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L Olmedilla

Publications and source records attributed to L Olmedilla.

15 recordsLinked to original sources
PubMed2005

Radial to femoral arterial blood pressure differences during liver transplantation.

This observational study compared femoral and radial arterial blood pressure in 72 patients undergoing liver transplant surgery. Simultaneous femoral and radial arterial blood pressures, cardiac index, core temperature and vasoconstrictor therapy were recorded at seven time points during the operation. No significant differences between radial and femoral pressures were found at the start of surgery. Femoral and radial systolic arterial blood pressures were statistically significantly different during liver reperfusion (mean (SD) arterial pressure = 92 (22) mmHg vs. 76 (22) mmHg, p < 0.01). Mean arterial blood pressures showed no statistically significant differences throughout the study. Vasoconstrictor drug administration was associated with a larger systolic pressure difference between femoral and radial arteries (28 (24) mmHg in patients being given vasoconstrictor drugs vs. 9 (19) mmHg in patients not needing vasoconstrictors during reperfusion, p < 0.001). In conclusion, differences in systolic arterial blood pressure occur between femoral and radial arterial monitoring sites during liver reperfusion, and in particular in patients being given vasoconstrictor therapy. Thus, if femoral arterial monitoring is not available, clinicians should rely on mean rather than systolic arterial pressure measurements from a radial artery catheter during liver transplantation.

Adult↗
PubMed2004

[Recombinant activated factor VII used in a man with refractory bleeding from a stab wound injuring the liver and kidney].

A 30-year-old man bled massively from a stab wound that injured his liver and right kidney and entered a life-threatening cycle of transfusion, hypothermia, coagulopathy, and rebleeding in spite of surgery and aggressive resuscitation. He was given a single dose of recombinant activated factor VII (rVIIa; NovoSeven, Novo Nordisk, Denmark) in a final attempt to save his life. The patient responded favorably, as bleeding stopped almost immediately and coagulation markers became normal. Clinical course following rVIIa administration was good. Severe bleeding in the trauma patient needing massive transfusion can become complicated by dilutional coagulopathy and hypothermia. Therapy with rVIIa is a promising aid to controlling bleeding in the repeatedly transfused patient who does not respond to standard replacement of blood products.

Adult↗
PubMed2004

[Paravertebral analgesia in thoracic surgery].

Managing postoperative pain from thoracotomy is one of the greatest challenges anesthesiologists face in daily practice. Proper management is assumed to improve the patient's prognosis. The thoracic paravertebral block, following its rediscovery, is being used with increasing frequency and success for both surgery and recovery from thoracotomy, challenging the supremacy of thoracic epidural analgesia, which to date has been considered the gold standard. We describe the history, anatomy, techniques and complications of the thoracic paravertebral block and review published randomized controlled trials comparing the thoracic paravertebral block to placebo and to epidural analgesia. In view of published evidence, it seems that the thoracic paravertebral block may replace the thoracic epidural technique as the gold standard for providing analgesia for patients undergoing thoracotomy.

Analgesia↗
PubMed2003

Autonomic neuropathy in end-stage cirrhotic patients and evolution after liver transplantation.

Autonomic neuropathy (AN), which is frequently observed in cirrhosis patients, has been associated with a higher mortality. We have prospectively evaluated the prevalence of AN, its relationship with the degree of liver dysfunction and circulatory disturbances, and the evolution of AN after liver transplantation (LT) in 62 end-stage liver cirrhosis patients. AN was evaluated by seven cardiovascular tests assessing sympathetic or parasympathetic function before and 6 months after LT. Patients were classified as showing absent (A), early (E), or definite dysfunction (D). AN appeared in 67.7% of cases (E: 24.2%, D: 43.5%) without relation to liver disease etiology. Parasympathetic dysfunction was more prevalent than sympathetic dysfunction (59.7% vs. 20.9%). AN was significantly related to Child-Pugh score. Hyperdynamic circulation was more marked in the D than the A group as shown by a greater cardiac output (CO)(9 vs. 7.3 L/min) and a lower peripheral resistance (SVR)(666 vs. 866 dyn.s.cm(-5)). Moreover, AN scores significantly correlated with CO and SVR. Overall the prevalence of AN decreased 6 months after LT (67.7% vs 48%) due to a significant reduction in definite AN (43.5 vs. 14.8%; P<.05). AN improved in 70% of cases after LT. Sympathetic dysfunction remained in only one patient. We conclude that AN is frequent in liver transplant candidates; its severity is associated with the degree of liver failure. Systemic circulatory disturbances seem to correlate with the severity of AN. AN is clearly improved by LT. The evaluation of AN may contribute to a better selection of LT recipients.

Autonomic Nervous System Diseases↗
PubMed2003

Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation.

