scholarly journals Anesthetic Considerations in Hepatectomies under Hepatic Vascular Control

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Aliki Tympa ◽  
Kassiani Theodoraki ◽  
Athanassia Tsaroucha ◽  
Nikolaos Arkadopoulos ◽  
Ioannis Vassiliou ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Ischemia Reperfusion ◽  
Anesthetic Management ◽  
Vascular Occlusion ◽  
Air Embolism ◽  
Preoperative Assessment ◽  
Mortality Rates ◽  
Vascular Control ◽  
Hemodynamic Management ◽  
Anesthetic Considerations

Background. Hazards of liver surgery have been attenuated by the evolution in methods of hepatic vascular control and the anesthetic management. In this paper, the anesthetic considerations during hepatic vascular occlusion techniques were reviewed. Methods. A Medline literature search using the terms “anesthetic,” “anesthesia,” “liver,” “hepatectomy,” “inflow,” “outflow occlusion,” “Pringle,” “hemodynamic,” “air embolism,” “blood loss,” “transfusion,” “ischemia-reperfusion,” “preconditioning,” was performed. Results. Task-orientated anesthetic management, according to the performed method of hepatic vascular occlusion, ameliorates the surgical outcome and improves the morbidity and mortality rates, following liver surgery. Conclusions. Hepatic vascular occlusion techniques share common anesthetic considerations in terms of preoperative assessment, monitoring, induction, and maintenance of anesthesia. On the other hand, the hemodynamic management, the prevention of vascular air embolism, blood transfusion, and liver injury are plausible when the anesthetic plan is scheduled according to the method of hepatic vascular occlusion performed.

Abstract P237: Is Ischemia/Reperfusion an Efficient Method for Producing Heart Failure in Rats?

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Ana Carolina M Omoto ◽  
Fábio N Gava ◽  
Mauro de Oliveira ◽  
Carlos A Silva ◽  
Rubens Fazan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Pressure ◽  
Histopathological Examination ◽  
Ischemia Reperfusion ◽  
Mitral Annulus ◽  
Mortality Rates ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Artery Ligation

Myocardium infarction (MI) elicited by coronary artery ligation (CAL) is commonly used to induce chronic heart failure (HF) in rats. However, CAL shows high mortality rates. Given that ischemia-reperfusion (IR) may cause the development of HF, this approach may be useful for obtaining a model of HF with low mortality rates. Therefore, it was compared the model of CAL vs. IR in rats, evaluating the mortality and cardiac morphological and functional aspects. The IR consisted of 30 minutes of cardiac ischemia. Wistar rats were assigned into three groups: CAL: n=18; IR: n=7; SHAM (fictitious IR): n=7. After four weeks of CAL, the subjects were evaluated by echocardiography and ventriculography as well. The statistical analysis consisted of ANOVA combined with Tukey’s posthoc test (p<0.05). There were no deaths in the IR and SHAM groups, whereas in the CAL group the mortality rate was 33.33% (6 out of 18). In the CAL group echocardiography showed increased left ventricular (LV) cavity during systole (8.3 ± 1mm) and diastole (10.5 ± 1mm); decreased LV free wall during systole (1.4 ± 0.5 mm); increased left atrium/aorta (2.3 ± 0.4) ratio. These changes were not significant in IR (4.8 ± 0.5mm, 7.6 ± 0.6mm, 2.6 ± 0.3 mm, 1.6 ± 0.2) and SHAM (4.6 ± 0.6 mm, 7.7 ± 0.8mm, 2.8 ± 0.4mm, 1.5 ± 0.2) groups. There was also the reduction in the ejection fraction in the CAL group (41 ± 12 %) when compared with IR (65 ± 9%) and SHAM (69 ± 7%) groups. The tissue Doppler analysis from the lateral mitral annulus showed reduction in E′ in CAL (-29 ± 8 mm/s) and IR (-31± 9 mm/s) groups when compared with the SHAM (-48 ± 11 mm/s) group. The ventriculography in the CAL group showed smaller maximum dP/dt (6519 ± 1062) and greater end-diastolic pressure (33 ± 8 mmHg) when compared with IR (8716 ± 756 mmHg/s; 9 ± 9 mmHg) and SHAM (7989 ± 1230 mmHg/s; 9 ± 7 mmHg) groups. The CAL group presented transmural infarct size of 40% of the left ventricular wall, measured under histopathological examination. In conclusion, IR for 30 minutes caused only small changes in LV diastolic function, assessed by tissue Doppler; however, the IR was not effective for promoting HF, as observed with CAL. Thus, it is possible that prolonged IR is necessary for promoting significant HF in rats.

scholarly journals Mitogen Activated Protein Kinases in Steatotic and Non-Steatotic Livers Submitted to Ischemia-Reperfusion

2019 ◽  
Vol 20 (7) ◽  
pp. 1785 ◽  
Author(s):  
Jiménez-Castro ◽  
Cornide-Petronio ◽  
Gracia-Sancho ◽  
Casillas-Ramírez ◽  
Peralta
Keyword(s):  
Risk Factor ◽  
Clinical Practice ◽  
Protein Kinases ◽  
Hepatic Steatosis ◽  
Ischemic Preconditioning ◽  
Liver Surgery ◽  
Clinical Studies ◽  
Ischemia Reperfusion ◽  
Mitogen Activated Protein Kinases ◽  
Mitogen Activated Protein

