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epidural surgery liver

Michael C Grant, Philip M Sommer, Cathy He, Sylvia Li, Andrew J Page, Alexander B Stone, Deborah Hobson, Elizabeth Wick, Christopher L Wu
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways are designed to restore baseline physiology, mitigate surgical stressors, and hasten recovery. Paramount to this approach is optimal pain control through multimodal analgesia and limiting reliance on opioid-based medications. Recent studies have fostered growing controversy surrounding the use of epidural analgesia in the ERAS setting, especially for higher-risk procedures. We examine the analgesic end points associated with the use of epidural within the ERAS framework for open hepatectomy...
July 2017: Regional Anesthesia and Pain Medicine
Shamil D Cooray, Duncan J Topliss
SUMMARY: A 58-year-old man with metastatic radioiodine-refractory differentiated thyroid cancer (DTC) presented with left thigh and right flank numbness. He had known progressive and widespread bony metastases, for which he received palliative radiotherapy, and multiple bilateral asymptomatic pulmonary metastases. CT scan and MRI of the spine revealed metastases at right T10-L1 vertebrae with extension into the central canal and epidural disease at T10 and T11 causing cord displacement and canal stenosis but retention of spinal cord signal...
2017: Endocrinology, Diabetes & Metabolism Case Reports
Eliza W Beal, Curtis Dumond, Jung-Lye Kim, Khalid Mumtaz, Don Hayes, Ken Washburn, Bryan A Whitson, Sylvester M Black
Major hepatic surgery with inflow occlusion, and liver transplantation, necessitate a period of warm ischemia, and a period of reperfusion leading to ischemia/reperfusion (I/R) injury with myriad negative consequences. Potential I/R injury in marginal organs destined for liver transplantation contributes to the current donor shortage secondary to a decreased organ utilization rate. A significant need exists to explore hepatic I/R injury in order to mediate its impact on graft function in transplantation. Rat liver hilar clamp models are used to investigate the impact of different molecules on hepatic I/R injury...
April 2, 2017: Journal of Visualized Experiments: JoVE
Sung-Soo Kim, Dong-Ju Lim
INTRODUCTION: Epidural lipomatosis of the lumbar spine is a rare condition, which is described as the accumulation of fat in the extradural territory. PRESENTATION OF CASE: We report the case of a 60-year-old, non-obese, and chronic alcoholic man who was transferred to our spine department with cauda equina syndrome (CES) for 4 months. On magnetic resonance imaging (MRI), spinal epidural lipomatosis (SEL) was confirmed in the multilevel lumbar lesion. A decompression surgery was performed and the patient recovered significantly...
February 20, 2017: International Journal of Surgery Case Reports
Shelby Allen, Amy DeRoche, Lu Adams, Karen Valerie Slocum, Clancy J Clark, Nora F Fino, Perry Shen
BACKGROUND: Epidural analgesia is routinely used for postoperative pain control following abdominal surgeries, yet data regarding the safety and efficacy of epidural analgesia is controversial. METHODS: Pain-related and clinical perioperative data were extracted and correlated with baseline clinicopathologic data and method of analgesia (epidural vs. intravenous patient-controlled analgesia) in patients who underwent hepatectomy from 2012 to 2014. Chronic pain was defined by specific narcotic requirements preoperatively...
March 2017: Journal of Surgical Oncology
Y Xu, Y Sun, H Chen, Y Wang, G N Wang
This study aims to investigate the effects of epidural block in combination with general anesthesia and general anesthesia alone on the immune function of patients undergoing primary liver cancer resection. Twenty-four patients with liver cancer who received treatment in the Third Hospital of Harbin Medical University, Heilongjiang, China, were enrolled and randomly allocated into group A and group B, with 12 in each group. The data on the T lymphocyte subpopulation, pro-inflammatory cytokines and antiinflammatory cytokines were recorded before, immediately after and 24 h after liver cancer resection to compare differences and changes...
