Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical ... more Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial
Background Routine administration of antibacterials in patients with Covid-19 has been a subject ... more Background Routine administration of antibacterials in patients with Covid-19 has been a subject of debate, with no solid data about the true prevalence of respiratory coinfections in Covid-19 patients in different geographic areas. The aim of the current study was to identify respiratory coinfections in Covid-19 patients admitted to the hospital and to identify its genetic resistance pattern using the respiratory multiplex polymerase chain reaction (PCR). Results The study included 40 patients, 32 males (80%) and 8 (20%) females with a mean age of 59.3 ± 12.6. Half of the patients had respiratory bacterial coinfections documented by pneumonia (PN) panel. The most common isolate was Klebsiella pneumoniae (10/20, 50%), followed by Acinetobacter calcoaceticus baumanni complex (7/20, 35%). Regarding genetic resistance, thirteen (13/20, 65%) isolates were proven extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. Thirteen (13/20, 65%) isolates were proven carbapenemase...
Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical p... more Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. It has not been found to increase postoperative cardiorespiratory morbidity, sympathoadrenal stress, or mortality. On the other hand, it significantly reduces costs and improves resource utilization. Methods: Fifty two consecutive patients underwent open heart surgeries and were managed by the same anesthesiologist. All adult patients undergoing elective cardiac operations were included in the study. They were divided into 2 groups, 26 patients each, UFTA group and conventional group. Patients were given intravenous midazolam, before surgery as a premedication. Induction was achieved using midazolam, fentanyl, and propofol. Tracheal intubation was facilitated by atracurium. Maintenance of anesthesia was achieved using sevoflurane, and a continuous intravenous infusion of morphine. Postoperatively, patients received intravenous morphine infusion, intra...
Background Dexmedetomidine, a centrally acting α 2 -adrenoceptor agonist, has been used as an adj... more Background Dexmedetomidine, a centrally acting α 2 -adrenoceptor agonist, has been used as an adjunct to anesthesia and in sedation because of its efficient sympatholytic, analgesic, and anxiolytic properties. Recently, several studies have focused on the potential neuroprotective and renoprotective effects of dexmedetomidine in patients undergoing different surgical procedures. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass is associated with a high incidence of perioperative renal dysfunction that is believed to be caused partly by the increased sympathetic nervous system activity leading to compromised hemodynamics and attenuated renal function. Aim of the work To test the hypothesis that dexmedetomidine would exert a renal protective effect and prevent the development of acute kidney injury in patients with mild to moderate renal dysfunction undergoing elective CABG during the early postoperative days. Methods A double-blind randomized placebo-controlled stud...
Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myoca... more Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myocardial protection due to the increasing complexity of cardiac surgical procedures, especially thoracic aortic operations which require extended myocardial ischemic periods. The goal of this study was to assess the safety and efficacy of cold crystalloid single dosage Histidine Tryptophan Ketogultarate (Custodiol) cardioplegia to cold blood multidose cardioplegia in aortic surgery patients. Methods: Our study included 100 elective and emergency aortic surgery patients. Fifty patients received Custodiol cardioplegic solution (group A) and fifty received cold blood cardioplegia (group B). We evaluated post-operative cardiac Troponin I release, postoperative morbidities and mortality. Results: Troponin I peak release, duration of inotropic support & intensive care unit stay were more in the cold blood group. Hemofiltration and intraoperative requirement of blood products transfusion were mor...
Background Due to limited capacity, health care systems worldwide have been put in challenging si... more Background Due to limited capacity, health care systems worldwide have been put in challenging situations since the emergence of COVID-19. To prioritize patients who need hospital admission, a better understanding of the clinical predictors of disease severity is required. In the current study, we investigated the predictors of mortality and severity of illness in COVID-19 from a single center in Cairo, Egypt. Methods This retrospective cohort study included 175 patients hospitalized with COVID-19 pneumonia and had positive real-time polymerase chain reaction (RT-PCR) results for SARS-CoV-2 from 1 May 2020 to 1 December 2020. Severe COVID-19 was defined as requiring high-flow oxygen (flow rate of more than 8 L/min or use of high flow oxygen cannula), noninvasive ventilation, or invasive mechanical ventilation at any time point during the hospitalization. We used univariate and multivariate regression analyses to examine the differences in patient demographics and clinical and labora...
