The continuation of hemodynamic, respiratory, and metabolic support for a variable period after liver transplantation (LT) in the intensive care unit (ICU) is considered routine by many transplant programs. However, some LT recipients may be liberated from mechanical ventilation shortly discontinuation anesthesia. These patients might appropriately discharged postanesthesia (PACU) to surgical ward bypass ICU entirely. In 2002, our program started fast-tracking program: select are transferred...

In Brief Two-dimensional ultrasound guidance has been used as an adjunct for neural blockade. With the development of newer technology, three-dimensional imaging is now available and may offer improved visualization anatomic structures relationships. We describe successful blockade popliteal nerve with image description. IMPLICATIONS: first real-time application reconstruction guiding insertion a catheter ankle surgery. Three-dimensional technology provide substantially better during...

Intracardiac thrombosis (ICT) during orthotopic liver transplantation (OLT) is an uncommon event. However, it a devastating complication with high mortality when occurs. This study aimed to identify possible predisposing factors for ICT OLT. We retrospectively identified the cases of all patients OLT at our institution from 1998 2014. Of 2750 OLTs performed, 10 had intraoperatively. The patients' immediate prethrombosis intraoperative hemodynamic and coagulation values thromboelastography...

Abstract Introduction For patients with catecholamine‐resistant vasoplegic syndrome (VS) during liver transplantation (LT), treatment methylene blue (MB) and/or hydroxocobalamin (B12) has been an acceptable therapy. However, data on the effectiveness of B12 is limited to case reports and series. Methods We retrospectively reviewed records undergoing LT from January 2016 through March 2022. identified VS treated vasopressors MB, abstracted hemodynamic parameters, vasopressor requirements,...

1 Evidence for the existence of sympathetic vasodilator nerves in human skeletal muscle is controversial. Manoeuvres such as contralateral ischaemic handgripping to fatigue that cause vasoconstriction resting forearm evoke vasodilatation after local α-adrenergic receptor blockade, raising possibility both constrictor and dilator fibres are present. The purpose this study was determine whether dilatation neurally mediated. 2 Ten subjects (3 women, 7 men) performed before acute anaesthetic...

Intraoperative transesophageal echocardiography (TEE) has commonly been used for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. Anesthesiologists may be dissuaded from using TEE in orthotopic liver transplantation (OLT) out of concern about rupture esophageal varices. Complications associated with OLT were evaluated.We retrospectively reviewed charts videos all cases January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida).Of...

Phenylephrine is generally regarded as a “pure” α 1 -agonist. However, after treatment of the forearm with α-adrenergic-blocking drug phentolamine, brachial artery infusion phenylephrine can cause transient vasodilation. To determine whether this response was β-receptor mediated, phenylephrine, and propranolol were infused into arteries six healthy volunteers. Forearm vascular conductance (FVC) also calculated expressed arbitrary units (units). Infusion by itself (0.5 μg · dl volume −1 min )...

Immersive virtual reality (IVR) is utilized as an adjunct to anesthesia distract patients from their intraoperative environment, thereby potentially reducing sedative and narcotic medication usage. This study evaluated acute postoperative results of undergoing primary total hip (THA) knee arthroplasty (TKA) with without IVR.Utilizing IVR spinal anesthesia, 18 THAs (n = 8) TKAs 10) were performed. These cases 1:2 matched based on procedure type, age, sex, body mass index those performed IVR....

We present a 16-year-old male athlete with hyperthermia, altered mental status, and respiratory distress during summer football practice. Multisystem organ failure ensued, which he survived. Malignant hyperthermia was suspected in this patient who had history of rhabdomyolysis. Specific muscle contracture testing later eliminated diagnosis. This case discusses the importance rapid hydration isonatremic fluid, aggressive cooling, full support measures, including plasmapheresis, further...

Abstract Transfusion decisions are guided by clinical factors and measured hemoglobin (Hb). Time required for blood sampling analysis may cause Hb measurement to lag conditions, thus continuous intraoperative trend monitoring provide useful information. This multicenter study was designed compare three methods of determining changes (trend accuracy) laboratory determined changes. Adult surgical patients with planned arterial catheterization were studied. With each gas performed, pulse...

During prolonged laparoscopy, the diffusion of other gases in carbon dioxide (CO(2)) pneumoperitoneum may lessen its safety. Nitrous oxide (N(2)O)/CO(2) gas mixtures become hazardous with regard to embolization and fire risk. We therefore evaluated kinetics pneumoperitoneal intrusion N(2)O. In five anesthetized domestic pigs, controlled ventilation, an initial fraction inspired oxygen = 1.0, was adjusted keep ETCO(2) pressure between 35 45 mm Hg. The peritoneum insufflated CO(2) a 12 Hg,...

During prolonged laparoscopy, the diffusion of other gases in carbon dioxide (CO2) pneumoperitoneum may lessen its safety. Nitrous oxide (N2O)/CO2 gas mixtures become hazardous with regard to embolization and fire risk. We therefore evaluated kinetics pneumoperitoneal intrusion N2O. In five anesthetized domestic pigs, controlled ventilation, an initial fraction inspired oxygen = 1.0, was adjusted keep ETCO2 pressure between 35 45 mm Hg. The peritoneum insufflated CO2 a 12 Hg, which...

Nitrous oxide (N2O) accumulates in the CO2 pneumoperitoneum during laparoscopy when N2O is used as an adjuvant for inhaled anesthesia. This may worsen consequences of gas embolism and introduce a fire risk. In this study, we quantified pneumoperitoneal venting necessary to prevent significant contamination by N2O. Four domestic pigs (26-30 kg) were anesthetized ventilated with 66% oxygen. A was insufflated maintained at pressure 12 mm Hg. Each animal underwent three experimental conditions,...

Immersive virtual reality (IVR) is an adjunctive form of anesthesia intended to distract patients from their intraoperative environment and reduce other side effects sedating or narcotic agents. While this technology has been applied sparingly in various orthopedic procedural environments, its clinical utility not widely evaluated major, nonelective surgical settings. The use IVR the geriatric hip fracture population represents a novel indication with potential benefit reduced cognitive...

Background: During awake craniotomy, securing the patient’s airway might be necessary electively or emergently. The objective of this study was to compare feasibility management using a laryngeal mask (LMA) and 4 alternative techniques in an craniotomy simulation. Methods: After completing questionnaire, 9 anesthesia providers attempted cadaver positioned simulate conditions. Following simulation, participants rated ranked devices their order preference. Results: Only 3 approaches resulted...

Reliable devices that quantitatively monitor the level of neuromuscular blockade after blocking agents' administration are crucial. Electromyography and acceleromyography two monitoring modalities commonly used in clinical practice. The primary outcome this study is to compare onset blockade, defined as a Train-Of-Four Count (TOFC) equal 0, measured by an electromyography-based device (TetraGraph) acceleromyography-based (TOFscan). secondary was intubating conditions when one these reached...

Descrevemos um caso incomum de insuficiência hepática hiperaguda após a anestesia geral em uma paciente que recebeu transplante simultâneo rim‐pâncreas. Apesar avaliação agressiva das causas estruturais, imunológicas, virais e toxicológicas, causa definitiva não pôde ser identificada. A precisou fígado resultou prolongamento da internação hospitalar. Discutimos as potenciais fulminante o manejo no período perioperatório seu subsequente fígado. We describe an unusual case of hyperacute...