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Anesthesia for liver transplant

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https://www.readbyqxmd.com/read/27932181/use-of-terlipressin-in-an-elderly-patient-with-moderate-aortic-valve-stenosis-accompanied-by-episodic-atrial-fibrillation-during-liver-transplantation-a-case-report
#1
Y J Won, B G Lim, D Chung, E Park, H Kim, I O Lee, M H Kong
Anesthesia for patients with moderate aortic stenosis accompanied by atrial fibrillation during high-risk surgery such as liver transplantation remains a challenge in maintaining control of heart rate and maintenance of cardiac output. The action of terlipressin on vasopressin receptors (mainly V1 receptors) leads to splanchnic vasoconstriction and is the key mechanism responsible for increasing systemic vascular resistance and reducing heart rate. We report successful anesthetic management using low-dose terlipressin infusion in an elderly patient who had moderate aortic stenosis with atrial fibrillation during urgent deceased-donor liver transplantation...
November 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27884494/consensus-conference-on-tips-management-techniques-indications-contraindications
#2
Stefano Fagiuoli, Raffaele Bruno, Wilma Debernardi Venon, Filippo Schepis, Francesco Vizzutti, Pierluigi Toniutto, Marco Senzolo, Paolo Caraceni, Francesco Salerno, Paolo Angeli, Roberto Cioni, Alessandro Vitale, Maurizio Grosso, Andrea De Gasperi, Gennaro D'Amico, Alfredo Marzano
The trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty...
October 29, 2016: Digestive and Liver Disease
https://www.readbyqxmd.com/read/27837084/intraoperative-diagnosis-of-intracardiac-thrombus-during-orthotopic-liver-transplantation-with-transesophageal-echocardiography-a-case-series-and-literature-review
#3
Adam A Dalia, Hisham Khan, Antolin S Flores
Anesthesia for orthotopic liver transplantation (OLT) is challenging for any anesthesiologist as the patients undergoing this procedure are among the most critically ill. Adding to the underlying complexity of OLT management is the rare complication of an intracardiac thrombus (ICT). Intracardiac thrombi can present following liver allograft reperfusion resulting in high morbidity and mortality. Currently there is no consensus treatment for ICT, and the gold standard for diagnosis is intraoperative transesophageal echocardiography (TEE); these 2 factors lead to a dangerous amalgam of the difficulty in diagnosing and treating the disease...
November 10, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27833495/postoperative-pain-management-of-liver-transplantation-in-cystic-fibrosis-is-it-time-to-start-us-guided-neuraxial-blocks
#4
M Piazza, G Martucci, A Arcadipane
Cystic fibrosis (CF) is the most common life-limiting genetic disease in Caucasians. Declining lung function is the principal cause of death, but liver involvement can lead to the need for liver transplantation. General anesthesia has detrimental effects on pulmonary function, increasing perioperative morbidity and mortality in CF patients. Regional anesthetic techniques improve outcomes by reducing anesthetic drugs and administration of opioids, and hastening extubation, awakening, and restarting respiratory of physiotherapy...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27788811/effects-of-intraoperative-magnesium-sulfate-administration-on-postoperative-tramadol-requirement-in-liver-transplantation-a-prospective-double-blind-study
#5
B Gucyetmez, H K Atalan, S Aslan, S Yazar, K Y Polat
BACKGROUND: Magnesium is an N-methyl-d-aspartate receptor blocker and is known to have analgesic effect. Hypomagnesemia can often be seen in liver transplantation and may be associated with higher morbidity and mortality. The objective of this study was to investigate the effects of intraoperative magnesium sulfate administration on postoperative tramadol requirement in liver transplant patients. METHODS: Liver transplant patients >18 years of age were screened prospectively from October 2014 to April 2015...
October 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27742300/n-acetylcysteine-use-in-hepatic-ischemia-reperfusion-in-rats-minimizing-bowel-injury
#6
S H Lauz Medeiros, A de Oliveira Menezes, L Zogbi, E Frasson de Souza Montero
BACKGROUND: The ischemia/reperfusion (I/R) phenomenon can cause the dysfunction of some transplanted organs and other distant organs. Liver surgery success, including transplantations, may depend on the adverse effects of intestinal mucosa injury arising from temporary porta triad occlusion. The study objective was to examine I/R liver effects on the small intestine in rats after N-acetylcysteine (NAC) treatment. METHODS: Twenty-four male Wistar rats were randomly divided into 2 groups...
