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Anesthesia for liver transplant

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https://www.readbyqxmd.com/read/29764373/a-subclinical-high-tricuspid-regurgitation-pressure-gradient-independent-of-the-mean-pulmonary-artery-pressure-is-a-risk-factor-for-the-survival-after-living-donor-liver-transplantation
#1
Yosuke Saragai, Akinobu Takaki, Yuzo Umeda, Takashi Matsusaki, Tetsuya Yasunaka, Atsushi Oyama, Ryuji Kaku, Kazufumi Nakamura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Kosei Takagi, Takuya Adachi, Nozomu Wada, Yasuto Takeuchi, Kazuko Koike, Fusao Ikeda, Hideki Onishi, Hidenori Shiraha, Shinichiro Nakamura, Hiroshi Morimatsu, Hiroshi Ito, Toshiyoshi Fujiwara, Takahito Yagi, Hiroyuki Okada
BACKGROUND: Portopulmonary hypertension (POPH) is characterized by pulmonary vasoconstriction, while hepatopulmonary syndrome (HPS) is characterized by vasodilation. Definite POPH is a risk factor for the survival after orthotopic liver transplantation (OLT), as the congestive pressure affects the grafted liver, while subclinical pulmonary hypertension (PH) has been acknowledged as a non-risk factor for deceased donor OLT. Given that PH measurement requires cardiac catheterization, the tricuspid regurgitation pressure gradient (TRPG) measured by echocardiography is used to screen for PH and congestive pressure to the liver...
May 15, 2018: BMC Gastroenterology
https://www.readbyqxmd.com/read/29725794/cardiac-output-measurement-in-liver-transplantation-patients-using-pulmonary-and-transpulmonary-thermodilution-a-comparative-study
#2
Luigi Vetrugno, Elena Bignami, Federico Barbariol, Nicola Langiano, Francesco De Lorenzo, Carola Matellon, Giuseppe Menegoz, Giorgio Della Rocca
During liver transplantation surgery, the pulmonary artery catheter-despite its invasiveness-remains the gold standard for measuring cardiac output. However, the new EV1000 transpulmonary thermodilution calibration technique was recently introduced into the market by Edwards LifeSciences. We designed a single-center prospective observational study to determine if these two techniques for measuring cardiac output are interchangeable in this group of patients. Patients were monitored with both pulmonary artery catheter and the EV1000 system...
May 3, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29699477/effects-of-bacterial-translocation-on-hemodynamic-and-coagulation-parameters-during-living-donor-liver-transplant
#3
Heba A Moharem, Fawzia Aboul Fetouh, Hamed M Darwish, Doaa Ghaith, Mohamed Elayashy, Amr Hussein, Riham Elsayed, Mohammad M Khalil, Amr Abdelaal, Mahmoud ElMeteini, Ahmed Mukhtar
BACKGROUND: Bacterial translocation (BT) has been proposed as a trigger for stimulation of the immune system with consequent hemodynamic alteration in patients with liver cirrhosis. However, no information is available regarding its hemodynamic and coagulation consequences during liver transplantation. METHODS: We screened 30 consecutive adult patients undergoing living-donor liver transplant for the presence of BT. Bacterial DNA, Anti factor Xa (aFXa), thromboelastometry, tumor necrosis factor-α TNF-α, and interleukin-17 (IL-17) values were measured in sera before induction of anesthesia...
April 25, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29690758/hyperthermia-associated-with-biliary-obstruction-during-living-donor-liver-transplantation
#4
Hyeryung Kang, Joohyun Park, Jeong Jin Lee, Gaab-Soo Kim
Intraoperative hypothermia occurs frequently, but hyperthermia is relatively rare during general anesthesia. We experienced a case of hyperthermia during living donor liver transplantation that appeared to be significantly associated with biliary obstruction. A 65-year-old male patient was diagnosed with intrahepatic cholangiocarcinoma, and living donor liver transplantation was planned after confirmation of no metastasis via intraoperative frozen biopsy. Following resection of a segment of common bile duct for frozen biopsy, the surgeon clamped the common bile duct, and the patient's body temperature increased gradually to 39...
