß-Glucan (50 mg.kg(-1) . day(-1)) was orally administered for 10 days to rats in the ß-glucan and IR + ß-glucan groups. The rats in the IR and IR + ß-glucan groups were subjected to ischemia and reperfusion (IR) for 60 minutes each. All rats were killed on day 11 to evaluate histological changes as well as tissue levels of oxidants and antioxidants. RESULTS: Malondialdehyde (MDA) levels were significantly higher in the IR than the sham group (P = .001). MDA level was significantly higher in the IR group than in the IR + ß-glucan group (P = .001). The levels of tissue antioxidant markers (superoxide dismutase [SOD], glutathione-peroxidase [GPx], and catalase [CAT]) were significantly lower in the IR group than in the sham group (P < .05). SOD and GPx levels did not differ significantly between the IR and IR + ß-glucan groups. CAT activity was significantly higher in the IR than the IR + ß-glucan group (P = .001). Histological tissue damage was reduced in the IR + ß-glucan than the IR group. CONCLUSION: Liver IRI is an inevitable problem during liver surgery. Our results suggested that ß-glucan pretreatment suppressed oxidative stress and increased antioxidant levels in an rat model of liver IRI.


Assuntos
Antioxidantes/administração & dosagem , Fígado/irrigação sanguínea , Fígado/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Traumatismo por Reperfusão/prevenção & controle , beta-Glucanas/administração & dosagem , Administração Oral , Animais , Catalase/sangue , Modelos Animais de Doenças , Glutationa Peroxidase/sangue , Fígado/enzimologia , Fígado/patologia , Masculino , Malondialdeído/sangue , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Superóxido Dismutase/sangue
13.
Eur Rev Med Pharmacol Sci ; 16(4): 559-61, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22696887

RESUMO

Children with congenital anomalies such as Goldenhar syndrome affecting the airway can be a problem for the anaesthesiologist. We present the case of an 18 month-old child with Goldenhar syndrome, in whom the ProSeal Laryngeal Mask Airway was successfully used for inguinal hernia surgery.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Anestesia Geral/instrumentação , Síndrome de Goldenhar/complicações , Hérnia Inguinal/cirurgia , Máscaras Laríngeas , Desenho de Equipamento , Hérnia Inguinal/complicações , Humanos , Lactente , Masculino
14.
Eur Rev Med Pharmacol Sci ; 16(2): 207-12, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22428471

RESUMO

BACKGROUND: Neuroaxial blockade for ambulatory transurethral resection of the prostate is a well established technique. Patients in this group are often at high risk for perioperative complications from concurrent diseases. The purpose of this study was to compare the elderly patients who received intrathecal fentanyl alone or intrathecal fentanyl plus bupivacaine or epidural anesthesia for transurethral resection of prostate surgery. MATERIAL AND METHODS: Ninety-nine patients were prospectively randomized to receive fentanyl 25 microg (Group F), fentanyl 25 microg plus hyperbaric bupivacaine 2.5 mg (Group BF), or epidural anesthesia adding fentanyl 50 microg (Group E) by combined spinal epidural anesthesia technique. RESULTS: The amount of local anesthetics used until when the sensorial block reached the level of T10 was significantly lower in the Group BF than in the Group E and the Group F (p < 0.001). Maximum level of sensory block was significantly lower in the Group BF than in the Group E and the Group F (p = 0.01). The time elapsed until the sensory block reached T10, the regression of sensory block to L5 level were significantly lower in the Group BF than in the Group E and the Group F (p = 0.005, p < 0.001, respectively). Compared to the basal values, mean arterial pressures were significantly lower in the Group BF than in the Group E and the Group F (p < 0.05). The occurrence of hypotension was significantly lower in the Group BF (9.4%) than in the Group E (18.2%) and the Group F (24.2%). CONCLUSIONS: Intrathecal hyperbaric bupivacaine 2.5 mg plus fentanyl 25 microg administration provides shorter motor block onset time, less local anesthetic usage and adequate hemodynamic stability in elderly patients.


Assuntos
Anestesia Epidural/métodos , Raquianestesia/métodos , Anestésicos Intravenosos/administração & dosagem , Fentanila/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais , Pressão Sanguínea/efeitos dos fármacos , Estatura/fisiologia , Peso Corporal/fisiologia , Bupivacaína , Fentanila/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Ressecção Transuretral da Próstata
15.
Transplant Proc ; 43(3): 892-5, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21486622

RESUMO

It has been shown that anesthetic requirements during liver transplantation are inversely proportional to the degree of hepatic dysfunction. We investigate alterations during the three phases of requirements for intraoperative isoflurane within the target of 40 to 55 Bispectral Index (BIS) values concerning patients with end-stage liver disease who are undergoing liver transplantation. After faculty ethics committee approval, we studied 50 patients of (age range, 18 to 65 years) who were undergoing liver transplantation. After induction, we used isoflurane with air/oxygen (FiO(2) = 0.5%) for anesthetic maintenance. The isoflurane concentration was set within the range of 40 to 55 BIS values. Remifentanil (0.15 µg/kg/min) was infused for analgesia and cisatracurium was administered via continuous infusion. After anesthetic induction, we inserted arterial, pulmonary artery, and central venous catheters. The heart rate, mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), body temperature, BIS values, end-tidal isoflurane concentration (ETiso) and end-tidal carbon dioxide concentration (ETCO(2)) were recorded at 30-minute intervals during the dissection and neohepatic phases, at 15-minute intervals during the anhepatic phase. In addition, we calculated the cardiac index during the three phases. There was no difference in heart rates among the operative phases. In contrast, there were significant changes in MAP, MPAP, BIS, ETCO(2) and body temperature values. However, all of these parameters were in physiological ranges and clinically acceptable. The ETiso values were lowest in the anhepatic phase compared to other phases, but the differences were not clinically important. The ETiso values in the dissection and neohepatic phases were compared with the anhepatic phase higher 5% and 8.6% respectively. During liver transplantation, ETiso requirement for the anhepatic phase was lower compared with the other two phases within the range of 40 to 55 BIS values.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Doença Hepática Terminal/cirurgia , Isoflurano/administração & dosagem , Transplante de Fígado/métodos , Monitorização Fisiológica/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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