September 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27595164/review-of-remote-ischemic-preconditioning-from-laboratory-studies-to-clinical-trials
#7
Vesa Anttila, Henri Haapanen, Fredrik Yannopoulos, Johanna Herajärvi, Tuomas Anttila, Tatu Juvonen
In remote ischemic preconditioning (RIPC) short periods of non-lethal ischemia followed by reperfusion of tissue or organ prepare remote tissue or organ to resist a subsequent more severe ischemia-reperfusion injury. The signaling mechanism of RIPC can be humoral communication, neuronal stimulation, systemic modification of circulating immune cells, and activation of hypoxia inducible genes. Despite promising evidence from experimental studies, the clinical effects of RIPC have been controversial. Heterogeneity of inclusion and exclusion criteria and confounding factors such as comedication, anesthesia, comorbidities, and other risk factors may have influenced the efficacy of RIPC...
September 20, 2016: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/27492429/effective-evaluation-of-arterial-pulse-waveform-analysis-by-two-dimensional-stroke-volume-variation-stroke-volume-index-plots
#8
Teiji Sawa, Mao Kinoshita, Atsushi Kainuma, Koichi Akiyama, Yoshifumi Naito, Hideya Kato, Fumimasa Amaya, Keiji Shigemi
Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV-SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV-SVI (stroke volume variation index) plot...
August 4, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27466988/anaesthesiological-strategies-to-improve-outcome-in-liver-transplantation-recipients
#9
V Perilli, P Aceto, T Sacco, C Modesti, P Ciocchetti, F Vitale, A Russo, G Fasano, A Dottorelli, L Sollazzi
Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes...
July 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27375806/axillobifemoral-bypass-for-aortitis-syndrome-in-a-living-donor-liver-transplant-patient
#10
Naoto Fukunaga, Kenji Uryuhara, Tadaaki Koyama
A 64-year-old female patient with aortitis syndrome presented with progressive intermittent claudication for 6 months. Her medical history was notable for living-donor liver transplantation for primary biliary cirrhosis 4-years prior and chronic immunosuppressive therapy. Evaluation included normal laboratory examination, and contrast-enhanced computed tomography angiography which demonstrated severely calcified descending aorta with high-grade stenosis below the diaphragm. The patient was treated by axillobifemoral bypass using an 8-mm ringed expanded polytetrafluoroethylene graft under general anesthesia...
2016: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/27375383/intraoperative-effect-of-dexmedetomidine-infusion-during-living-donor-liver-transplantation-a-randomized-control-trial
#11
E Sayed, K A Yassen
BACKGROUND: Dexmedetomidine hydrochloride (Dex) is a useful adjuvant for general anesthesia. The aim was to evaluate the effects of Dex infusion during living donors liver transplantation (LDLT) on the general anesthetic requirements, hemodynamics, oxygen consumption (VO2), and CO2 production (VCO2). MATERIALS AND METHODS: Forty LDLT recipients were allocated randomly to receive either Dex (0.2-0.7 μg/kg/h) or placebo (control [C]). Patient state index (PSI), SEDLine monitored anesthesia depth (25-50) with desflurane (Des) % and fentanyl altered accordingly...
July 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27364362/propofol-attenuated-liver-transplantation-induced-acute-lung-injury-via-connexin43-gap-junction-inhibition
#12
Dongdong Yuan, Guangjie Su, Yue Liu, Xinjin Chi, Jiayu Feng, Qianqian Zhu, Jun Cai, Gangjian Luo, Ziqing Hei
BACKGROUND: Postoperative acute lung injury (ALI) is a severe complication after liver transplantation, which influences patient survival rate obviously. However, its mechanisms are unclear and effective therapies are still lacking. The current study focused on effects of propofol on liver transplantation-induced ALI and whether its underlying mechanism was relative with connexin43 (Cx43) alternation. The authors postulated that endotoxin induced enhancement of Cx43 gap junction (GJ) plays a critical role in mediating post liver transplantation ALI and that pretreatment with the anesthetic propofol, known to inhibit gap junction, can confer effective protection...
2016: Journal of Translational Medicine
https://www.readbyqxmd.com/read/27320559/retrospective-cohort-study-to-compare-anesthesia-in-living-donor%C3%A2-liver-transplantation-recipients-who-received-single-and-dual%C3%A2-liver-grafts
#13
K W Cheng, C W Ma, C L Chen, C H Wang, C J Huang, T H Shih, S C Yang, S E Juang, Y E Lee, Z W Wong, B Jawan, C E Huang, S C Wu
OBJECTIVE: Dual graft living donor liver transplantation (LDLT) is an alternative way to overcome small-for-size syndrome in LDLT. Surgical technique and outcome of using dual grafts have been reported, but there are no reports regarding anesthetic management. The aim of the current study is to compare the anesthetic management of single graft and dual graft liver transplantation. METHODS AND PATIENTS: Anesthesia records of 24 single graft liver transplantation recipients (GI) and 6 dual graft recipients (GII) were reviewed, analyzed, and compared retrospectively...
