Impact of a goal-directed therapy protocol on postoperative fluid balance in patients undergoing liver transplantation: a retrospective study.

OBJECTIVE: Liver transplantation carries major risks during the perioperative period. Few studies focused on the hemodynamics of patients undergoing liver transplantation. The present study was aimed to evaluate the impact of the implementation of a protocol including goal-directed therapy in patients undergoing liver transplantation. Our first goal was to determine its impact on the fluid balance. Secondarily, we evaluated possible improvements in the patient outcomes. STUDY DESIGN: A before and after study. PATIENTS AND METHODS: Fifty patients undergoing liver transplantation were included during two successive six-month periods. During the first period, the management of the patients was left at the discretion of the senior physicians (control group, n=25). During the second period, the patients were treated according to a predetermined protocol including a specific hemodynamic monitoring (protocol group, n=25). RESULTS: The fluid balance was negative in the protocol group and positive in the control group at 24h (-606mL vs. +3445mL, P<0.01) and 48h (-2315mL vs. +1170mL, P<0.01) after liver transplantation. The volume of the crystalloid administration was lower in the protocol group than in the control group (5000mL vs. 8000mL, P<0.01, and 1500mL vs. 6000mL, P<0.01, during surgery and 48h after liver transplantation, respectively). The duration of mechanical ventilation and postoperative ileus were significantly reduced in the protocol group, as compared with the control group, 20h vs. 94h (P<0.01) and 4days vs. 6days (P<0.01), respectively. CONCLUSION: For patients undergoing liver transplantation, the implementation of a protocol aiming to optimize hemodynamics was associated with reduced fluid balance and decreased requirement for mechanical ventilation and postoperative ileus duration.

[Rapid sequence induction in a patient with Steinert myotonic dystrophy: Interest of the association of high doses of rocuronium and sugammadex]. / Induction en séquence rapide chez un patient porteur d'une dystrophie myotonique de Steinert : intérêt de l'association d'une forte dose de rocuronium et de sugammadex.

We report in this clinical case the successful use of a combination of rocuronium and sugammadex in a patient with Steinert myotonic dystrophy to perform a rapid sequence induction of anaesthesia. The patient had both contraindication to succinylcholine and a risk of prolonged neuromuscular blockade with non-depolarizing neuromuscular blocking agents. The use of high dose rocuronium (1mg/kg) allowed a quick and easy orotracheal intubation but induced a prolonged neuromuscular block, reversed with success by sugammadex (8 mg/kg).

[Anaesthesia without anaesthetist?]. / L'anesthésie sans anesthésiste?

The continuing decline in the number of anaesthetists-intensive care physicians means that certain operations need to be performed under the responsibility of urologists alone. These procedures can be performed perfectly safely in selected patients, provided the urologist is aware of the inherent risks of each local and regional anaesthesia or sedation technique.

[Kinetic study of the cyclization of the addition compound of ethyl mercaptoacetate on benzylideneacetophenone]. / Etude cinétique de la cyclisation du composé d'addition du mercaptoacétate d'éthyle sur la benzylidèneacétophénone.

The study of the kinetic of cyclisation reaction of the additional compound of the mercaptoacetic ethylester on a benzylideneacetophenone was proposed. With the chromatography a retro-Michael reaction was obtained. The H NMR alone permitted to show the order 1 for the kinetic of cyclization and according to the amine used like reaction catalyst, two diastereoisomers could be formed.

[Laparoscopic cholecystectomy in a patient with Steinert disease]. / Cholécystectomie par voie laparoscopique chez un sujet atteint d'une maladie de Steinert.

Steinert's disease or myotonic myopathy is associated with chronic restrictive respiratory insufficiency. A case of a patient with Steinert's disease undergoing laparoscopic cholecystectomy, with a full recovery within three days is reported. It is concluded that laparoscopic surgery is a possible therapeutic tool in patients suffering from a myopathy.