James Y. Findlay

Aprotinin reduces vasoactive medication use during adult liver transplantation

STUDY OBJECTIVEnTo determine whether aprotinin use during adult liver transplantation results in an improvement in hemodynamic stability.nnnDESIGNnReview of data collected during a prospective, randomized, double-blind trial.nnnSETTINGnLiver transplantation program in a tertiary referral institution.nnnPATIENTSn63 adult patients undergoing orthotopic liver transplantation (OLT).nnnINTERVENTIONSnPatients were randomized to receive either aprotinin (1,000,000 KIU loading dose, followed by an infusion of 250,000 KIU/hr) for the duration of the surgery or a placebo infusion (normal saline).nnnMEASUREMENTSnHemodynamic parameters (mean systemic blood pressure, cardiac output, systemic vascular resistance, mean pulmonary artery (PA) pressure, and PA occlusion pressure) were compared at set time points during the procedure. The use of vasoactive medications during and after the reperfusion period was compared.nnnMAIN RESULTSnThere were no significant differences in any of the measured hemodynamic parameters at any time point. Vasoactive infusions were used in 1 of 33 patients in the aprotinin group and in 6 of 30 patients in the control group (p < 0.05). Bolus doses of pressor medications during the recirculation period did not differ between groups.nnnCONCLUSIONnAprotinin infusion during adult liver transplantation results in less requirement for vasoactive intervention.

Perioperative hearing impairment.

PERIOPERATIVE hearing loss is a rarely reported phenomenon. However, it occurs more frequently than most anesthesiologists suspect. Perioperative hearing impairment is often subclinical and may go unnoticed unless audiometry is performed. It can be conductive or sensorineural, unilateral or bilateral, and transient or permanent. Hearing loss has been reported following virtually every type of anesthetic technique. The hearing mechanism may be less susceptible to acoustic trauma during general anesthesia, but other mechanisms are capable of causing both conductive and sensorineural hearing losses (SNHL) in the perioperative period. The etiologies include mechanical, traumatic, noise-induced, changes in cerebrospinal fluid (CSF) pressure, nitrous oxide, embolism, pharmacologic, and other miscellaneous causes.

Skin injury with the use of a water warming device.

HYPOTHERMIA is common during extensive and prolonged surgery such as a liver transplantation (OLT). Hypothermia can cause or exacerbate preexisting coagulation abnormalities and myocardial dysfunction. Efforts to prevent hypothermia during OLT and other major operations have largely employed active warming devices utilizing forced-air warming. A new device, the Allon System with the ThermoWrap garment (MTRE Advanced Technologies Ltd., Centerville, OH), circulates warmed water through a special garment to prevent hypothermia. We report the case of pressure/burn injury secondary to the use of this device.

Epidural Blockade for Labor and Cesarean Section with Associated L4-5 Lipomyelocele

A LIPOMYELOCELE is an intraspinal lipoma that is associated with disruption of the meninges, displacement of neural elements, and spina bifida. Similar to other disorders of the lumbar spine, it may represent a relative contraindication to neuraxial anesthesia and analgesia. 1 We report a case of successful epidural blockade for labor analgesia and later cesarean section in a parturient with a lipomyelocele.