April 25, 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29661451/ischemia-with-preconditioning-in-wistar-rats-maintains-mitochondrial-respiration-even-with-mild-hepatocellular-disturbance
#5
R R Tártaro, G L Jorge, A H Dianin, C A F Escanhoela, I F S F Boin
INTRODUCTION: In hepatectomy or liver transplantation, preconditioning is a procedure indicated to protect the organ from ischemia-reperfusion injury (I-R). OBJECTIVE: Evaluate the effect of preconditioning after hepatic I-R in Wistar rats, through mitochondrial respiration, liver histology, and profile. METHOD: Twenty male Wistar rats, weighing on average 307.1 g, were anesthetized with sodium thiopental (25 mg/kg) intravenously and xylazine hydrochloride (30 mg/kg) intramuscularly...
April 2018: Transplantation Proceedings
https://www.readbyqxmd.com/read/29630119/intramuscular-islet-allotransplantation-in-type-1-diabetes-mellitus
#6
F Bertuzzi, G Colussi, A Lauterio, L De Carlis
OBJECTIVE: Alternative sites to the liver for islet transplantation have been studied for a long time. Intramuscular islet transplantation appears to be an alternative site to the liver because of the ease of access. First islet autotransplantations were reported in patients after total pancreatectomies. The transplanted islets showed a proper revascularization and their function was observed for up to 2 years after the implant. However, only a few cases of autotransplantation and no allotransplantation have been performed...
March 2018: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29538210/comparison-of-postoperative-coagulation-profiles-and-outcome-for-sugammadex-versus-pyridostigmine-in-992-living-donors-after-living-donor-hepatectomy
#7
Young-Jin Moon, Sung-Hoon Kim, Jae-Won Kim, Yoon-Kyung Lee, In-Gu Jun, Gyu-Sam Hwang
Donor safety is the major concern in living donor liver transplantation, although hepatic resection may be associated with postoperative coagulopathy. Recently, the use of sugammadex has been gradually increased, but sugammadex is known to prolong prothrombin time (PT) and activated partial thromboplastin time (aPTT). We compared the postoperative coagulation profiles and outcomes of sugammadex versus pyridostigmine group in donors receiving living donor hepatectomy.Consecutive donor hepatectomy performed between September 2013 and August 2016 was retrospectively analyzed...
March 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29488444/rapid-recovery-of-liver-transplantation-recipients-by-implementation-of-fast-track-care-steps-what-is-holding-us-back
#8
Gianni Biancofiore, Dana Rodica Tomescu, M Susan Mandell
A body of scientific studies has shown that early extubation is safe and cost-effective in a large number of liver transplant (LT) recipients including pediatric patients. However, fast-track practices are not universally accepted, and debate still lingers about whether these interventions are safe and serve the patients' best interest. In this article, we focus on reasons why physicians still have a persistent, although diminishing, reluctance to adopt fast-track protocols. We stress the importance of collection/analysis of perioperative data, adoption of a consensus-based standardized protocol for perioperative care, and formation of LT anesthesia focused teams and leadership...
June 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29475213/modified-multivisceral-transplantation-with-native-spleen-removal-in-rats
#9
Pablo Stringa, Nidia Monserrat Arreola, Ane M Andres Moreno, Carlota Largo, Martín Rumbo, Francisco Hernandez
BACKGROUND:  Modified multivisceral transplantation (MMVTx) refers to the use of a graft that includes all abdominal organs except the liver. The use of this type of transplant in children and adults expanded over the last years with good results. However, long-term survival in experimental models has not been reported. Our aim is to describe in detail some technical modifications of MMVTx to obtain long-term survival. MATERIALS AND METHODS:  Syngeneic (Lewis-Lewis) heterotopic MMVTx was performed in 16 male rats (180-250 g)...
