Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates.

BACKGROUND: Preoperative body mass index (pre-BMI) affecting patients' recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites. METHODS: Postoperative BMI values and ascites volumes of 206 patients undergoing OLT (2006-2007) were reviewed. RESULTS: There were 141 preoperatively "non-obese" patients (pre-BMI ≤ 30 kg/m2) and 65 "obese" patients (pre-BMI >30 kg/m2). Demographics and model for end-stage liver disease scores were similar for both groups. The mean volume of ascites removed from the "non-obese" patients was significantly larger compared to the "obese" ones (P=0.018). Seventeen "obese" patients became "non-obese" postoperatively. The duration of anesthesia, ischemia, surgery, hemodynamic parameters, estimated blood loss and transfused products were similar for both groups. Ascites volumes correlated significantly (P<0.05) with various intraoperative indices but not pre-BMI. At 24 h postoperatively, the extubation rate was better for the "obese" group (99%) versus the "non-obese" group (93%, P=0.03). However, "non-obese" patients were extubated earlier than the "obese" both by 6 h (45% versus 22%, respectively, P<0.01) and by 12 h (88% versus 74%, respectively, P=0.012). The postoperative, but not the preoperative BMI, correlated with extubation rate ≤ 6 h (r=0.924, P=0.0001). No "obese" patients died <1 month postoperatively, compared to 9 "non-obese" patients (P<0.01). Intensive Care Unit and hospital stay were ~25% longer for the "obese" group. CONCLUSION: Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.

Hemispheric-synchronisation during anaesthesia: a double-blind randomised trial using audiotapes for intra-operative nociception control.

The possible antinociceptive effect of hemispheric-synchronised sounds, classical music and blank tape were investigated in patients undergoing surgery under general anaesthesia. The study was performed on 76 patients, ASA 1 or 2, aged 18-75 years using a double-blind randomised design. Each of the three tapes was allocated to the patients according to a computer-generated random number table. General anaesthesia was standardised and consisted of propofol, nitrous oxide 66%/oxygen 33%, isoflurane and fentanyl. Patients breathed spontaneously through a laryngeal mask and the end-tidal isoflurane concentration was maintained near to its minimum alveolar concentration value of 1.2%. Fentanyl was given intravenously sufficient to keep the intra-operative heart rate and arterial blood pressure within 20% of pre-operative baseline values and the fentanyl requirements were used as a measure of nociception control. Patients to whom hemispheric-synchronised sounds were played under general anaesthesia required significantly less fentanyl compared with patients listening to classical music or blank tape (mean values: 28 microgram, 124 microgram and 126 microg, respectively) (p < 0.001). This difference remained significant when regression analysis was used to control for the effects of age and sex.

Use of 'Diprifusor' in anaesthesia for ophthalmic surgery.

A technique of balanced anaesthesia involving propofol infusions and a rapidly metabolised opioid offers advantages over traditional anaesthetic techniques for eye surgery. The most appropriate mode of delivery of propofol is by a 'Diprifusor' target controlled infusion system. This paper discusses the use of a 'Diprifusor' target controlled infusion system for eye surgery. Published data are reviewed and the results of a retrospective analysis of 138 successive eye surgery patients are presented.

Morphology and localization of sunburst varicosities: an electron microscopic and morphometric study.

The results of light and electron microscopy of 18 punch biopsies of sunburst varicosities are presented. Sunburst varicosities are widened cutaneous veins located within the superficial vessel net as well as within descending branches, often with an asymmetrically thickened wall. The thickened vessel walls contain collagenous and muscle fibers. Only a few elastic fibers have been detected, as opposed to numerous oxytalan fibers. Electron microscopy reveals an interfibrillar collagenous dysplasia, lattice collagen, and some matrix vesicles. The center of sunburst vessels is found at depths ranging from 175 to 382 microns below the stratum granulosum.