October 2016: Journal of Biological Regulators and Homeostatic Agents
Faisal Al-Alem, Rafif Essam Mattar, Ola Abdelmonem Fadl, Abdulsalam Alsharabi, Faisal Al-Saif, Mazen Hassanain
BACKGROUND: Hepatic resection is a major surgical procedure. Data on outcomes of hepatectomy in Saudi Arabia are scarce. OBJECTIVE: To measure morbidity and mortality and assess predictors of outcome after hepatectomy. DESIGN: Descriptive study. SETTING: Tertiary care center in Saudi Arabia with well established hepatobiliary surgery unit. PATIENTS AND METHODS: All patients undergoing liver resection in our institute during 2006-2014...
November 2016: Annals of Saudi Medicine
Sara Dichtwald, Menahem Ben-Haim, Laila Papismedov, Shoshana Hazan, Anat Cattan, Idit Matot
PURPOSE: Inadequate analgesia following abdominal surgery may affect outcome. Data in patients undergoing liver surgery suggested that postoperative coagulopathy might delay epidural catheter removal. Thus, alternative analgesic techniques should be evaluated. METHODS: We compared the analgesic efficacy of intraoperative intrathecal morphine [single injection 4 µg/kg before skin incision (ITM group, n = 23)] to intravenous opioids [iv remifentanil infusion during surgery followed by i...
April 2017: Journal of Anesthesia
Emmanuel Melloul, Martin Hübner, Michael Scott, Chris Snowden, James Prentis, Cornelis H C Dejong, O James Garden, Olivier Farges, Norihiro Kokudo, Jean-Nicolas Vauthey, Pierre-Alain Clavien, Nicolas Demartines
BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. METHODS: A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline...
October 2016: World Journal of Surgery
V S Yip, D F J Dunne, S Samuels, C Y Tan, C Lacasia, J Tang, C Burston, H Z Malik, G J Poston, S W Fenwick
BACKGROUND: Enhanced Recovery After Surgery (ERAS) has been proven effective in liver surgery. Adherence to the ERAS pathway is variable. This study seeks to evaluate adherence to key components of an ERAS protocol in liver resection, and identify the components associated with successful clinical outcomes. METHOD: All patients undergoing liver resections for two consecutive years were included in our ERAS pathway. Six key components of ERAS included preoperative assessment, nutrition and gastrointestinal function, postoperative analgesia, mobilisation and discharges...
October 2016: European Journal of Surgical Oncology
B Błaszczyk, B Wrońska, M Klukowski, E Flakiewicz, M Kołacz, L Jureczko, M Pacholczyk, A Chmura, J Trzebicki
BACKGROUND: Early extubation is a standard procedure after liver transplantation (LT). METHODS: The preoperative and perioperative data of 506 adult patients undergoing LT from July 2000 to March 2015 were analyzed. The goal of this study was to determine preoperative and perioperative independent predictors of early tracheal extubation. RESULTS: Of the 506 study patients, 73.7% were extubated early after LT. Patients in this group exhibited better preoperative and perioperative outcomes...
June 2016: Transplantation Proceedings
Juhong Ran, Yanping Wang, Fangkun Li, Wei Zhang, Minyu Ma
The objective of this study was to study the pharmacodynamics and pharmacokinetics of levobupivacaine used for epidural anesthesia in patients with liver dysfunction. Twenty patients aged 20-60, American Society of Anesthesiologists (ASA) graded I-III according to the ASA guidelines, scheduled for elective upper abdominal surgery, were included in the study. They were divided into two groups of ten each. In group I, the patients with liver dysfunction were included, whereas group II was composed of those with normal liver function...
