The underlying mechanisms of hyperkalemia occurring immediately after revascularization in orthotopic liver transplantation (OLT) are unknown. We investigated the possible pathophysiological mechanisms of hyperkalemia in relation to the donor and recipient. The study included 64 consecutive patients undergoing OLT. Recipients were divided into two groups: Group 1 consisted of 47 patients with serum K(+) concentration <5.5 mmol/L at 1-min postrevascularization, and Group 2 consisted of 17 patients with serum K(+) exceeding 5.5 mmol/L. Increased serum K(+) concentration, more progressive metabolic acidosis, and decreased mean arterial blood pressure and cardiac index during the anhepatic phase were recognized in Group 2. Multiple regression analysis showed that cardiac index, serum lactate, and serum K(+) concentration during the anhepatic phase were independent and significant factors that could predict serum K(+) concentration 1-min postrevascularization. Hyperkalemia at 1-min postrevascularization did not correlate with the extent of preservation injury of the graft liver (represented by the peak value of aspartate aminotransferase measured within the first 72 h after OLT) or the duration of cold ischemia. We conclude that hyperkalemia occurring immediately after revascularization in OLT is mainly caused by metabolic acidosis as a result of insufficient cardiac output during the anhepatic phase.
We describe in three patients the use of adenosine to arrest the heart without cardiopulmonary bypass during endoluminal repair of thoracic aortic aneurysms. The pharmacology of adenosine, a purine nucleoside present in all cells, is reviewed briefly, with special reference to its use in causing transient asystole, which is required for successful surgical expansion of the graft stent in the thoracic aorta.
One hundred cases of endoluminal aortic stent surgery were retrospectively reviewed and analysed with respect to outcome. The overall mortality rate was consistent with standard rates for open surgical repair. One hundred per cent of patients who developed multiorgan failure died (7), as did 78% of those who developed acute renal failure (9), and 55% of those who had a serum creatinine rise greater than 100 µmol/l (9). Patients given mannitol had an increased incidence of a serum creatinine rise of greater than 100 µmol/l, at 16% versus 4% for those not given mannitol. Patients with documented intra-or postoperative anaemia (Hb <80 g/l) had a mortality rate of 22% compared to 5% for non-anaemic patients. The mortality rate increased from 3% to 15% if the procedure took more than four hours. The anaesthetic requirements for this new type of surgery are outlined and discussed with respect to these results. The surgical technique is summarized.
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