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Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice

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World Journal of Hepatology 2016年第26期8卷 1097-1104页

作者： Antonio Siniscalchi Lorenzo Gamberini Tommaso Bardi cristiana laici Elisa Gamberini Letizia Francorsi Stefano Faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna

AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific *** A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia. RESULTS Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure(P = 0.041) and received more colloid infusions(P = 0.007). Postoperative liver and kidney function did not differ *** of mechanical ventilation(P = 0.003) and hospital stay(P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was *** The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies.

关键词： Anesthesia Postoperative care Analgesia Epidural Postoperative Liver cirrhosis Liver function tests Complication

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Thoracic epidural anesthesia:Effects on splanchnic circulation and implications in Anesthesia and Intensive care

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World Journal of Critical Care Medicine 2015年第1期4卷 89-104页

作者： Antonio Siniscalchi Lorenzo Gamberini cristiana laici Tommaso Bardi Stefano Faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna

AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic ***:A Pub Med search was conducted using the Me SH ***,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,Splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction ***,Cochrane library,ClinicalT *** and *** were also searched using the same ***:Twenty-seven relevant studies and four ongoing trials were *** data regarding the effects of epidural anesthesia on splanchnic perfusion are *** studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster ***:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive *** there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics.

关键词： Anesthesia Epidural Circulation Splanchnic Intestine Microcirculation Pancreatitis Liver function tests

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Post reperfusion syndrome during liver transplantation:From pathophysiology to therapy and preventive strategies

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World Journal of Gastroenterology 2016年第4期22卷 1551-1569页

作者： Antonio Siniscalchi Lorenzo Gamberini cristiana laici Tommaso Bardi Giorgio Ercolani Laura Lorenzini Stefano Faenza Division of Anesthesiology Alma Mater Studiorum University of Bologna40138 BolognaItaly Division of Surgery Alma Mater Studiorum University of Bologna40138 BolognaItaly

This review aims at evaluating the existing evidence regarding post reperfusion syndrome, providing a description of the pathophysiologic mechanisms involved and possible management and preventive strategies. A Pub Med search was conducted using the Me SH database, "Reperfusion" AND "liver transplantation" were the combined Me SH headings; EMBASE and the Cochrane library were also searched using the same terms. 52 relevant studies and one ongoing trial were found. The concept of post reperfusion syndrome has evolved through years to a multisystemic disorder. The implications of the main organ, recipient and procedure related factors in the genesis of this complex syndrome are discussed in the text as the novel pharmacologic and technical approaches to reduce its incidence. However the available evidence about risk factors, physiopathology and preventive measures is still confusing, the presence of two main definitions and the numerosity of possible confounding factors greatly complicates the interpretation of the studies.

关键词： Liver transplantation Reperfusion Ischemiareperfusioninjury Hemodynamics Drug therapy

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三氧化二砷治疗复发难治性急性早幼粒细胞白血病临床疗效观察

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癌症进展 2005年第2期3卷 98-101页

作者：马军展昭民梁红贡铁军唐庆华任实郝文鹏靳明华夏国强邵秀茹王来慈张伯龙哈尔滨血液病肿瘤研究所哈尔滨150010

目的　探讨三氧化二砷治疗复发难治性急性早幼粒细胞白血病 (APL)的疗效。方法　 1988～ 2 0 0 0年 1月对 388例复发的APL给予三氧化二砷治疗 (10mg) ,连续用药至完全缓解。结果　应用三氧化二砷治疗的 388例复发APL中完全缓解 (CR)率为... 详细信息

目的　探讨三氧化二砷治疗复发难治性急性早幼粒细胞白血病 (APL)的疗效。方法　 1988～ 2 0 0 0年 1月对 388例复发的APL给予三氧化二砷治疗 (10mg) ,连续用药至完全缓解。结果　应用三氧化二砷治疗的 388例复发APL中完全缓解 (CR)率为 74 13% ,部分缓解 (PR)率 10 14 % ,CR+PR为 84 2 7% ,预计 10年无病生存率为 6 9%。早期死亡率及治疗相关死亡率分别为 7%、 10 %。主要死亡原因是脑出血、DIC、脑梗死。本组高白细胞综合征发生率为 15 %。副作用主要是消化道症状 ,发生率为 2 6 % ,肝功能损害发生率为 9% ,肾功能损害 6 % ,心电图改变 16 % ,精神症状 7%。结论　临床研究表明三氧化二砷是治疗复发APL最有效的药物之一 ,并可治愈APL。

关键词：急性早幼粒细胞白血病三氧化二砷

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