Aprotinin reduces nitric oxide production in vitro and in vivo in a dose-dependent manner.

1. Cardiopulmonary bypass is associated with an increase in nitric oxide concentrations, and plasma levels of tumour necrosis factor and interleukin-1. Aprotinin, a serine protease inhibitor, commonly used during cardiopulmonary bypass to reduce blood loss, has been demonstrated to exhibit significant anti-inflammatory effects during and after cardiopulmonary bypass.

Diuretic-induced hypokalaemia inducing torsades de pointes.

Torsades de pointes (TP), an unique polymorphous type of ventricular tachycardia, is associated with either an acquired or congenitally prolonged QT interval. Several reports have demonstrated TP to follow an acquired prolonged QT interval secondary to chronic hypocalcaemia, hypomagnesaemia, or hypokalaemia. We report a rapid onset, acute extracellular hypokalaemia not associated with other electrolyte disturbances inducing a prolonged QT interval followed by TP.

Calcium channel blockade and uncontrolled blood pressure during phaeochromocytoma surgery.

Phaeochromocytoma has traditionally been managed by preoperative adrenergic blockade followed by surgical devascularization and excision. Recently, various studies have reported the use of calcium channel blocking drug therapy, either as monotherapy or in combination with other non-adrenergic blocking antihypertensive medications for blood pressure control in the preoperative management of phaeochromocytoma. In this case report, diltiazem as monotherapy was used to establish adequate preoperative blood pressure control in a patient with metastatic phaeochromocytoma to the liver.

Anesthesia for liver transplantation.

A successful liver transplant program needs cooperation and communication from the surgical, blood banking, pathology, primary care, and anesthesia services. Rapid availability of laboratory data, efficient blood banking services, ability to infuse blood products rapidly, coagulation management capability, and plentiful manpower are essential.

Fentanyl intermittent bolus technique for anesthesia in infants and children undergoing cardiac surgery.

The use of fentanyl by an incremental intravenous (IV) bolus technique was evaluated in eight pediatric patients (ages 4 months to 5 years, ASA III-IV) undergoing corrective surgery for congenital heart defects. Anesthesia was induced with 5 to 10 micrograms/kg of fentanyl. Additional boluses of comparable size were given intermittently thereafter, in order that a total dose of 100 micrograms/kg was achieved just before instituting cardiopulmonary bypass (CPB).