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Relative Contributions of Intraoperative Low Dose k.tamine, Lidocaine and k.tamine-Lidocaine Combination in Addition to Intrathecal Morphine for Postoperative Analgesia in Open Liver Resection: A Prospective, Randomized, Four-Arm, Triple Blind, Placebo-Controlled Trial

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Open Journal of Anesthesiology 2020年第9期10卷 313-326页

作者： Shalini dhir Debashis Roy Tim Hall Yves Bureau Janice Yu achal k. dhir Department of Anesthesia and Perioperative Medicine Schulich School of Medicine London Ontario Canada Sunnybrook.Health Sciences Centre Department of Anesthesiology Toronto Ontario Canada Department of Anesthesia & Perioperative Medicine Auckland Hospital University of Auckland Auckland New Zealand Department of Psychology Department of Medical Biophysics Western University London Ontario Canada Department of Anesthesia Michael G. DeGroote School of Medicine McMaster University Hamilton Ontario Canada

Back.round and Aims: Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low ... 详细信息

Background and Aims: Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low dose lidocaine and ketamine would reduce opioid consumption when given in conjunction with intrathecal morphine for liver resection surgery. Methods: In this triple blind, parallel group four-arm placebo-controlled trial, we randomized 124 adult ASA 2 - 4 liver resection patients to receive intraoperative lidocaine 0.33 mg/kg/h (group L), ketamine 70 μg/kg/h (group K), combination of lidocaine 0.33 mg/kg/h and ketamine 70 μg/kg/h (group KL) and saline (group P). All patients received 300 μg intrathecal morphine prior to induction of anesthesia. All infusions were started immediately after intubation and continued until the end of surgery. Primary outcome measurements included opioid consumption at 24-hours. Secondary outcomes included pain scores, opioid consumption at 48 and 72-hours and side effects including nausea, vomiting, dizziness, hallucinations, headaches and signs of local anaesthetic toxicity. Patients were followed up for 12 weeks. Results: There was no difference in the primary outcome of opioid consumption within all 4 groups at rest or movement at 24-hours. Secondary outcome of 48-hour rest pain score was significantly higher in the L group (p = 0.03) but without any difference in opioid use.

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Intraoperative management of liver transplant in a patient with an undiagnosed ventricular septal defect:A case report

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World Journal of Anesthesiology 2021年第1期10卷 1-6页

作者： Tejal Vivek.Desai achal dhir Douglas Quan Raffael Zamper Department of Anesthesia and Perioperative Medicine University HospitalLondon Health Sciences CentreLondon N6A 5A5OntarioCanada Department of General Surgery University HospitalLondon Health Sciences CentreLondon N6A 5A5OntarioCanada

BACk.ROUND The intraoperative management of patients undergoing orthotopic liver transplantation(OLT)frequently encounters hemodynamic instability after reperfusion of the new liver *** resulting post-reperfusion syndrome is characterized by an increase in pulmonary vascular resistance and decrease in systemic vascular *** the presence of a left to right intracardiac shunt,this hemodynamic perturbance can lead to shunt reversal followed by hypoxemia and embolization of air and debris into the systemic circulatory *** SUMMARY A 43 years-old male with end-stage liver disease due to primary sclerosing cholangitis complicated by portal hypertension and hepatocellular carcinoma presented for an OLT.A bedside transthoracic echocardiography(TTE)was performed immediately before the procedure and unexpectedly identified a ventricular septal defect(VSD).The patient and the surgical team agreed to proceed with the surgery as it was a time critical donation after circulatory organ *** developed an intraoperative plan to optimize pulmonary and systemic pressures using vasoactive support,optimized mechanical ventilation,and used transesophageal echocardiography(TEE)for intraoperative *** reperfusion,considerable turbulent flows with air were noted in the right ventricle,but no air was visualized in the left *** flow Doppler showed no reversal flow in the *** the end of the procedure,the patient was extubated in the operating room without complication and was transferred to the transplant unit for *** Our case highlights the importance of echocardiography in the perioperative assessment of patients undergoing liver *** TTE findings obtained immediately before the procedure and the real-time use of intraoperative TEE to modify our management during the critical phases of the transplant resulted in continuity of care and a good surgical outcome for this patient.

关键词： Liver transplant Ventricular septal defect Transesophageal echocardiography Intracardiac shunt Paradoxical embolism Case report

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