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B Jawan

Publications and source records attributed to B Jawan.

At least 37 records · Page 2Linked to original sources
PubMed2001

Biliary complications in living related liver transplantation.

BACKGROUND: Biliary tract reconstruction has long been considered the Achilles' heel of liver transplantation as biliary complications can increase morbidity and mortality especially in partial liver graft transplantation. METHODS: Thirty-four living related liver transplants were performed at Chang Gung Memorial Hospital in Kaohsiung for 33 children and 1 adolescent during a 5.5-year period. All potential donors underwent a detailed preoperative imaging study of the vascular and biliary anatomy, including three-dimensional helical computed tomographic cholangiography (n = 20), magnetic resonance cholangiography (n = 14), and intra-operative cholangiography (n = 31) before graft retrieval. All hepatic artery anastomoses were performed in the standard microsurgery fashion and their patency was confirmed intra-operatively using Doppler ultrasound. RESULTS: The biliary complication rate was 8.8% (3/34), including multiple intrahepatic biliary stenosis of unknown origin (n = 1), bile leakage from the Roux-en-Y loop (n = 1), and a missed biliary radicle (n = 1) which were treated via interventional radiological and surgical procedures. The overall graft and patient survival rates were 100%. CONCLUSION: The biliary complication rate in this series was low compared to those of other experienced centers. Complete study of the variations of intrahepatic duct ramification pre-and-intra-operatively provided adequate information on the appropriate transection plane. Furthermore, intra-operative Doppler ultrasound verification of vessel patency helps prevent vascular complications, which has been identified as a cause of biliary complications.

Adolescent↗
PubMed2001

Bullous eruptions caused by extravasation of mannitol--a case report.

Extravasation is one of the common complications seen with intravenous infusion. We bring forward a case of subcutaneous mannitol extravasation, which caused swelling and multiple cutaneous bullous eruptions in the hand and forearm during craniotomy. Treatment consisting of elevation of the affected extremity and application of silver sulfadiazine ointment twice daily to the injured area was successful. The possible mechanisms relevant to extravasation and its tissue damage are reviewed and discussed. Selecting proper intravenous infusion site, using pliable catheters and frequent inspection are important steps for prevention of extravasation.

Aged↗
PubMed2000

Outflow tract reconstruction in living donor liver transplantation.

BACKGROUND: Hepatic venous reconstruction is critical in living donor liver transplantation because outflow obstruction may lead to graft dysfunction or loss. We describe our experience and analyze outcomes with a technique of creating a single outflow tract using venoplasties of the graft and recipient hepatic veins. PATIENTS AND METHODS: A retrospective study was done on 38 consecutive living donor liver transplants performed from June 1994 to March 2000. The grafts included 36 left-side grafts and 2 right-side grafts. Nine grafts had multiple hepatic veins and required a venoplasty of two or three hepatic veins to create a single outflow orifice. Triple recipient hepatic venoplasty was performed in 32 patients, double venoplasty in 5 and none in 1. RESULTS: There were four cases of outflow obstruction, three occurring in patients with a double recipient venoplasty. Two of the problems were remedied intraoperatively by adjusting the position of the graft although two were structural in nature and required the insertion of expandable metallic vascular stents. All donors and recipients with their original grafts are alive at a mean follow-up period of 27 months. CONCLUSION: A triple recipient venoplasty with a matching venoplasty of multiple graft hepatic veins to create a single wide outflow orifice is recommended in living donor liver transplantation using left side grafts.

Adolescent↗
PubMed2000

Minimal blood loss living donor hepatectomy.

BACKGROUND: Donor hepatectomy with maximal safety while preserving graft viability is of principal concern in living donor liver transplantation. There are compelling reasons for avoiding blood transfusion, even with autologous blood, to avoid the potential risks it imposes on healthy donors. This study aims to describe the surgical technique and clinical outcomes of living donor hepatectomy with minimal blood loss requiring no blood transfusion. METHODS: Donor hepatectomy was performed in 30 living donors according to a detailed preoperative imaging study of the vascular and biliary anatomy. Liver parenchymal transection was carried out with strict adherence to a meticulous surgical technique without vascular inflow occlusion to either side of the liver. Pre-, intra-, and postoperative data were gathered, and factors related to blood loss were analyzed retrospectively. RESULTS: The intraoperative blood loss ranged from 20 to 300 ml with a mean of 72.0+/-58.9 ml (median, 55 ml), and neither homologous nor autologous blood transfusion was required in any of the donors intra- and postoperatively. All 30 donors were discharged with minimal complications, and remain well at a mean follow-up of 24 months after donation. Excellent graft viability was verified by the fact that all 30 recipients are alive and well with a few manageable complications. The actual graft and patient survival are both 100% at the time of writing. CONCLUSIONS: Regardless of the extent of donor hepatectomy, blood loss can and should be kept to a minimum, and living donor hepatectomy without blood transfusion is a realistic objective.

Adolescent↗
PubMed2000

Aspiration in chest compression alone without mechanical ventilation in the head down position in dogs.