: We analyzed the participation of mitogen-activated protein kinases (MAPKs), namely p38, JNK and ERK 1/2 in steatotic and non-steatotic livers undergoing ischemia-reperfusion (I-R), an unresolved problem in clinical practice. Hepatic steatosis is a major risk factor in liver surgery because these types of liver tolerate poorly to I-R injury. Also, a further increase in the prevalence of steatosis in liver surgery is to be expected. The possible therapies based on MAPK regulation aimed at reducing hepatic I-R injury will be discussed. Moreover, we reviewed the relevance of MAPK in ischemic preconditioning (PC) and evaluated whether MAPK regulators could mimic its benefits. Clinical studies indicated that this surgical strategy could be appropriate for liver surgery in both steatotic and non-steatotic livers undergoing I-R. The data presented herein suggest that further investigations are required to elucidate more extensively the mechanisms by which these kinases work in hepatic I-R. Also, further researchers based in the development of drugs that regulate MAPKs selectively are required before such approaches can be translated into clinical liver surgery.

Management and Anesthetic Considerations for Patients With Anomalous Aortic Origin of a Coronary Artery

2018 ◽  
Vol 22 (4) ◽  
pp. 383-394 ◽  
Author(s):  
Benjamin Kloesel ◽  
Martina Richtsfeld ◽  
Mojca Konia ◽  
John L. Bass
Keyword(s):  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Arteries ◽  
Anesthetic Management ◽  
Heterogeneous Group ◽  
Coronary Anomalies ◽  
Disease Group ◽  
Coronary Artery Anomalies ◽  
Fatal Disease ◽  
Anesthetic Considerations

The term “coronary artery anomalies” encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.

Transsphenoidal/Pituitary Surgery

2018 ◽  
Author(s):  
Vaia T. Abatzis ◽  
Edward C. Nemergut
Keyword(s):  
Pituitary Gland ◽  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
Pituitary Surgery ◽  
Anesthetic Care ◽  
Anesthetic Agents ◽  
Intraoperative Management ◽  
Transsphenoidal Pituitary Surgery ◽  
Early Diagnosis Of Diabetes

Patients with tumors of the pituitary gland represent a heterogeneous yet commonly encountered neurosurgical population. Optimal anesthetic care requires an understanding of the complex pathophysiology secondary to each patient’s endocrine disease. Although patients presenting with Cushing’s disease and acromegaly have unique manifestations of endocrine dysfunction, all patients with tumors of the pituitary gland require meticulous preoperative evaluation and screening. There are many acceptable strategies for optimal intraoperative anesthetic management; however, the selection of anesthetic agents should be tailored to facilitate surgical exposure, preserve cerebral perfusion and oxygenation, and provide for rapid emergence and neurological assessment. Postoperatively, careful monitoring of fluid balance and serum sodium is essential to the early diagnosis of diabetes insipidus (DI). DI is most often transient but can require medical therapy. A thorough understanding of the preoperative assessment, intraoperative management, and potential complications are fundamental to successful perioperative patient care and avoidance of morbidity and mortality.

scholarly journals A Case of Transposition of Great Arteries with Ventricular Septal Defect and Mesocardia Presenting for Neurosurgery

2019 ◽  
Vol 10 (04) ◽  
pp. 715-717
Author(s):  
Soniya Biswas ◽  
Keta Thakkar ◽  
Neeraja Ajayan ◽  
Ajay Prasad Hrishi ◽  
Manikandan Sethuraman
Keyword(s):  
Ventricular Septal Defect ◽  
Brain Abscess ◽  
Vascular Resistance ◽  
Septal Defect ◽  
Anesthetic Management ◽  
Air Embolism ◽  
Paradoxical Embolism ◽  
Systemic Complications ◽  
Transposition Of Great Arteries ◽  
Congenitally Corrected Transposition

AbstractCongenitally corrected transposition of great arteries (CC-TGAs) associated with a ventricular septal defect (VSD) presents with cyanotic spells and systemic complications such as brain abscess. In mesocardia, the heart lies in the midline with no apex seen on the left side. We report the anesthetic management of a child with CC-TGA, VSD, and mesocardia presenting with parietal brain abscess for neurosurgery. The significant anesthetic challenges include maintenance of peripheral vascular resistance lower than systemic vascular resistance, prevention of air embolism and paradoxical embolism, avoidance of hyperviscosity in addition to avoiding any rise in intracranial pressure, and maintenance of cerebral perfusion pressure.

scholarly journals Anesthetic Management of a Case of Coarctation of Aorta Taken Up for Intracranial Aneurysm Coiling

2019 ◽  
Vol 7 (01) ◽  
pp. 38-40
Author(s):  
Shamik Paul ◽  
Summit D. Bloria ◽  
Hemant Bhagat ◽  
Ankur Luthra
Keyword(s):  
Intracranial Aneurysm ◽  
Anesthetic Management ◽  
Coarctation Of Aorta ◽  
Unruptured Intracranial Aneurysm ◽  
Anesthetic Considerations ◽  
Aneurysm Coiling

AbstractWe describe our experience of management of a young hypertensive male taken up for coiling of an unruptured intracranial aneurysm whom we diagnosed to be a case of coarctation of aorta during preanesthetic check-up. This diagnosis changed the treatment of the patient completely. We report this to emphasize the need to do a thorough preoperative check-up in every case. We also touch upon the important anesthetic considerations to be observed while managing such cases.

