Transplantation proceedings
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Although the contraindications for thoracic epidural anesthesia (TEA) are well defined, the debate continues about whether TEA improves outcomes. Pro and con trials and a metaanalysis in the past have yielded equivocal results; they did not deal with new vascular intervention or drugs. The benefit of TEA in surgery is to provide analgesia. ⋯ TEA suitability is based on an evaluation of the contraindications, comorbidities, coagulation profiles, hepatic reserve, and balance of benefits and risks. The insertion or withdrawal of the epidural catheter should be made with care according to the neuroaxial guidelines and in the presence of a normal TEG. The decreasing level of prothrombin content and platelet counts after hepatectomy should be closely monitored every 2 to 5 days.
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The concept of brain death has not been accepted by the majority of Chinese. Importantly, it is not recognized as a legal entity. We have developed a non-heart-beating donation protocol based on literature searches (Medline, Ovid, and CNKI) and issues related to Chinese customs and ethics. ⋯ We hope to find the right solutions through international debate. We believe that the use of non-heart-beating-donor organs has potential in China. We are hopeful that it will become a major organ source that is developed in such a way so as to be accepted internationally as well as in China.
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Pancreatic carcinoma, an important leading cause of cancer death, has increased steadily in incidence and still has a poor prognosis. Pain is one of the most frequent symptoms, affecting more than 75% of patients. It is often present in the early stages of disease and may be severe and difficult to treat. ⋯ Thus, painful tumors in these viscera may have pain relieved through the use of a neurolytic celiac plexus block (NCPB). Although some investigators questioned the role and the efficacy of NCPB in the treatment of upper abdominal cancer pain, most of them have suggested that it may represent the optimal treatment, especially for pancreatic cancer pain. In this report we have reviewed the techniques, results, and complications of NCPB for the treatment of pancreatic cancer pain.
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The family advocate plays a crucial role in the organ and tissue procurement process for transplantation and research. This responsibility can weigh profoundly on the consent/conversion rates for family advocates. Some potential donor families consider time as a critical factor when deciding to donate. It was hypothesized that case time will decrease by >or=20% if family advocates were trained to become level 1 recovery coordinators and utilized during organ only cases with brain-dead donors. ⋯ The results indicate that family advocates who can function in the role of level 1 recovery coordinators may decrease donor management by hours. Incorporating family services with donor management can improve the standard in the donation process.
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Severe sepsis in transplant recipients results in an extremely high morbidity mortality rate. Microvascular alterations play an important role in the development of sepsis-induced organ dysfunction. ⋯ Comparable trials in humans are still not available for the other coagulation, inhibitor antithrombin. We also report clinical trials discussing whether hyperimmune products reduce the infection rate during myelosuppression, but further trials are requested for the feasible evaluation of these products.