Assuntos
Morte Encefálica/diagnóstico , Doadores de Tecidos , Adolescente , Adulto , Criança , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Unidades de Terapia Intensiva , Transplante de Rim , Transplante de Fígado , Readmissão do Paciente , Adulto , Idoso , Feminino , Humanos , Infecções/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapiaRESUMO
We conducted a prospective case series study to investigate the causes of and factors influencing morbidity and mortality in 102 consecutive patients after elective infrarenal abdominal aneurysm (AAA) surgery between 1992 and 1995. Preoperative factors (demographics, risk factor indexes, electrocardiographic findings, ejection fraction, and stress imaging scans were indicated) and intraoperative factors (duration of surgery, size of aneurysm, complications, units of blood transfused, and additional procedures performed) were recorded. Patients were admitted to the intensive care unit (ICU) for at least 24 hours and followed for 30 days postoperatively. The mortality rate was 4.9%, due in all cases to multiorgan dysfunction syndrome (MODS). Death was preceded by colon ischemia (two patients), intraabdominal bleeding (two patients), or sepsis (one patient). Only the preoperative blood urea nitrogen correlated with mortality (p = 0.042). Complications occurred in 59% of patients in the ICU and involved the cardiovascular system in 83% of them (heart rate > 90 bpm in 49%). On multivariate analysis, only duration of surgery was associated with ICU complications (p = 0.018). No complication resulted in mortality. Ward complications occurred in 13%, and 5% of these patients required readmission to the ICU. Although cardiac complications are considered the major cause of mortality after infrarenal AAA surgery, all five deaths in the present series were due to MODS. Preoperative screening should be more selective, and intraoperative and postoperative care should be stressed.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Feminino , Humanos , Rim , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do TratamentoAssuntos
Transplante de Fígado/fisiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Imunossupressores/uso terapêutico , Israel , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Complicações Pós-Operatórias/classificação , Período Pós-Operatório , Estudos RetrospectivosRESUMO
Patients scheduled for orthotopic liver transplantation (OLT) undergo extensive routine preoperative cardiac assessment. We describe a 32-year-old male who underwent uneventful OLT for endstage liver failure on the basis of chronic hepatitis C and alcoholism. Despite a normal preoperative cardiac workup, the patient developed acute pulmonary edema on the second postoperative day. A diagnosis of beriberi was entertained and confirmed by (1) the thiamine diphosphate effect and (2) the dramatic response to intravenous thiamine. Possible precipitating factors are described. Thiamine, which has no significant toxicity, should probably be routinely supplemented in all patients undergoing OLT, especially those with a previous history of alcohol abuse.