BACKGROUND: Previous work by the authors has shown that chest compressions alone without mechanical ventilation during cardiopulmonary resuscitation in the natural supine position was associated with pulmonary aspiration in dogs. The purpose of this investigation was to test the hypothesis that a head down position may prevent aspiration during chest compressions alone and whether oxygenation can be improved by simply insufflation of oral oxygen 10 min after cardiac arrest. METHODS: Cardiac arrest was induced in ten mongrel dogs which were anesthetized and paralysed. Eight underwent chest compressions alone in different head down positions using an automatic compressor at 9 kg compression force and 3 cm compression depth. The study was composed of two parts. Part 1 evaluated the effect of insufflation of 10 l/min O2, into the mouth of the dogs, 10 min after initiation of resuscitation, using chest compressions alone. Part 2 was designed to test our hypothesis that the head down position may protect the lungs from aspiration during chest compression alone. The mouths of the dogs were filled with mixed barium and the dogs underwent serial episodes of chest compressions, for 10 min each, in the 20 degree head down, 10 degree head down and the natural supine positions. Chest X-rays with antero-posterior and lateral views were taken to evaluate pulmonary aspiration. Two additional dogs underwent direct chest compression alone in the natural supine position and the time of chest compression was shortened to 5 min. RESULTS: All dogs in the natural position showed evidence of pulmonary aspiration of barium, five or six of the dogs showed tracheal aspiration in the 10 degree head down position, while no any barium was visualized in the tracheo-broncheal trees of the dogs in the 20 degree head down position. Supplemental oxygen in the mouth improved the mean PaO2 from 67 +/- 26 to 160 +/- 97 mmHg during chest compressions alone. CONCLUSION: Chest compression alone without mechanical ventilation in the supine position caused pulmonary aspiration in the unprotected airway in dogs. This complication could be prevented by adopting a 20 degree head down position. The 10 degree head down position seemed to reduce the severity of the pulmonary aspiration, but not enough to eliminate the danger altogether. Supplemental oxygen in the mouth can improve oxygenation in chest compressions alone.

Administration, Oral↗
PubMed2000

Repeated hypotensive episodes due to hepatic outflow obstruction during liver transplantation in adult patients.

We report two cases of unusual repeated hypotension, decreased cardiac output, decreased mixed venous oxygen saturation, decreased central venous pressure, pulmonary artery pressure, and pulmonary wedge pressure after the completion of all vascular anastamoses of liver transplantation. These unstable hemodynamics appear to reflect a clinically relevant picture of hypovolemia. However, the real cause was partial hepatic outflow obstruction. The obstruction was suspected because hypotension was alleviated by elevating the full-sized liver graft ventrally and to the left. Doppler ultrasound examination confirmed that the flow velocity of the hepatic vein outflow was insufficient when the liver fell to its resting position in the right hepatic fossa. An additional side-to-side cavo-caval anastomosis resolved the problem in one patient, whereas the other required not only the additional anastomosis, but also application of a tissue expander filled with 770 mL normal saline beneath the liver to eliminate the obstruction. We emphasize that obstruction of the hepatic outflow causes only temporal hypovolemia because of a decrease of venous return and that treatment of this complication should be surgical intervention to relieve the obstruction. Blind resuscitation with fluids will not solve the problem and, in fact, may result in fluid overload with subsequent complications.

Adult↗
PubMed2000

International sharing of split liver grafts in Asia: initial experience.

The donor shortage problem is particularly serious in Asia and has markedly limited progress in liver transplantation. The increasing demand has, in fact, made it necessary to resort to living donor liver transplantation in both pediatric and adult recipients. Nevertheless, expanding the use of split liver allografts is yet another option to increase the supply. This has a wide potential application on a regional level because most liver transplant programs are still small and may have limited resources in terms of being able to do two transplants in one sitting. The first experience of overseas sharing of split liver grafts in Asia took place in January 1999. The graft was from a 35-yr-old donor from Kaohsiung, Taiwan, who sustained irreversible brain damage in a vehicular accident and had optimal conditions for multiorgan donation. The liver was split ex vivo and the left lateral segment was given to a 3-yr-old girl with biliary atresia at the Chang Gung Memorial Hospital. The extended right lobe split graft was transported to Hong Kong and transplanted into a 51-yr-old male patient with end-stage hepatitis C cirrhosis who was then in a state of acute failure with hepatorenal syndrome. Graft function was excellent in both recipients and the patient from Taiwan was discharged without any complications. Unfortunately, the Hong Kong recipient developed a cerebrovascular accident and required a reoperation for bile leakage from the cut surface of the liver in the early postoperative period. He has made a steady recovery since then; graft function has remained good and his kidneys have recovered. Both patients are currently alive and well 11 months post-transplant. This initial experience of overseas sharing of split liver grafts in Asia demonstrates its feasibility. It has a potentially wide applicability and could lead to the establishment of a formal organ-sharing network in the region. Established competence and mutual trust among the participating liver transplant teams would be essential in perpetuating such a graft-multiplying strategy on an organized basis.

Adult↗
PubMed2000

Aspiration in transtracheal oxygen insufflation with different insufflation flow rates during cardiopulmonary resuscitation in dogs.

