[Management of hyperkalemia-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation without venovenous bypass: report of 3 cases].

The causes of high serum potassium-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation were analyzed in 3 cases without venovenous bypass, and the effectiveness of insulin was evaluated in correcting hyperkalemia during the anhepatic stage. To improve the survival rate of patients with such cardiac arrest, early cardiopulmonary resuscitation and timely defibrillation should be performed.

Clinical efficacy of brachial plexus block with patient-controlled analgesia for postoperative analgesia and recovery in the antebrachium.

OBJECTIVE: To evaluate the analgesic effect of brachial plexus block using patient-controlled analgesia device after micro-surgery in the antebrachium and its impact on postoperative recovery. METHOD: Twenty-four patients (ASA class I or II ) scheduled for micro-surgery in the antebrachium under brachial plexus block were randomly divided into PCBPA group (n=12) with patient-controlled analgesia and control group (n=12) without postoperative analgesia. In PCBPA group, postoperative patient-controlled analgesia was implemented using the mixture of 1% lidocaine and 0.25% bupivacaine and a computer- based system (Graseby 9300) with basal infusion of 2 ml/h, bolus dose of 3 ml and lockout time of 45 min. Visual analogue scale (VAS) was adopted for the evaluation of the pain intensity in both groups within 72 h after surgery, and changes in the mean arterial pressure (MAP) and heart rate (HR) observed during the peri-operation period. RESULTS AND CONCLUSION: VAS, MAP and HR in PCBPA group were significantly lower than those in the control group ( P<0.05) within 24 h after surgery, suggesting the effectiveness of the analgesic modality using patient-controlled analgesia, which also inhibits postoperative stress reaction and promotes recovery following micro-surgery of the antebrachium.

Effects of patient-controlled upper and lower epidural analgesias on postoperative respiratory and circulatory function.

OBJECTIVE: To compare the effects of patient-controlled high thoracic epidural analgesia (PCHEA) and low thoracic epidural analgesia (PCLEA) on respiratory and circulatory functions after operation. METHODS: Thirty-six patients were divided into 2 groups with 18 in each, and one group (Group H) received PCHEA during thoracic operations and the other (Group L) received PCLEA during abdominal operations. Postoperative patient-controlled analgesia (PCA) was performed in all the patients with 0.125% bupivacaine and 0.01% morphine delivered through the same epidural space for PCHEA or PCLEA. RESULTS: Postoperative analgesia did not produce significant differences in the respiration rate (Rr), tidal volume (Vt), vital capacity (VC) and oxygen saturation (SpO2) between the groups, but in both groups, Vt and VC were significantly improved compared with those before starting patient-controlled epidural analgesia (PECA) (P<0.01). In group H, its effects on systolic and diastolic blood pressure and heart rate were more obvious than in group L (P<0.05), and both groups showed these improvements after PCA started(P<0.01). CONCLUSION: PCHEA shows more marked effects on the respiratory and circulatory functions of the patients, which may mainly result from its blocking the cardiac sympathetic nerves. PCEA is able to improve postoperative respiratory function but both PCHEA and PCLEA necessitate individual-based adjustment of the PCA pump for the safety of the patient.