Incidence of Venous Air Embolism during Craniectomy for Craniosynostosis Repair

2000 ◽  
Vol 92 (1) ◽  
pp. 20-20 ◽  
Author(s):  
Lisa W. Faberowski ◽  
Susan Black ◽  
J. Parker Mickle
Keyword(s):  
Air Embolism ◽  
Hemodynamic Instability ◽  
Mortality Rates ◽  
Cardiovascular Collapse ◽  
Ultrasonic Probe ◽  
Safe Method ◽  
Venous Air Embolism ◽  
Doppler Probe ◽  
Initiation Of Therapy ◽  
A Prospective Study

Background Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. Methods A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. Results Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. Conclusion The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.

scholarly journals Impact of Ischemic Preconditioning on Outcome in Clinical Liver Surgery: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Michael J. J. Chu ◽  
Ryash Vather ◽  
Anthony J. R. Hickey ◽  
Anthony R. J. Phillips ◽  
Adam S. J. R. Bartlett
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Resection ◽  
Reperfusion Injury ◽  
Ischemic Preconditioning ◽  
Liver Surgery ◽  
Clinical Studies ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Hepatocellular Damage

Background. Ischemia-reperfusion injury is a major cause of post-liver-surgery complications. Ischemic preconditioning (IPC) has been demonstrated to protect against ischemia-reperfusion injury. Clinical studies have examined IPC in liver surgery but with conflicting results. This systematic review aimed to evaluate the effects of IPC on outcome in clinical liver surgery.Methods. An electronic search of OVID Medline and Embase databases was performed to identify studies that reported outcomes in patients undergoing liver surgery subjected to IPC. Basic descriptive statistics were used to summarise data from individual clinical studies.Results. 1093 articles were identified, of which 24 met the inclusion criteria. Seven topics were selected and analysed by subgroup. There were 10 studies in cadaveric liver transplantation, 2 in living-related liver transplantation, and 12 in liver resection. IPC decreases hepatocellular damage in liver surgery as determined by transaminases but does not translate to any significant clinical benefit in orthotopic liver transplant or liver resection.Conclusions. Available clinical evidence does not support routine use of IPC in liver surgery as it does not offer any apparent benefit in perioperative outcome. Further clinical studies will need to be carried out to determine the subset of patients that will benefit from IPC.

Effect of acute nitrate and citrulline supplementation on muscle microvascular response to ischemia–reperfusion in healthy humans

2017 ◽  
Vol 42 (9) ◽  
pp. 901-908 ◽  
Author(s):  
Thibault Le Roux-Mallouf ◽  
Florence Vibert ◽  
Stéphane Doutreleau ◽  
Samuel Verges
Keyword(s):  
Near Infrared ◽  
Ischemia Reperfusion ◽  
Area Under The Curve ◽  
Vascular Occlusion ◽  
No Production ◽  
Control Mechanisms ◽  
Healthy Humans ◽  
Microvascular Response ◽  
Reperfusion Period ◽  
Ischemic Period

Nitric oxide (NO) is implicated in vasomotor control mechanisms altering the diameter of the vessels under various physiological and pathological conditions. There are 2 main NO production pathways, 1 NO synthase (NOS) independent (nitrate–nitrite–NO) and the other is NOS dependent (citrulline–arginine–NO). The objective of the study was to evaluate the effect of acute nitrate and citrulline supplementation on post-ischemic vascular response in healthy subjects. Fourteen subjects performed 2-leg vascular occlusion tests, 3 days apart. They were randomly assigned to consume a drink containing 1200 mg (19.4 mmol) of nitrate and 6 g of citrulline (N+C) or a placebo (Pl). Changes in total hemoglobin (Hbtot) and oxyhemoglobin (HbO2) concentrations were recorded by near-infrared spectroscopy on the thigh and calf muscles. No differences between N+C and Pl were observed during the ischemic period. Hbtot increased to a larger extent during the reperfusion period for the thigh (e.g., area under the curve, 821 ± 324 vs. 627 ± 381 mmol·s−1, p = 0.003) and the calf (515 ± 285 vs. 400 ± 275 mmol·s−1, p = 0.029) in the N+C versus Pl conditions. Similar results were found regarding HbO2 for the thigh (e.g., area under the curve, 842 ± 502 vs. 770 ± 491 mmol·s−1, p = 0.077) and the calf (968 ± 536 vs. 865 ± 275 mmol·s−1, p = 0.075). The larger postocclusive Hbtot and HbO2 responses observed after N+C intake suggests a greater post-ischemic vasodilation, which may be due to increased NO availability, via the activation of the 2 main NO production pathways.

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