December 2015: Cell Biochemistry and Biophysics
X T Wang, M Lv, H Y Guo
This study discusses the changes of T helper cells (Th cells) of patients who received different anesthesia methods in liver cancer resection. We selected 122 patients who were diagnosed with hepatocellular carcinoma and underwent liver cancer resection and divided them into a general anesthesia combined with epidural anesthesia group (group A) and general anesthesia group (group B). Peripheral blood was collected to detect Th cells on the day of surgery, and on the second and seventh days after surgery. Th1 and Th2 cell frequency and mRNA expression of interferon-γ (IFN-γ) of all patients significantly rose on the second day but recovered to the previous level on the seventh day...
January 2016: Journal of Biological Regulators and Homeostatic Agents
Aparna Dalal
Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation...
April 2016: Transplantation Reviews
Senthil Ganapathi, Gemma Roberts, Susan Mogford, Barbara Bahlmann, Bazil Ateleanu, Nagappan Kumar
BACKGROUND: Epidural analgesia has been the reference standard for the provision of post-operative pain relief in patients recovering from major upper abdominal operations, including liver resections. However, a failure rate of 20-32% has been reported. AIM: The aim of the study was to analyse the success rates of epidural analgesia and the outcome in patients who underwent liver surgery. METHODS: We collected data from a prospectively maintained database of 70 patients who underwent open liver surgery by a bilateral subcostal incision during a period of 20 months (February 2009 to September 2010)...
May 2015: British Journal of Pain
Giuseppe Zimmitti, Jose Soliz, Thomas A Aloia, Vijaya Gottumukkala, Juan P Cata, Ching-Wei D Tzeng, Jean-Nicolas Vauthey
INTRODUCTION: Previous studies have suggested that the use of regional anesthesia can reduce recurrence risk after oncologic surgery. The purpose of this study was to assess the effect of epidural anesthesia on recurrence-free (RFS) and overall survival (OS) after hepatic resection for colorectal liver metastases (CLM). METHODS: After approval of the institutional review board, the records of all adult patients who underwent elective hepatic resection between January 2006 and October 2011 were retrospectively reviewed...
March 2016: Annals of Surgical Oncology
M J Hughes, E M Harrison, N J Peel, B Stutchfield, S McNally, C Beattie, S J Wigmore
BACKGROUND: Analgesia after liver surgery remains controversial. A previous randomized trial of continuous wound infiltration (CWI) versus thoracic epidural analgesia (TEA) after liver surgery (LIVER trial) showed a faster recovery time in the wound infiltration group but better early postoperative pain scores in the TEA group. High-level evidence is, however, limited and opinion remains divided. The aim was to determine whether there is a difference in functional recovery time between patients having CWI plus abdominal nerve blocks versus TEA after liver resection...
December 2015: British Journal of Surgery
Yumiko Kohno, Keiko Koishi, Tomoki Nishiyama
Malignant hyperthermia occurred 10 hours after surgery in a 72-year-old man who had received emergency laparoscopic cholecystectomy for severe acute cholecystitis with cholelethiasis. He had a high fever (39.4 degrees C) with liver damage before surgery. Anesthesia was induced with propofol and fentanyl and maintained with sevoflurane and epidural block using ropivacaine. Rocuronium was used as a muscle relaxant During surgery, body temperature decreased by cooling the body surface, but tachycardia continued...
June 2015: Masui. the Japanese Journal of Anesthesiology
S T Karna, C K Pandey, S Sharma, A Singh, M Tandon, V K Pandey
BACKGROUND: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. MATERIALS AND METHODS: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted...
July 2015: Journal of Postgraduate Medicine
H Sayan, M S Aydogan, M Bıcakcıoğlu, H I Toprak, B Isık, S Yılmaz
BACKGROUND: Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Our aim in this study was to compare thoracic epidural anesthesia and general anesthesia effects on liver blood flow by means of liver function tests and indocyanine green and compared with living-donor liver transplantation. METHODS: Subjects were divided into 2 equal groups: the control group (group I) and the epidural block group (group II, closed envelope method)...
June 2015: Transplantation Proceedings
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