Intraoperative management and early post-operative outcomes of patients with coronary artery disease who underwent orthotopic liver transplantation

Background: Coronary artery disease (CAD) is frequently observed in aging end-stage liver disease (ESLD) patients who require orthotopic liver transplantation (OLT). This situation is challenging for both the pa- tients and the medical staff. Methods: We retrospectively studied the case records of 26 ESLD patients with CAD who underwent OLT with total clamping of the inferior vena cava between 2014 and 2018. We analyzed the details of the pre-operative evaluation, intraoperative anesthetic management and post-operative prognosis of these patients. Results: All patients tolerated the anhepatic stage well. Post-reperfusion syndrome (PRS) was observed in 13 patients (50%) and 2 of them were severe but corrected well. ST-segment depression was frequently observed during the anhepatic stage and reperfusion stage. No mortality due to cardiac-related events occurred among the patients during hospitalization. OLT with the modi ed piggyback technique could successfully be performed in ESLD patients with mild and moderate CAD. Conclusions: A thorough evaluation and optimization of recipients, strict monitoring and optimized man-agement of circulation, knowledge of the complicated changes during OLT procedures, and strategies to ameliorate post-reperfusion syndrome favorite the outcomes.

Relationship between genetic variation in the α2A-adrenergic receptor and the cardiovascular effects of dexmedetomidine in the Chinese Han population

There are differences in individual cardiovascular responses to the administration of dexmedetomidine,a highly selective α2A-adrenergic receptor(ADRA2A) agonist.The aim of this study was to investigate ADRA2A gene polymorphisms in the Chinese Han population and their association with the cardiovascular response to intravenous dexmedetomidine infusion.Sixty elective surgery patients of Chinese Han nationality were administered 1 μg/kg dexmedetomidine intravenously over 10 min as a premedication.ADRA2A C-1291G and A1780G polymorphism status was determined in these patients,and their relationships to changes in blood pressure and heart rate after dexmedetomidine administration were analyzed.There were neither significant differences in systolic or diastolic blood pressure changes in individuals with different A1780G and C-1291G genotypes after dexmedetomidine administration,nor in heart rates among the different A1780G genotypes.However,there were significant differences in changes in heart rates in patients with different C-1291G genotypes.There were no significant differences in the sedative effects of dexmedetomidine among different A1780G and C-1291G genotypes.Logistic regression revealed that the C-1291G polymorphism was associated with differential decreases in heart rate after intravenous infusion of dexmedetomidine.These findings indicate that the ADRA2A C-1291G polymorphism can affect heart rate changes in patients after in-utravenous infusion of dexmedetomidine.

Comparison of the effects of deep and moderate neuromuscular block on respiratory system compliance and surgical space conditions during robot-assisted laparoscopic radical prostatectomy: a randomized clinical study

Objective:Robot-assisted radical prostatectomy(RARP)requires pneumoperitoneum(Pnp)and a steep head-down position that may disturb respiratory system compliance(Crs)during surgery.Our aim was to compare the effects of different degrees of neuromuscular block(NMB)on Crs with the same Pnp pressure during RARP.Methods:One hundred patients who underwent RARP were enrolled and randomly allocated to a deep or moderate NMB group with 50 patients in each group.Rocuronium was administered to both groups:in the moderate NMB group to maintain 1–2 responses to train-of-four(TOF)stimulation;and in the deep NMB group to maintain no response to TOF stimulation and 1–2 responses in the post-tetanic count.Pnp pressure in both groups was 10 mm Hg(1 mm Hg=133.3 Pa).Peak inspiratory pressure(Ppeak),mean pressure(Pmean),Crs,and airway resistance(Raw)were recorded after anesthesia induction and at 0,30,60,and 90 min of Pnp and post-Pnp.Surgical space conditions were evaluated after the procedure on a 4-point scale.Results:Immediately after the Pnp,Ppeak,Pmean,and Raw significantly increased,while Crs decreased and persisted during Pnp in both groups.The results did not significantly differ between the two groups at any of the time points.There was no difference in surgical space conditions between groups.Body movements occurred in 14 cases in the moderate NMB group and in one case in the deep NMB group,and all occurred during obturator lymphadenectomy.A significant difference between the two groups was observed.Conclusions:Under the same Pnp pressure in RARP,deep and moderate NMBs resulted in similar changes in Crs,and in other respiratory mechanics and surgical space conditions.However,deep NMB significantly reduced body movements during surgery.