Living donor hepatectomy (LDH)--comparative study between two different anesthetic techniques

BACKGROUND: Living donor hepatectomy (LDH) is now widely used to meet the need for liver grafts due to the shortage of cadaveric livers. Donor safety and perioperative anesthetic management are our major concern. The aim of our study was to compare two anesthetic techniques for management of living donor hepatectomy. PATIENTS & METHODS: After ethical committee approval and informed written consent, 20 donors ASA I physical status undergoing hepatectomy for living-relative liver transplant were allocated randomly to one of two groups. Group A where anesthesia was induced with fentanyl 2 microg/kg and propofol 2-3 mg/kg(-1), and maintained with isoflurane 0.8-1.2% and fentanyl infusion 1-2mcg/kg(-1)/h(-1). In group B anesthesia was induced with sufentanyl 0.2mcg/kg(-1), and propofol 2-3mg/kg(-1), and maintained with propofol infusion 6-12 mg/kg(-1)/h(-1), and sufentanyl infusion 0.2-0.4mcg/kg(-1)/h(-1). Atracurium was the muscle relaxant for intubation and maintenance in both groups. RESULTS: There were no perioperative mortality in both groups, no significant statistical differences between both groups as regard demographic data, duration of surgery, duration of anesthesia, hospital stay, intraoperative hemodynamics, blood loss, liver function tests (PT, AST, & ALT) measured in the first, third, and seventh days postoperative. CONCLUSION: In conclusion, our study demonstrated that both anesthetic techniques were well tolerated for living donor hepatectomy, with no blood transfusion required, with short and safe discharge from PACU and short hospital stay, but with significant laboratory changes reflecting transient impairment in metabolic liver function. These procedures have proven useful as an important alternative to the cadaveric liver transplantation. Both techniques can be used as fast tract technique for living donor hepatectomy.     

Summary of measurements of employee exposure to airborne dust and fiber in sixteen facilities producing man-made mineral fibers.

The results of an industry-wide study to determine the exposure of workers to man-made mineral fibers are summarized. The purpose of the study was to determine current employee exposures to airborne fibers and to utilize results to estimate past exposures. Measured exposures of workers to airborne total particulate matter and fibers are presented; samples were evaluated by phase contrast and electron microscopy. Results of the three year study, which encompassed 16 facilities and over 1500 eight hour samples, show that although there is a wide variation in concentrations of airborne fibers and particulate matter between and within the facilities surveyed, the concentrations of airborne particulate matter and fibers are generally less than 2.5 mg/m3 and 0.5 fibers/cm3, respectively. The norminal fiber size of the fibers manufactured and average airborne fiber concentration were highly correlated.     

Early Detection of Anastomotic Leakage After Elective Low Anterior Resection

Background  

Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, we investigated the early detection of anastomotic leakage before its clinical presentation.