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Anaesthetic perioperative management of patients with pancreatic cancer

World Journal of Gastroenterology 2014年第9期20卷 2304-2320页

作者： Lesley De Pietri Roberto Montalti bruno begliomini Division of Anaesthesiology and Intensive Care Unit Azienda Ospedaliero-Universitaria di Modena-Policlinico 41100 Modena Italy Transplantation Surgery Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona 60126 Modena Italy

Pancreatic cancer remains a significant and unresolved therapeutic ***,the only curative treatment for pancreatic cancer is surgical *** surgery represents a technically demanding major abdominal procedure that can occasionally lead to a number of pathophysiological alterations resulting in increased morbidity and ***,rather than surgical complications,cause the majority of *** patients are increasingly referred to surgery with at advanced ages and because pancreatic surgery is extremely complex,anaesthesiologists and surgeons play a crucial role in preoperative evaluations and diagnoses for surgical *** anaesthetist plays a key role in perioperative management and can significantly influence patient *** optimise overall care,patients should be appropriately referred to tertiary centres,where multidisciplinary teams(surgical,medical,radiation oncologists,gastroenterologists,interventional radiologists and anaesthetists)work together and where close cooperation between surgeons and anaesthesiologists promotes the safe performance of major gastrointestinal surgeries with acceptable morbidity and mortality *** this review,we sought to provide simple daily recommendations to the clinicians who manage pancreatic surgery patients to make their work easier and suggest a joint approach between surgeons and anaesthesiologists in daily decision making.

关键词： Pancreatic cancer Pancreatic surgery Perioperative anaesthesia management

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Perioperative effects of high doses of intraoperative thymoglobulin induction in liver transplantation

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World Journal of Transplantation 2015年第4期5卷 320-328页

作者： Lesley De Pietri Valentina Serra Giuseppe Preziosi Gianluca Rompianesi bruno begliomini Division of Anaesthesiology and Intensive Care Unit Azienda Ospedaliero-Universitaria di Modena-Policlinico Liver and Multivisceral Transplant Centre Azienda Ospedaliero-Universitaria di Modena-Policlinico Division of General Surgery University College London

AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin *** optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administration during LT remains *** release syndrome,haemolytic anaemia,thrombocytopenia,neutropenia,fever and serum sickness are potential adverse effects associated with ATG ***:Between December 2009 and December 2010,16 adult non-randomized patients(ATG group),receiving a liver graft from a deceased donor,received an intraoperative infusion(4-6 h infusion)of thymoglobulin(3 mg/kg,ATG:Thymoglobuline).These patients were compared(case control approach)with 16 patients who had a liver transplant without ATG treatment(control group)to evaluate the possible effects of intraoperative ATG *** matching parameters were:Sex,recipient age(±5 years),LT indication including viral status,MELD score(±5 points),international normalized ratio and platelet count(as close as possible).The exclusion criteria for both groups included the following:Multi-organ or living donor transplant,immunosuppressive therapy before transplantation,contraindications to the administration of any thymocyte globulin,human immunodeficiency virus seropositivity,thrombocytopenia[platelet<50000/μL]or leukopenia[white blood cells<1000/μL].The perioperative side effects(haemodynamic alterations,core temperature variations,colloids and crystalloids requirements,and surgical time)possibly related to ATG infusion and the thromboelastographic(TEG)evaluation of the ATG effects on coagulation,blood loss and blood product transfusion were analysed during the operation and the first three postoperative ***:Intraoperative ATG administration was associated with longer surgical procedures[560±88 min vs 480±83 min(control group),P=0.013],an intraoperative core temperature more than 37℃(50%of ATG patients vs 6.2%of control patients,P=0.015),major intraoperative bloo

关键词： Immunosuppression induction Cytokine release Thymoglobulin Thromboelastography Liver transplant

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Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation

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World Journal of Transplantation 2016年第3期6卷 583-593页

作者： Lesley De Pietri Marcello Bianchini Gianluca Rompianesi Elisabetta Bertellini bruno begliomini Division of Anaesthesiology and Intensive Care Unit Department of Cardiology Thoracic and Vascular Surgery Critical Care Medicine Arcispedale Santa Maria Nuova Gastroenterology Unit Department of Internal Medicine Azienda Ospedaliero Universitaria di Modena Liver and Multivisceral Transplant Center Azienda Ospedaliero-Universitaria di Modena Division of Anaesthesiology and Intensive Care Unit Department of Surgery Azienda Ospedaliero Universitaria di Modena

AIM To describe the thromboelastography(TEG) "reference" values within a population of liver transplant(LT) candidates that underline the differences from healthy *** Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease(MELD) score between 15 and 40 were studied. In particular the adult patients(aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time(r), coagulation time(k), Angle-Rate of polymerization of clot(α Angle), Maximum strenght of clot(MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured(A30 and A60), and Fibrinolysis at 30 and 60 min after MA(Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score(higher or lower than 20) and indications for transplantation(liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score. RESULTS Most of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r(41.5% of the values), k(48.6%), α(43.7%), MA(79.3%), A30(74.4%) and A60(80.9%), indicating a prevailing trend to h

关键词： Thromboelastography Liver cirrhosis Blood coagulation disorder Liver transplantation Reference values

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