The Egyptian Journal of Cardiothoracic Anesthesia, 2021
The outbreak of coronavirus disease 2019 was first detected in Wuhan City, and from there it is b... more The outbreak of coronavirus disease 2019 was first detected in Wuhan City, and from there it is become a pandemic and global health threat. In the time of pandemic, Cardiac surgery in nearly all cardiac centers all over the world was only confined to emergency cases. Dealing with a patient infected with this highly contagious disease is a great risk, and anesthesiologists are at a higher risk of becoming infected because of their close contact with infected patients, and when these patients are urgently in need for a lengthy difficult procedure, the risk will be at its maximum. The challenge of the anesthetic team while dealing with these patients is more difficult than we expected; so, the authors wanted to record their management and their experience with these patients.
Open Access Macedonian Journal of Medical Sciences
INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial an... more INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay. AIM: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section. PATIENT AND METHODS: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection. RESULTS: Demographic data and the baseline, headache score, neck muscle spasm, and nausea were...
Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end... more Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end of the operation. This study compares the effect of ultrafast track anesthesia versus continued postoperative mechanical ventilation on the intensive care unit length of stay. Fifty-two elective adult patients were randomly allocated into ultrafast track anaesthesia and conventional groups by computer-generated random numbers. Redo operations, pre-operative intubation, uncontrolled diabetes, shock/left ventricular ejection fraction < 45%, pulmonary artery systolic pressure >55mmHg, creatinine clearance -1, haemodynamic instability, or those with concerns of postoperative bleeding were excluded. Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all. Intra-operatively, haemodynamic parameters, urine output, oxygen saturation, arterial blood gas analysis, 5-lead electrocardiogram, operative bypass- and cross-clamp time, and opioid consumptio...
Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. However... more Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. However, the ideal anesthetic management of patients with a history of takotsubo cardiomyopathy remains unclear, especially in patients undergoing liver transplantation. We describe the use of dexmedetomidine in a patient with a history of takotsubo cardiomyopathy undergoing living-donor liver transplantation.
Annals of transplantation : quarterly of the Polish Transplantation Society, Jan 22, 2014
Fungal infections have a significant impact on patient survival after liver transplantation, most... more Fungal infections have a significant impact on patient survival after liver transplantation, mostly caused by Candida and Aspergillus. The clinical manifestations vary, and range from colonization, active local infection, to severe invasive form. A high degree of suspicion is required for the early diagnosis and, accordingly, the optimal management of these infections. This study aimed to evaluate fungal infection in the Intensive care Unit (ICU) in admitted liver transplant patients, focussing of etiologic agent, clinical/laboratory presentation (including mortality), and risk factors. This retrospective study included living related liver transplanted patients admitted to the ICU. Clinical data was collected, thorough clinical evaluation was done, and laboratory tests were performed. Microbiological examination detecting the presence of fungus in various samples, using cultures and serology, and imaging investigations were carried out in all patients. This study included 23 cases ...
This is short single center review of experience in perioperative anesthetic management, and post... more This is short single center review of experience in perioperative anesthetic management, and postoperative intensive care provided to pediatric and adult patients undergoing living related liver transplantation in the armed forces hospital in Egypt (Wadi-Al-Nile hospital, Cairo). ...
We describe a patient with structurally normal heart who developed hemodynamic instability during... more We describe a patient with structurally normal heart who developed hemodynamic instability during orthotropic liver transplantation caused by severe dynamic left ventricular outflow tract obstruction. Successful management of this adverse event was facilitated by the use of intravenous terlipressin. The case highlights a role for terlipressin as a selective vasopressin receptor agonist with subsequent effects on systemic vascular resistance.