May 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27320553/preoperative-portal-vein-velocity-size-and-effect-on-living-donor-liver-transplantation-recipient-hemodynamics-during-inferior-vena-cava-clamping
#14
T-H Shih, C-E Huang, Y-E Lee, C-L Chen, C-H Wang, C-J Huang, K-W Cheng, S-C Wu, S-E Juang, B Jawan, S-C Yang
BACKGROUND: The aim of this study is to determine whether preoperative portal vein flow velocity or size has any correlative effect on hemodynamic changes during clamping of the inferior vena cava in liver transplantation. PATIENTS AND METHODS: A total of 42 anesthesia charts of adult patients who underwent living donor liver transplantation (LDLT) were analyzed and compared retrospectively. Preoperative portal vein (PV) flow velocity and sizes were obtained using Doppler ultrasound...
May 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27320547/predictive-risk-factors-in-the-development-of-intraoperative-hyperkalemia-in-adult-living-donor-liver-transplantation
#15
S-E Juang, C-E Huang, C-L Chen, C-H Wang, C-J Huang, K-W Cheng, S-C Wu, T-H Shih, S-C Yang, Z-W Wong, B Jawan, Y-E Lee
BACKGROUND: Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT). METHODS AND PATIENTS: Four hundred eighty-seven adult LDLT patients were included in the study...
May 2016: Transplantation Proceedings
https://www.readbyqxmd.com/read/27285002/anesthetic-considerations-for-the-parturient-after-solid-organ-transplantation
#16
Daria M Moaveni, Jennifer H Cohn, Katherine G Hoctor, Ryan E Longman, J Sudharma Ranasinghe
Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents...
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27221384/perioperative-management-of-living-donor-liver-transplantation-for-methylmalonic-acidemia
#17
Chiaki Baba, Mureo Kasahara, Yasuhiro Kogure, Shugo Kasuya, Sukeyuki Ito, Takako Tamura, Akinari Fukuda, Reiko Horikawa, Yasuyuki Suzuki
Methymalonic acidemia (MMA) is a hereditary metabolic disorder characterized by a defect of the methylmalonyl-CoA mutase that breaks down propionate. The efficacy of liver transplantation for MMA was recently reported. However, the anesthetic management of liver transplant for MMA is not clear. The aim of this article is to describe an anesthetic management algorithm of liver transplant for MMA by reviewing our cases of liver transplant for MMA. Fourteen patients received a liver transplant; three cases showed metabolic decompensation during the transplant and two of the patients died...
July 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27129535/donor-derived-tuberculosis-in-an-anesthetist-after-short-term-exposure-an-old-demon-transplanted-from-the-past-to-the-present
#18
I Freytag, J Bucher, M Schoenberg, M Stangl, G Schelling
We report a case of a 27-year-old anesthetist who acquired tuberculosis (TB) while performing general anesthesia in a renal transplant (RTX) patient who had donor-derived contagious TB. The anesthetist developed pleural TB 6 months after exposure. Contact investigations (CIs) did not include health care workers (HCWs) of the Department of Anesthesiology, thereby missing the opportunity for the early diagnosis and treatment of TB. Genomic fingerprinting revealed identical Mycobacterium tuberculosis (MT) isolates in the anesthetist and in the RTX patient...
May 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27126572/anesthetic-management-of-a-pediatric-patient-with-pulmonary-arteriovenous-fistula-undergoing-liver-transplantation-a-case-report
#19
Ho-Jin Lee, Jung-Man Lee, Chul-Woo Jung, Jiwon Lee
For patients with HPS who require anesthesia for a procedure, HPV should be maintained to prevent worsening hypoxemia. Here, the case of a 9-yr-old girl who was scheduled for a living donor liver transplantation is presented. The patient suffered from end-stage liver disease with HPS due to biliary atresia, which contributed to the development of a diffuse pulmonary AVF. Consequently, anesthetic management of this patient involved two different types of pulmonary shunt. It is important to maintain HPV, not only to prevent worsening of the hypoxia caused by HPS but also to inhibit an increase in PVR that could cause an increase of shunt flow through the pathological fistula...
August 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/27005827/-chronic-hepatothorax-due-to-right-diaphragmatic-rupture-an-anesthetic-challenge-in-a-rare-case
#20
Maria Teresa Rincón Vieira Lugarinho-Monteiro, Luciane Pereira, Carlos Seco
BACKGROUND: Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. CASE REPORT: We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia, resulting from a car accident when she was 8 years old...
March 19, 2016: Revista Brasileira de Anestesiologia
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