February 23, 2018: European Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29424263/intraoperative-transesophageal-echocardiogram-during-orthotopic-liver-transplantation-tee-to-the-rescue
#10
Lorenzo De Marchi, Janice Lee, Nina Rawtani, Vinh Nguyen
Supported by a growing number of studies and case reports in the literature, perioperative use of TEE in non-cardiac cases has significantly increased the past two decades. The utility of TEE in monitoring hemodynamic, and diagnosing causes of hypotension refractory to conventional therapy, have made it an almost indispensible tool during major surgeries, such liver transplantation. Despite this fact, compared to the adult population, there is a lack of an equivalent amount of literature on the perioperative use of TEE in pediatric cases...
June 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29423554/performance-of-a-second-generation-pulmonary-capnotracking-system-for-continuous-monitoring-of-cardiac-output
#11
Philip J Peyton, Monique Kozub
Technologies for minimally-invasive cardiac output measurement in patients during surgery remain little used in routine practice. We tested a redeveloped system based on CO2 elimination (VCO2 ) by the lungs for use in ventilated patients, which can be seamlessly integrated into a modern anesthesia/monitoring platform, and provides automated, continuous breath-by-breath cardiac output monitoring. A prototype measurement system was constructed to measure VCO2 and end-tidal CO2 concentration with each breath. A baseline measurement of non-shunt cardiac output was made during a brief oscillating change in ventilator rate, according to the differential CO2 Fick approach and repeated at 5-10 min intervals...
February 8, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29400258/noteworthy-literature-published-in-2017-for-abdominal-organ-transplantation
#12
Jeron Zerillo, Natalie K Smith, Tetsuro Sakai
In 2017, we identified more than 400 peer reviewed publications on the topic of pancreas transplantation, more than 500 on intestinal transplantation, more than 4000 on renal transplantation, and more than 4700 on liver transplantation. This annual review highlights the most pertinent literature for anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We explore a wide range of topics, including risk for and prediction of perioperative complications, recommendations on perioperative management, economic analyses, and education of the trainees in abdominal transplantation anesthesia and critical care...
March 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29303422/use-training-and-opinions-about-effectiveness-of-transesophageal-echocardiography-in-adult-liver-transplantation-among-anesthesiologists-in-the-united-states
#13
Jeron Zerillo, Bryan Hill, Sang Kim, Samuel DeMaria, M Susan Mandell
STUDY OBJECTIVE: Describe transesophageal echocardiography (TEE) use, preparatory training and opinions about clinical importance, and future training pathways in a sample of liver transplant anesthesiologists. DESIGN: Online survey questionnaire. SETTING: Liver Transplant Centers in the United States. PARTICIPANTS: Director of Liver Transplant Anesthesia or designated alternate respondent. RESULTS: A total of 79 Directors or alternates from 111 (71%) centers were identified...
June 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29235211/pretransplant-serum-procalcitonin-level-for-prediction-of-early-post-transplant-sepsis-in-living-donor-liver-transplantation
#14
Takanobu Hara, Akihiko Soyama, Masaaki Hidaka, Koji Natsuda, Tomohiko Adachi, Shinichiro Ono, Satomi Okada, Takashi Hamada, Mitsuhisa Takatsuki, Susumu Eguchi
AIM: Infection is a frequent cause of in-hospital mortality after liver transplantation (LT). Elimination of possible risks in the pretransplant period, early diagnosis of post-transplant sepsis, and prompt treatment with antimicrobial agents are important. The objectives of this study were to analyze the impact of early post-transplant sepsis on outcomes and to clarify the value of predictive factors for early post-transplant sepsis. METHODS: The study included 136 patients who underwent initial living donor LT (LDLT) at our institute between April 2009 and December 2016...
December 13, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/29229261/preliminary-experience-in-combined-somatic-and-cerebral-oximetry-monitoring-in-liver-transplantation
#15
Tina Hu, Yves Collin, Réal Lapointe, François Martin Carrier, Luc Massicotte, Annik Fortier, Jean Lambert, Franck Vandenbroucke-Menu, André Y Denault
OBJECTIVE: The use of cerebral near-infrared spectroscopy (NIRS) has become widespread in cardiac surgery after research demonstrated an association between perioperative cerebral desaturations and postoperative complications. Somatic NIRS desaturation also is associated with an increased risk of postoperative complications and mortality. The objective of this study was to explore the trends of both somatic and cerebral NIRS during liver transplantation. DESIGN: A prospective, single-site, observational case series...
