A Kogan

Premedication with midazolam in young children: a comparison of four routes of administration

Summary Background: We undertook a study to determine the effects of four routes of administation on the efficacy of midazolam for premedication.

Readmission to an intensive care unit following liver and kidney transplantation: a 50-month study.

THE INCREASING number of transplants being performed in recent years has led to an increase in the number of patients developing severe transplant-related complications and requiring readmission to an intensive care unit (ICU). This group of patients has, however, not been extensively assessed. The purpose of this study was to establish the incidence, etiology, and outcome of patients readmitted to our general ICU following initial successful liver (OLT) or kidney (RTX) transplantation.

Establishment of a heart valve homograft bank using existing facilities.

THE PROGRESS of cryobiology together with broadening surgical indications have increased the demand for heart valve homografts. Cryopreserved aortic valves have been implanted either in the sub-coronary position or as a complete aortic root replacement. Reconstruction of the right ventricular outflow tract for various forms of congenital heart defects has been performed with aortic or pulmonary homografts. Pulmonary valve homografts have been used for right ventricular outflow reconstruction during the “Ross” procedure. Mitral valve homografts are used for the replacement of the mitral valve in female patients of child-bearing age and in other patients who bears contraindications for anticoagulation. The disadvantages of homografts include limited availability and durability. Although some authors claim the durability of cryopreserved homograft to be superior to that of fresh homografts, other studies did not affirm this, and the different results are probably related to some extent to variability in the sterilization and the preservation protocols. On the other hand, it is widely agreed that cryopreservation increases the shelf life of homografts from a few weeks of the fresh antibiotic-preserved material to at least 5 years among cryopreserved grafts. Thus the problem of availability may be partly solved by using cryopreservation rather than “fresh” grafts, and by establishing more homograft laboratories (“banks”) in remote areas. Establishing an independent homograft bank is costly. We sought to establish an independent bank at no additional cost as a model that can be implemented in any medical center containing some form of tissue bank (eg, a bone marrow bank).

Optimizing early extubation after coronary surgery.

Early extubation after isolated coronary artery bypass surgery was assessed retrospectively in 545 of 779 patients treated by the same surgical team over one year. All underwent extubation within 10 hr of arrival at the cardiothoracic intensive care unit: 343 in < 6 hr and 202 in 6–10 hr. Operative mortality was 2.2%. Group comparisons revealed that patients who had earlier extubation were younger (61 vs. 66 years; p < 0.001), more likely to be male (72.5% vs. 61.3%; p < 0.05), with a shorter aortic crossclamp time (49.2 ± 15.0 vs. 53.3 ± 14.0 min; p < 0.05), cardiopulmonary bypass time (65 ± 18.4 vs. 72.2 ± 19.2 min; p < 0.05), intensive care unit stay (18.8 ± 5.6 vs. 22.4 ± 3.2 hr; p < 0.05) and postoperative hospital stay (5.2 ± 2.2 vs. 6.0 ± 2.4 days; p = 0.01). Extubation < 6 hr after cardiopulmonary bypass may accelerate recovery. The finding of no significant differences in clinical parameters between the groups suggests that efforts to further reduce the time to extubation might be worthwhile.

Lipid metabolism and immunosuppressive therapy in heart transplant recipients

This study included 30 heart transplant patients with follow up to 6 years. The subjects were retrospectively divided in two groups based on the immunosuppressive therapy—cyclosporine or FK506. Total cholesterol blood levels were measured regularly together with the immunosuppressant drug levels and anti-lipidic treatmentrecorded. Concomitant therapy with low-dose steroids and azathioprine was similar in both groups. T-tests were performed to compare the mean values of the two groups.

Atrial fibrillation after adult lung transplantation

ATRIAL fibrillation (AF) is the most common dysrhythmia seen early after major thoracic surgery. Atrial dysrhythmia has been observed in children undergoing lung transplantation, but AF after adult lung transplantation in the early postoperative period has not previously been reported. A Heart and Lung Transplantation Unit in the Department of Cardiothoracic Surgery in a university hospital is the setting for this retrospective analysis.

Outcome of Marginal Donors in Heart Transplantation

THE NUMBER of patients awaiting organ transplantation has progressively increased over the last decade. The progression of the discrepancy between suitable donors and potential recipients on waiting lists will have the consequence of an increasing use of organs from marginal donors. Organs that would have been thought unsuitable for transplantation not so long ago are currently used for transplantation. Advanced age, prolonged CPR, heavy inotropic support, or coronary lesions define marginal donors. Marginal recipients are advanced in age, have other diseases as limiting factors, or have been hospitalized in critical condition. From a total number of 100 transplantations (heart and/or lung) performed in our center, we present three cases in which ethical difficulties arose.

Organ transplantation statistics in different countries: Internet review

TYPE THE WORDS “kidney transplantation” or “heart transplantation” or a similar combination into one of the more robust search engines on the World Wide Web and you will retrieve hundreds of thousands of different sites that refer to the specialty in some manner. Most international and national transplant associations have web sites, and a world of news, research, clinical cases, and statistical data are available on-line over the Internet. The aim of this study was to search international and national transplantation databases

The intensive care unit course of patients undergoing liver transplantation: a report on success with a clinical pathway

THE IMMEDIATE postoperative course of liver transplant recipients is complicated and requires intensive monitoring and nursing so that quality of care may significantly affect outcome. In addition certain interventions may positively affect the subsequent patient course. Thus early enteral feeding maintains gut mucosal integrity and may prevent bacterial translocation; early extubation may decrease the incidence of nosocomial pneumonia; and early ICU discharge decreases exposure to resistant bacteria as well as improving ICU utilization. We report on our experience with a clinical pathway that actively targeted these end-points.

Foreign candidates on the transplantation waiting list: an ethical dilemma

T IS NOW well recognized that the gap between the supply of available transplantable human organs and the need is constantly increasing. Medical suitability is the basis of organ allocation, although the social, economic, psychologic, and demographic situation of each potential recipient represents important considerations. The ethical dilemma that we face is whether foreign, nonresident candidates should be placed on a national waiting list, and, if the answer is positive, under what terms? Organ transplantation, especially heart or lung, requires not only a well-trained group, but also an extensive infrastructure, which does not exist in each country. The lack of organs in the one hand and the lack of infrastructure in other countries on the other hand lead to the need for a mutual partnership among nations. Among the 100 organs transplanted in our center, 3 were donated by nonresident Palestinians who were treated in Israeli hospitals, 1 of whom was a victim of a violent act during the “Intifada.” The Palestinian population, although being provided with diverse medical services, is not entitled to be on the Israeli national waiting list. The ethical question that the medical community faces in these circumstances is whether to accept a family request to donate the organs to a close relative of the donor instead of offering them to all patients on the list. The other debate is whether the waiting list should be equally open to residents and nonresidents, now that they have became part of the potential population to donate.