Articles: operative.
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Pediatr Crit Care Me · Jul 2002
Mortality risk factors of a pediatric population with fulminant hepatic failure undergoing orthotopic liver transplantation in a pediatric intensive care unit.
To determine risk factors of mortality in the preoperative, perioperative, and immediate postoperative period of a pediatric population that has undergone orthotopic liver transplantation for fulminant hepatic failure in a pediatric intensive care unit. DESIGN: Retrospective review of medical records. SETTING: A pediatric intensive care unit in a children's hospital. PATIENTS: Sixty patients with fulminant hepatic failure who fulfilled King's College criteria for liver transplantation. INTERVENTION: Orthotopic liver transplantation was performed according to standard techniques. Before transplantation, patients were admitted to a pediatric intensive care unit when intensive care was required, and patients were always admitted to a pediatric intensive care unit after the operation. Measurements: A total of 20 variables were studied via univariate and multivariate analysis; statistical significance was accepted when p =.05. MAIN ⋯ Hepatitis A virus is the major cause of fulminant liver failure in Argentina, but non-A non-B non-C hepatitis is an independent risk factor of mortality. Reduced-size graft, longer ischemia time, ventilatory support before orthotopic liver transplantation, neurologic complications, and acute rejection after transplantation are independent predictive factors of mortality. Better sanitary conditions and universal immunization for hepatitis A virus should reduce hepatitis A virus and hepatitis A virus-induced fulminant hepatic failure.
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Rofecoxib is a cyclo-oxygenase 2 selective inhibitor. This systematic review of rofecoxib in acute pain examined studies in adults of analgesic efficacy over six hours, the amount and quality of the evidence on extended duration of analgesia, and the quality and quantity of evidence on adverse events. ⋯ Rofecoxib at 2-4 times the standard daily dose for chronic pain is an effective single dose oral analgesic in acute pain. Limitations in trial reporting constrain conclusions about longer duration of analgesia and adverse event profile.
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In Mexico, guidelines for fasting periods, or any audits on this topic are unavailable, and therefore the attitudes of anesthesiologists for recommending preoperative fasting periods are unknown. MATERIAL AND ⋯ Preoperative fasting periods recommended by Mexican anesthesiologists differ from international guidelines.
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Hypotensive epidural anaesthesia (HEA) combines a high epidural anaesthesia, performing a sympathetic blockade, with low-dose iv-infusion of epinephrine to stabilize circulation in the conscious patient. Mean artery blood pressure is reduced to 45-50 mmHg and hereby a reduced blood loss. In this study we have combined HEA with preoperative acute normovolaemic hemodilution (ANH) in attempt to further reduce the blood loss and need for blood transfusion in total knee arthroplasty surgery (TKR). ⋯ These data suggest no benefits in combining HEA and ANH in TKR surgery. Probably because of the reduced viscosity of the blood after ANH, there is an increased postoperative blood loss. The need for homologous blood transfusion was identical.
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Pediatr Crit Care Me · Apr 2002
Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors.
A total of 212 children =36 months of age underwent 230 congenital heart operations. Eleven children (5.2%) died perioperatively. After excluding patients who died, there were 219 surgeries among 202 patients; 25.9% (51 of 197), 51.8% (102 of 197), and 72.6% (143 of 197) of patients were successfully extubated by 12, 24, and 48 hrs, respectively. There were 22 cases in which an initial attempt at extubation failed at a median of 67.8 hrs (range, 2.4-335.5 hrs). Five patients failed a subsequent attempt at extubation at a median of 189.5 hrs (range, 115.8-602.5 hrs). The most common causes of initial FE were cardiac dysfunction (n = 6), lung disease (n = 6), and airway edema (n = 3). Risk factors for FE included pulmonary hypertension (EOR, 38.7; 95% CI, 2.9-25.8; p <.001), Down syndrome (EOR, 4.6; 95% CI, 1.8-11.8; p =.002), and deep hypothermic circulatory arrest (EOR, 4.5; 95% CI, 1.3-17.5; p =.018). All were independent predictors of FE (area under the curve, 0.837). The strongest predictor was pulmonary hypertension, which when used alone to predict FE provided a sensitivity of 0.83 (95% CI, 0.59-0.94) and a specificity of 0.75 (95% CI, 0.68-0.80). ⋯ Extubation fails after approximately 10% of congenital heart surgery in young patients. Causes of FE are diverse. In our population, preoperative pulmonary hypertension, presence of a congenital syndrome, and intraoperative circulatory arrest are risk factors for FE. Prospective validation of our predictive model with larger numbers and at multiple institutions would improve its utility.