Role of Transesophageal Echocardiography in the Diagnosis of Multi-chamber Intracardiac Thrombosis During Liver Transplantation: A Case Series.

Intra-cardiac thrombosis is one of the most devastating complications during liver transplantation. In the majority of cases, ICT, followed by massive pulmonary embolism, is commonly occurring shortly after liver graft reperfusion, but it has been reported to occur at any stage of the surgery. We present a series of 3 cases of intra-cardiac thrombosis during orthotopic liver transplantation surgery, including a case of four-chamber intra-cardiac clot formation during the pre-anhepatic stage.

A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation.

Decreases in endothelial nitric oxide synthase derived nitric oxide (NO) production during liver transplantation promotes injury. We hypothesized that preemptive inhaled NO (iNO) would improve allograft function (primary) and reduce complications post-transplantation (secondary). Patients at two university centers (Center A and B) were randomized to receive placebo (n = 20/center) or iNO (80 ppm, n = 20/center) during the operative phase of liver transplantation.

Treatment of severe lactic acidosis during the pre-anhepatic stage of liver transplant surgery with intraoperative hemodialysis.

Severe uncompensated lactic acidosis manifesting during the pre-anhepatic stage of orthotopic liver transplant surgery is an uncommon event, but it poses serious concern because of the additional lactate production and impaired elimination by the liver that develops during the anhepatic and allograft reperfusion stages of the procedure. A man with end-stage liver disease secondary to hepatitis C and hemochromatosis and normal renal function, who developed severe lactic acidosis in the pre-anhepatic stage of liver transplantation, was treated successfully with intraoperative, continuous venovenous hemodialysis. Hemodialysis effectively corrected the patient's lactic acidosis and removed lactate, which contributed to hemodynamic stability during the anhepatic and graft reperfusion stages of his liver transplant surgery.

Drug management in emergent liver transplantation of mitochondrial disorder carriers: review of the literature.

Background: Mitochondrial respiratory-chain disorders (MRCD) lead to progressive disabling of neurological and cellular conditions that involve muscles, brain, kidney, and liver dysfunction. Affected individuals may need surgery, including orthotopic liver transplantation (OLT). Surgery poses anesthesia challenges because of the prolonged use of anesthetic drugs and sedatives, which may inhibit oxidative phosphorylation, mimic mitochondrial cytopathic disorders, or unveil them ex novo.

Anesthetic implications of the new anticoagulant and antiplatelet drugs.

In this review, we discuss the anesthetic implications of the new anticoagulant and antiplatelet drugs, focusing our discussion mainly on neuroaxial/regional anesthesia and central catheter placement issues. We offer practical recommendations for their use.

Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation: a case report and review of the literature.

Background: The presence of pulmonary hypertension in patients scheduled for liver transplantation requires a comprehensive perioperative heart evaluation and treatment with epoprostenol (prostacycline) infusion until a liver donor becomes available. We contended that intraoperative attenuation of severe pulmonary hypertension could be achieved by epoprostenol infusion combined with nitric oxide inhalation.

Case Report: A 49 years old man with end stage liver disease secondary to hepatitis C and ethanol abuse presented for orthotopic liver transplantation.

Adjuvant drugs for end-stage liver failure and transplantation.

End-stage liver failure is currently treatable both by dialysis and by liver transplantation, but this does not detract from its being a complex pathophysiological and pharmacological entity. More patients survive after transplant because of the impressive developments that enabled improved liver preservation, anesthesia and surgical techniques, as well as immunosuppressive drug therapy. Because of its multifaceted metabolism, liver failure can nevertheless cause a complex of pathophysiological conditions and, as such, poses a challenge for surgeons and anesthesiologists alike, not only before surgery but during transplantation as well.

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report.

Purpose: To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy.

Clinical Features: A 59-yr-old man - height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I - presented as kidney donor for laparoscopic donor nephrectomy.

Preoperative fasting after soft drink intake: 2 hours may be enough.

Sufficient preoperative fasting time is essential for safe induction of anesthesia to prevent aspiration of gastric contents. However, the time recommended for sufficient preoperative fasting varies greatly, depending on the nature of the oral intake, from 2 h for clear liquids to 6 h for solid foods. We report the case of a 30-year-old man who drank about 600 ml of the carbonated, glucose-rich soft drink, 7-UP, 2 h before surgery and absorbed nearly all of it within these 2 preoperative hours.

Laryngeal mask anesthesia in children: a case report.

The laryngeal mask airway has become one of the major tools of modern anesthesia airway management. Despite the fact that no time limit has been recommended regarding its safe use in spontaneously breathing children, or adults, there is still reluctance to use the laryngeal mask airway in operations of long duration. We report the case of an uneventful 5-hour long laryngeal mask anesthesia in a spontaneously breathing 11-year-old boy undergoing lower limb surgery.