February 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29045240/prediction-of-thromboembolic-complications-after-liver-resection-for-cholangiocarcinoma-is-there-a-place-for-thromboelastometry
#16
Annabel Blasi, Victor Molina, Santiago Sanchez-Cabús, Jaume Balust, J Carlos Garcia-Valdecasas, Pilar Taura
: Postoperative venous thromboembolism has a poor prognosis in patients with cancer. We aimed to investigate the utility of thromboelastometry in detecting the risk of postoperative venous thromboembolism in patients with cholangiocarcinoma. We prospectively included patients submitted to liver resection for cholangiocarcinoma at our hospital between May 2011 and July 2014. Patients undergoing major hepatectomy for adult living donor transplantation in the same time period served as a control group. Thromboelastometry was performed before anesthesia...
January 2018: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29029588/society-for-the-advancement-of-transplant-anesthesia-liver-transplant-anesthesia-fellowship-white-paper-advocating-measurable-proficiency-in-transplant-specialties-training
#17
Ryan M Chadha, Cara Crouch, Jeron Zerillo, Ernesto A Pretto, Raymond Planinsic, Sang Kim, Ramona Nicolau-Raducu, Dieter Adelmann, Elia Elia, Christopher L Wray, Coimbatore Srinivas, M Susan Mandell
The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology, and not all anesthesia residency programs are associated with transplant centers...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28868984/the-new-kidney-donor-allocation-system-and-implications-for-anesthesiologists
#18
Srikanth Sridhar, Sara Guzman-Reyes, Sam D Gumbert, Semhar J Ghebremichael, Angelina R Edwards, Mark J Hobeika, Wasim A Dar, Evan G Pivalizza
Given potential disparity and limited allocation of deceased donor kidneys for transplantation, a new federal kidney allocation system was implemented in 2014. Donor organ function and estimated recipient survival in this system has implications for perioperative management of kidney transplant recipients. Early analysis suggests that many of the anticipated goals are being attained. For anesthesiologists, implications of increased dialysis duration and burdens of end-stage renal disease include increased cardiopulmonary disease, challenging fluid, hemodynamic management, and central vein access...
September 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28858130/effect-of-bispectral-index-guided-anesthesia-on-consumption-of-anesthetics-and-early-postoperative-cognitive-dysfunction-after-liver-transplantation-an-observational-study
#19
Ying-Hao Cao, Ping Chi, Yan-Xing Zhao, Xi-Chen Dong
The objective of this study was to summarize the incidence of postoperative cognitive dysfunction (POCD) after 7days following liver transplantation (LT), and to evaluate the effectiveness of bispectral index (BIS) guided anesthetic intervention in reducing POCD. Additional serum concentrations of S100β and neuron-specific enolase (NSE) were detected during surgery to determine whether they were reliable predictors of POCD.Patients who underwent LT at Beijing YouAn Hospital Affiliated to Capital University of Medical Science from January 2014 to December 2015 were enrolled...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28833618/intra-operative-predictors-of-postoperative-takotsubo-syndrome-in-liver-transplant-recipients-an-exploratory-case-control-study
#20
Stephen Aniskevich, Ryan M Chadha, Prith Peiris, Cemal Burcin Taner, Klaus L Torp, Colleen S Thomas, Maria L Yataco, Sher-Lu Pai
INTRODUCTION: Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy or stress-induced cardiomyopathy, has been described following a variety of surgeries and disease states. The relationship between intra-operative anesthesia management and the development of this syndrome has never been fully elucidated. OBJECTIVES: The primary objective of this study was to determine the relationship of multiple intra-operative factors on the pathogenesis of TTS. METHODS: A single-center retrospective review of all liver transplants performed at Mayo Clinic Florida from January 2005 to December 2014...
November 2017: Clinical Transplantation
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