The link between high factor VIII to protein C ratio values and poor liver function after major hepatectomy.

Our goal was to assess the coagulation profile in the immediate postoperative time after major liver surgery and its association with the liver function. Our hypothesis is that a decreased synthesis of the coagulation factor levels reflects an impaired liver synthesis following hepatic resection and will be associated with poor outcomes. This is a prospective, observational study recruiting consecutive patients scheduled for major liver resection in a tertiary hospital. Coagulation profile was assessed by conventional assays, viscoelastic assays and coagulation factor levels preoperatively and, on postoperative days 1, 2 and 6. Factor VIII to protein C (FVIII/PC) ratio has been used as a surrogate marker of hemostatic imbalance. Liver function was measured with conventional and indocyanine green (ICG) clearance tests, which were obtained preoperatively and on postoperative days 1 and 2. Sixty patients were recruited and 51 were included in the study. There is a clear increase in FVIII/PC ratio after surgery, which was significantly associated with low liver function, being more pronounced beyond postoperative day 2 and in patients with poorer liver function ( P  < 0.001). High FVIII/PC ratio values were significantly associated with higher postoperative morbidity, prolonged ICU and hospital stay and less survival ( P  < 0.05). High FVIII/PC ratio on postoperative day 2 was found to be predictor of posthepatectomy liver failure (PHLF; area under the ROC curve = 0.8129). Early postoperative high FVIII/PC ratio values are associated with low liver function, PHLF and poorer outcomes in patients undergoing major hepatic resection.

Manejo anestésico en paciente pediátrico con distroña miotónica tipo 1. Reporte de caso / Management of anesthesia in a pediatric patient with myotonic dystrophy type 1. Case report

Abstract Myotonic dystrophy is a disease affecting the muscle fibers with loss of muscle mass. The principal characteristic of the disease is myotony or slow muscle relaxation following muscle contraction that is further aggravated as a result of stress, pain, cold, or by the administration of succinylcholine. Similar to other muscle pathologies, myotonic dystrophy is considered a multisystem disorder, usually with cardiac and respiratory involvement, a fact to be kept in mind when planning anesthesia. Moreover, there is a potential association with malignant hyperthermia or rhabdomyolysis associated with some muscle diseases. The case herein discussed is an example of the management of anesthesia in this group of patients to avoid the potential triggers of a myotonic crisis.

Resumen La distrofia miotónica es una enfermedad de las fibras musculares que cursa con pérdida de masa muscular y cuya característica principal es la miotonía, que describe la relajación muscular lenta tras una contracción muscular, situación agravada por estrés, dolor, frío, o por la administración de succinilcolina. Como toda enfermedad muscular, es considerada multisistémica, con afectación cardíaca y respiratoria en la mayoría de los casos, lo cual deberá tenerse en cuenta a la hora de elaborar un plan anestésico. Además, se debe considerar la posible relación con el desarrollo de hipertermia maligna o rabdomiólisis asociada a algunas enfermedades musculares. El caso que presentamos es un ejemplo del manejo anestésico de estos pacientes evitando los posibles desencadenantes de una crisis miotónica.

Trombocitopenia inducida por heparina con trombosis aortoilíaca tratada con argatrobán / Heparin-induced thrombocytopenia with aortoiliac thrombosis treated with argatroban

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