We investigated whether transtracheal insufflation of oxygen with different insufflation flow rates protects against aspiration of gastric contents during cardiopulmonary resuscitation (CPR). Its ventilation and oxygenation effects were also evaluated. Cardiac arrest was induced in anesthetized and paralyzed 18 mongrel dogs. Chest compression using an automatic thumper was performed while the dogs randomly received no mechanical ventilation (Group I, n = 6) or were transtracheally insufflated with 4 L/min oxygen (Group II, n = 6) or 10 L/min oxygen (Group III, n = 6). Blood samples were drawn every 5 min for 20 min for blood gas analysis. the mouths of the dogs were then filled with 70 mL mixed barium, and 10 min after chest compression, chest radiographs were taken to evaluate the incidence of pulmonary aspiration. Results showed that pulmonary aspiration occurred in all dogs of Group I and three of the six dogs in Group II, whereas dogs in Group III were free from pulmonary aspiration. Both transtracheal oxygen insufflation groups maintained oxygen saturation significantly better than Group I, but mild hypercapnia was observed in all groups after 20 min of CPR. We conclude that transtracheal oxygen insufflation, but not chest compression alone, was able to maintain oxygenation for 20 min during CPR in dogs with cardiac arrest. Mild hypercapnia was noted in all groups. Chest compression alone caused pulmonary aspiration, whereas insufflation of 10 L O(2)/min provided better protection against pulmonary aspiration than that of 4 L O(2)/min.

Animals↗
PubMed2000

Cardiac arrest induced by accidental inhalation of anoxic gases, is the cause always a lack of oxygen?

BACKGROUND: We experienced a case of accidental administration of 100% carbon dioxide (CO2) during anesthesia, which resulted in cardiac arrest. After successful cardio-pulmonary resuscitation the child recovered without brain damage. This outcome was quite different than that of the more commonly reported accidental administration of 100% nituous oxide (N2O), as the latter usually results in death from cerebral damage rather than cardiac arrest. We speculated that the cause of death and/or cardiac arrest may differ between these two anoxic gases. METHODS: Fourteen dogs were anesthetized and divided into two groups to receive either 100% CO2 or 100% N2O. Blood pressure (BP), heart rate (HR), cardiac output (CO), dp/dt, pulmonary artery pressure (PAP), central venous pressure (CVP) and blood gases (BG) were measured every 30 seconds until cardiac arrest (CA) occurred. RESULTS: The CO2 group showed a rapid decline in BP, HR, dp/dt, CO, pH, and PaO2 and a rise in PAP, CVP, and PaCO2, with CA occurring at 119 +/- 41 seconds. At the time of CA, the BG values were pH 6.6 +/- 0.09, PaCO2 375 +/- 69, and PaO2 62 +/- 15 mm Hg. The N2O group maintained BP, HR, dp/dt, pH, PaCO2, and experienced a rapid decline in PaO2 as in the CO2 group until 180 seconds, at which time the PaO2 was 12.3 +/- 3 mm Hg. CA occurred at 390 +/- 52 seconds. The values for pH, PaCO2 and PaO2 were 7.5 +/- 0.05, 25 +/- 15 and 4.8 +/- 1 mm Hg, respectively, at the time of CA. CONCLUSION: One hundred percent CO2-induced cardiac arrest occurred in 119 seconds and was not oxygen-dependent, whereas 100% N2O induced cardiac arrest occurred in 390 seconds and was clearly dependent on hypoxemia.

Acute Disease↗
PubMed2000

Anesthesia for patients with aortic aneurysm for non-aneurysmal surgery--a retrospective study.

BACKGROUND: Most anesthesiologists at one time or other saw the anesthetic management of patients with aortic aneurysm who underwent surgical procedures other than correction of aneurysm with or without prior knowledge of the existence of the aneurysm. The risk of intraoperate rupture of aneurysm depends on its size, type, severity, and presentation of symptoms; stress and unstable hemodynamics have been usually held responsible for the aggravation and even rupture of aneurysm. There are numerous other factors that affect the hemodynamic force during anesthesia and surgery, the increase of which would be very dangerous to the surgical patients with aortic aneurysm whether they receive anesthesia for a radical correction of the disease per se or for a surgical procedure unrelated to its correction. Therefore the anesthetic management of a patient with aortic aneurysm is a great challenge which the anesthesiologist must accept. Here, we present eleven cases of aortic aneurysm, who underwent non-corrective surgery during 1992-1998. METHODS: There were eight cases of thoracoaortic dissecting aneurysm and three cases of abdominoaortic aneurysm. All underwent laparotomy under general anesthesia without the aneurysm being corrected. We reviewed the anesthetic management of these patients retrospectively. RESULTS: Our review showed that no aneurysm rupture was noted in these eleven cases. Seven of the eleven patients are still alive at the time of this report. CONCLUSIONS: We are of the opinion that under close monitoring and with prompt treatment, the allowance of a slow climb of arterial pulse pressure is acceptable and would not increase the risk of aneurysm rupture.

Aged↗