To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and pos... more To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and postoperative renal function in patients undergoing liver transplantation. Open-label, prospective, randomized study. Single-center study. Thirty patients who underwent elective, living-donor liver transplantation with portal pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 mm Hg. Patients were assigned randomly to one of two equal groups. The control group received saline, whereas the treatment group (TP group) received an initial bolus dose of terlipressin (1 mg over 30 mins) followed immediately by a continuous infusion of 2 μg·kg(-1)·h(-1) for 48 hrs. Portal pressure and gas exchange (radial artery, portal vein, and hepatic vein, blood gas analyses, and lactate concentration) were assessed at baseline (after ligation of the hepatic artery) and 2 hrs after drug administration. Systemic hemodynamic data and calculated tissue oxygenation parameters were compared throughout the procedure. Renal function was assessed by measurement of serum cystatin C after induction of anesthesia and on the first 2 days postoperatively. After the infusion of terlipressin, portal venous pressure decreased significantly from 26.3 ± 3.3 to 21.3 ± 3.6 mm Hg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The mean arterial pressure and systemic vascular resistance were significantly higher in the TP group than in the control group, whereas heart rate and cardiac index were comparable between the groups. Portal and hepatic base excess, and the level of serum lactate, did not differ between the two groups. The serum levels of both cystatin C and creatinine were significantly higher in the control group than in the TP group on postoperative day 2. Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008
Introduction: Liver transplantation is the standard form of treatment for patients with end stage... more Introduction: Liver transplantation is the standard form of treatment for patients with end stage liver disease, with the use of blood product as a standard method for transfusion. Recombinant factor VIIa (rVIIa) may help those patients to acquire less amount of transfusion. This will have an impact not only the morbidity and mortality of the recipient and the donor, but also on the economical aspect of this tremendously expensive procedure. We conducted this study to verify the possible beneficial effects of using rVIIa at a lower dose than the standard dosage, which could have an impact on the future use of rVIIa. Methods: Twenty-four patients scheduled for orthotropic liver transplantation, divided into 2 groups; a control group and an rVIIa group. Both groups received the same anesthetics enlisted in our protocol for liver transplantation. The rVIIa group received a loading dose of 30 ug/kg of rVIIa following the induction of anesthesia, followed by a maintenance dose of 5 ug/kg until the end of the dissection phase. Demographic data, coagulation profile [prothrombin time (PT), prothrombin concentration (PC), partial thromboplastin time (PTT), International normalized ratio (INR)], blood loss, transfusion requirements, the duration of the dissection phase, the duration of surgery, hemoglobin concentration (Hb), and platelet count were done immediately after induction and 1, 2, 3 and 6 hours post induction (dissection phase). Finally, a Doppler assessment of the graft vessels was performed subsequent to anastomosis Results: The rVIIa group had a lower PT in the first two hours of the dissection phase in relation to the baseline and significantly lower than the control group (P = 0.0002). The INR showed a significant improvement in the rVIIa group during the dissection phase compared to the control group, and during the first two hours compared with the baseline in the rVIIa group (P = 0.0002). When compared to the control group, the rVIIa group had a significant increase in the platelet count, in all samples taken during the dissection phase. There was a significant decrease in the intraoperative requirements of packed red blood cells (P = 0.014), platelets (P = 0.0005) and fresh frozen plasma (P = 0.01) in the rVIIa group compared to the control group Discussion: We conclude that administering low dose of rVIIa would be helpful during liver transplantation surgery. Improvement in the coagulation profile, transfusion requirements, and consequently postoperative morbidity and mortality could be achieved. References: Roberts HR, Monroe DM, White GC. The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood 2004;104:3858-3864.
Intravascular volume replacement therapy is an important issue in the perioperative management of... more Intravascular volume replacement therapy is an important issue in the perioperative management of liver transplantation. There is paucity of data on the safety of hydroxyethyl starch (HES) in patients undergoing liver transplantation. We evaluated the safety of a new HES 130/0.4 in the perioperative management of liver transplantation, with a special emphasis on renal function. Forty patients undergoing living donor liver transplantation were prospectively randomized into two groups. Patients in the ALB group (n = 20) received 5% human albumin. Patients in the HES group (n = 20) received third generation HES (6% HES 130/0.4). Total colloid administration was limited to 50 mL x kg(-1) x d(-1). The volume was given to maintain pulmonary artery occlusion pressure or central venous pressure between 5 and 7 mm Hg. If additional fluids were required, balanced crystalloid solution was used. Anesthetic and surgical techniques were standardized. Serum creatinine and cystatin C plasma levels ...
Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical ... more Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial
Background Routine administration of antibacterials in patients with Covid-19 has been a subject ... more Background Routine administration of antibacterials in patients with Covid-19 has been a subject of debate, with no solid data about the true prevalence of respiratory coinfections in Covid-19 patients in different geographic areas. The aim of the current study was to identify respiratory coinfections in Covid-19 patients admitted to the hospital and to identify its genetic resistance pattern using the respiratory multiplex polymerase chain reaction (PCR). Results The study included 40 patients, 32 males (80%) and 8 (20%) females with a mean age of 59.3 ± 12.6. Half of the patients had respiratory bacterial coinfections documented by pneumonia (PN) panel. The most common isolate was Klebsiella pneumoniae (10/20, 50%), followed by Acinetobacter calcoaceticus baumanni complex (7/20, 35%). Regarding genetic resistance, thirteen (13/20, 65%) isolates were proven extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. Thirteen (13/20, 65%) isolates were proven carbapenemase...
Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical p... more Background: Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. It has not been found to increase postoperative cardiorespiratory morbidity, sympathoadrenal stress, or mortality. On the other hand, it significantly reduces costs and improves resource utilization. Methods: Fifty two consecutive patients underwent open heart surgeries and were managed by the same anesthesiologist. All adult patients undergoing elective cardiac operations were included in the study. They were divided into 2 groups, 26 patients each, UFTA group and conventional group. Patients were given intravenous midazolam, before surgery as a premedication. Induction was achieved using midazolam, fentanyl, and propofol. Tracheal intubation was facilitated by atracurium. Maintenance of anesthesia was achieved using sevoflurane, and a continuous intravenous infusion of morphine. Postoperatively, patients received intravenous morphine infusion, intra...
Background Dexmedetomidine, a centrally acting α 2 -adrenoceptor agonist, has been used as an adj... more Background Dexmedetomidine, a centrally acting α 2 -adrenoceptor agonist, has been used as an adjunct to anesthesia and in sedation because of its efficient sympatholytic, analgesic, and anxiolytic properties. Recently, several studies have focused on the potential neuroprotective and renoprotective effects of dexmedetomidine in patients undergoing different surgical procedures. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass is associated with a high incidence of perioperative renal dysfunction that is believed to be caused partly by the increased sympathetic nervous system activity leading to compromised hemodynamics and attenuated renal function. Aim of the work To test the hypothesis that dexmedetomidine would exert a renal protective effect and prevent the development of acute kidney injury in patients with mild to moderate renal dysfunction undergoing elective CABG during the early postoperative days. Methods A double-blind randomized placebo-controlled stud...
Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myoca... more Background: Cardiac surgeons demand a cardioplegic solution providing extended durations of myocardial protection due to the increasing complexity of cardiac surgical procedures, especially thoracic aortic operations which require extended myocardial ischemic periods. The goal of this study was to assess the safety and efficacy of cold crystalloid single dosage Histidine Tryptophan Ketogultarate (Custodiol) cardioplegia to cold blood multidose cardioplegia in aortic surgery patients. Methods: Our study included 100 elective and emergency aortic surgery patients. Fifty patients received Custodiol cardioplegic solution (group A) and fifty received cold blood cardioplegia (group B). We evaluated post-operative cardiac Troponin I release, postoperative morbidities and mortality. Results: Troponin I peak release, duration of inotropic support & intensive care unit stay were more in the cold blood group. Hemofiltration and intraoperative requirement of blood products transfusion were mor...
Background Due to limited capacity, health care systems worldwide have been put in challenging si... more Background Due to limited capacity, health care systems worldwide have been put in challenging situations since the emergence of COVID-19. To prioritize patients who need hospital admission, a better understanding of the clinical predictors of disease severity is required. In the current study, we investigated the predictors of mortality and severity of illness in COVID-19 from a single center in Cairo, Egypt. Methods This retrospective cohort study included 175 patients hospitalized with COVID-19 pneumonia and had positive real-time polymerase chain reaction (RT-PCR) results for SARS-CoV-2 from 1 May 2020 to 1 December 2020. Severe COVID-19 was defined as requiring high-flow oxygen (flow rate of more than 8 L/min or use of high flow oxygen cannula), noninvasive ventilation, or invasive mechanical ventilation at any time point during the hospitalization. We used univariate and multivariate regression analyses to examine the differences in patient demographics and clinical and labora...
The Egyptian Journal of Cardiothoracic Anesthesia, 2021
The outbreak of coronavirus disease 2019 was first detected in Wuhan City, and from there it is b... more The outbreak of coronavirus disease 2019 was first detected in Wuhan City, and from there it is become a pandemic and global health threat. In the time of pandemic, Cardiac surgery in nearly all cardiac centers all over the world was only confined to emergency cases. Dealing with a patient infected with this highly contagious disease is a great risk, and anesthesiologists are at a higher risk of becoming infected because of their close contact with infected patients, and when these patients are urgently in need for a lengthy difficult procedure, the risk will be at its maximum. The challenge of the anesthetic team while dealing with these patients is more difficult than we expected; so, the authors wanted to record their management and their experience with these patients.
Open Access Macedonian Journal of Medical Sciences
INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial an... more INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay. AIM: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section. PATIENT AND METHODS: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection. RESULTS: Demographic data and the baseline, headache score, neck muscle spasm, and nausea were...
Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end... more Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end of the operation. This study compares the effect of ultrafast track anesthesia versus continued postoperative mechanical ventilation on the intensive care unit length of stay. Fifty-two elective adult patients were randomly allocated into ultrafast track anaesthesia and conventional groups by computer-generated random numbers. Redo operations, pre-operative intubation, uncontrolled diabetes, shock/left ventricular ejection fraction < 45%, pulmonary artery systolic pressure >55mmHg, creatinine clearance -1, haemodynamic instability, or those with concerns of postoperative bleeding were excluded. Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all. Intra-operatively, haemodynamic parameters, urine output, oxygen saturation, arterial blood gas analysis, 5-lead electrocardiogram, operative bypass- and cross-clamp time, and opioid consumptio...
Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. However... more Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. However, the ideal anesthetic management of patients with a history of takotsubo cardiomyopathy remains unclear, especially in patients undergoing liver transplantation. We describe the use of dexmedetomidine in a patient with a history of takotsubo cardiomyopathy undergoing living-donor liver transplantation.
Annals of transplantation : quarterly of the Polish Transplantation Society, Jan 22, 2014
Fungal infections have a significant impact on patient survival after liver transplantation, most... more Fungal infections have a significant impact on patient survival after liver transplantation, mostly caused by Candida and Aspergillus. The clinical manifestations vary, and range from colonization, active local infection, to severe invasive form. A high degree of suspicion is required for the early diagnosis and, accordingly, the optimal management of these infections. This study aimed to evaluate fungal infection in the Intensive care Unit (ICU) in admitted liver transplant patients, focussing of etiologic agent, clinical/laboratory presentation (including mortality), and risk factors. This retrospective study included living related liver transplanted patients admitted to the ICU. Clinical data was collected, thorough clinical evaluation was done, and laboratory tests were performed. Microbiological examination detecting the presence of fungus in various samples, using cultures and serology, and imaging investigations were carried out in all patients. This study included 23 cases ...
This is short single center review of experience in perioperative anesthetic management, and post... more This is short single center review of experience in perioperative anesthetic management, and postoperative intensive care provided to pediatric and adult patients undergoing living related liver transplantation in the armed forces hospital in Egypt (Wadi-Al-Nile hospital, Cairo). ...
We describe a patient with structurally normal heart who developed hemodynamic instability during... more We describe a patient with structurally normal heart who developed hemodynamic instability during orthotropic liver transplantation caused by severe dynamic left ventricular outflow tract obstruction. Successful management of this adverse event was facilitated by the use of intravenous terlipressin. The case highlights a role for terlipressin as a selective vasopressin receptor agonist with subsequent effects on systemic vascular resistance.
To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and pos... more To assess the effect of the intraoperative use of terlipressin on splanchnic hemodynamics and postoperative renal function in patients undergoing liver transplantation. Open-label, prospective, randomized study. Single-center study. Thirty patients who underwent elective, living-donor liver transplantation with portal pressure &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20 mm Hg. Patients were assigned randomly to one of two equal groups. The control group received saline, whereas the treatment group (TP group) received an initial bolus dose of terlipressin (1 mg over 30 mins) followed immediately by a continuous infusion of 2 μg·kg(-1)·h(-1) for 48 hrs. Portal pressure and gas exchange (radial artery, portal vein, and hepatic vein, blood gas analyses, and lactate concentration) were assessed at baseline (after ligation of the hepatic artery) and 2 hrs after drug administration. Systemic hemodynamic data and calculated tissue oxygenation parameters were compared throughout the procedure. Renal function was assessed by measurement of serum cystatin C after induction of anesthesia and on the first 2 days postoperatively. After the infusion of terlipressin, portal venous pressure decreased significantly from 26.3 ± 3.3 to 21.3 ± 3.6 mm Hg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The mean arterial pressure and systemic vascular resistance were significantly higher in the TP group than in the control group, whereas heart rate and cardiac index were comparable between the groups. Portal and hepatic base excess, and the level of serum lactate, did not differ between the two groups. The serum levels of both cystatin C and creatinine were significantly higher in the control group than in the TP group on postoperative day 2. Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2008
Introduction: Liver transplantation is the standard form of treatment for patients with end stage... more Introduction: Liver transplantation is the standard form of treatment for patients with end stage liver disease, with the use of blood product as a standard method for transfusion. Recombinant factor VIIa (rVIIa) may help those patients to acquire less amount of transfusion. This will have an impact not only the morbidity and mortality of the recipient and the donor, but also on the economical aspect of this tremendously expensive procedure. We conducted this study to verify the possible beneficial effects of using rVIIa at a lower dose than the standard dosage, which could have an impact on the future use of rVIIa. Methods: Twenty-four patients scheduled for orthotropic liver transplantation, divided into 2 groups; a control group and an rVIIa group. Both groups received the same anesthetics enlisted in our protocol for liver transplantation. The rVIIa group received a loading dose of 30 ug/kg of rVIIa following the induction of anesthesia, followed by a maintenance dose of 5 ug/kg until the end of the dissection phase. Demographic data, coagulation profile [prothrombin time (PT), prothrombin concentration (PC), partial thromboplastin time (PTT), International normalized ratio (INR)], blood loss, transfusion requirements, the duration of the dissection phase, the duration of surgery, hemoglobin concentration (Hb), and platelet count were done immediately after induction and 1, 2, 3 and 6 hours post induction (dissection phase). Finally, a Doppler assessment of the graft vessels was performed subsequent to anastomosis Results: The rVIIa group had a lower PT in the first two hours of the dissection phase in relation to the baseline and significantly lower than the control group (P = 0.0002). The INR showed a significant improvement in the rVIIa group during the dissection phase compared to the control group, and during the first two hours compared with the baseline in the rVIIa group (P = 0.0002). When compared to the control group, the rVIIa group had a significant increase in the platelet count, in all samples taken during the dissection phase. There was a significant decrease in the intraoperative requirements of packed red blood cells (P = 0.014), platelets (P = 0.0005) and fresh frozen plasma (P = 0.01) in the rVIIa group compared to the control group Discussion: We conclude that administering low dose of rVIIa would be helpful during liver transplantation surgery. Improvement in the coagulation profile, transfusion requirements, and consequently postoperative morbidity and mortality could be achieved. References: Roberts HR, Monroe DM, White GC. The use of recombinant factor VIIa in the treatment of bleeding disorders. Blood 2004;104:3858-3864.
Intravascular volume replacement therapy is an important issue in the perioperative management of... more Intravascular volume replacement therapy is an important issue in the perioperative management of liver transplantation. There is paucity of data on the safety of hydroxyethyl starch (HES) in patients undergoing liver transplantation. We evaluated the safety of a new HES 130/0.4 in the perioperative management of liver transplantation, with a special emphasis on renal function. Forty patients undergoing living donor liver transplantation were prospectively randomized into two groups. Patients in the ALB group (n = 20) received 5% human albumin. Patients in the HES group (n = 20) received third generation HES (6% HES 130/0.4). Total colloid administration was limited to 50 mL x kg(-1) x d(-1). The volume was given to maintain pulmonary artery occlusion pressure or central venous pressure between 5 and 7 mm Hg. If additional fluids were required, balanced crystalloid solution was used. Anesthetic and surgical techniques were standardized. Serum creatinine and cystatin C plasma levels ...
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