INTRODUCTION: End-stage liver disease is frequently associated with autonomic neuropathy (AN). The hemodynamic changes during liver transplantation (LT) require an adequate autonomic response to maintain cardiovascular stability. PATIENTS AND METHODS: Forty-one patients undergoing LT were evaluated for the influence of AN on the evolution after LT. AN was previously evaluated by seven cardiovascular tests assessing sympathetic (Sy) or parasympathetic (P) function. Patients were classified as absent (A), early (E), or definite dysfunction (D). A hemodynamic study was performed before and after vascular clampings. The analysis included the duration of LT, transfusion requirements, intra-operative artenal hypotensive episodes, incidence of postreperfusion syndrome (PRS), cardiac arrhythmias and vasoactive drug requirements. RESULTS: The hyperdynamic circulation worsened during surgery in D patients, as shown by a significantly increased cardiac output and a significantly decreased systemic vascular resistance. The incidence of PRS was greater in the AN group. Arterial hypotension during the neohepatic period was more frequent among patients with AN, more frequently requiring vasoconstrictor and inotropic therapy. CONCLUSIONS: AN is associated with hemodynamic impairment and with increased vasoactive drug requirements during liver transplantation, probably associated with impaired reflex vasoconstrictor responses to surgical manipulations and changes of blood volume. AN may be associated with a greater surgical risk during LT. Preoperative evaluation of AN may select a high-risk population of LT recipients.

Adult↗
PubMed1999

Presence of a nitric oxide synthase inhibitor in the graft efflux during reperfusion in human liver transplantation.

Involvement of the nitric oxide (NO) system in complications following human orthotopic liver transplants (OLT) has been reported, but the contribution of the graft to the modulation of the NO system during reperfusion in normal OLT has not been characterized. We have studied the contribution of the graft efflux to the modulation of the NO system in 20 consecutive OLT. We evaluated its effects on isolated vascular reactivity of the rabbit and on rat cultured macrophages stimulated with lipopolysaccharide (LPS). In none of the donor liver biopsies was expression of inducible NO synthase (iNOS) activity by Northern or Western blot analysis found. Graft efflux after the onset of liver reperfusion, but not pre-transplant patient plasma, reversibly inhibited the acetylcholine-induced relaxation of norepinephrine-contracted rabbit aortic rings. Moreover, graft efflux reversibly inhibited NO production in rat macrophages treated with LPS, as evidenced by both a decrease in nitrite plus nitrate formation and a decrease in the production of [14C]citrulline from [14C]arginine. Addition of a 10% dilution of graft efflux to cultured rat macrophages incubated with LPS increased iNOS mRNA levels, suggesting direct inhibition of the enzyme but not of its expression. These results cannot be ascribed to the depletion of arginine the iNOS substrate since they can be reproduced even in the presence of an excess (10 mM) of exogenously added arginine. No correlation was found between the iNOS inhibitory activity in each sample and the corresponding clinical parameters related to either the graft function after the OLT or the existence of post-reperfusion syndrome. Our results indicate the existence of a soluble factor in the graft efflux from human OLT that reversibly and unspecifically inhibits NOS activity. Its involvement in the physiology and/or pathology of human liver diseases deserves further study.

Acetylcholine↗
PubMed1999

Arterial oxygenation during one-lung ventilation: combined versus general anesthesia.

UNLABELLED: The optimal anesthetic management of patients undergoing thoracotomy for pulmonary resection has not been definitely determined. We evaluated whether general i.v. anesthesia (propofol-fentanyl) provides superior PaO2 during one-lung ventilation (OLV) compared with thoracic epidural anesthesia (TEA) with supplemental local and general anesthetics. We studied 60 patients who had prolonged periods of OLV for elective thoracic surgery for lung cancer and who were prospectively randomized into two groups. In 30 patients (GA group), fentanyl/propofol/rocuronium anesthesia was used. Another 30 patients (TEA group) were anesthetized with propofol/rocuronium/epidural thoracic bupivacaine 0.5%. A double-lumen endotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV (OLV + 15 and OLV + 30, respectively) in all patients. We measured PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture percentage (Qs/Qt%), and arterial and central venous oxygen content. The mean values for PaO2 during OLV in the GA group after 15 min (175 mm Hg) and 30 min (182 mm Hg) were significantly (P < 0.05) higher compared with the TEA group (120 and 118 mm Hg, respectively). Furthermore, Qs/Qt% was significantly (P < 0.05) increased in the TEA group during OLV. There were no other significant differences. We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total i.v. anesthesia alone. IMPLICATIONS: Sixty patients undergoing elective lung surgery during a prolonged period of intraoperative one-lung ventilation were studied and randomized to receive general i.v. anesthesia or general i.v. anesthesia combined with thoracic epidural anesthesia. The arterial oxygenation in the first group was better than that in the second group during one-lung ventilation.

Aged↗
PubMed1997

Response to clamping of the inferior vena cava as a factor for predicting postreperfusion syndrome during liver transplantation.

Postreperfusion syndrome (PRS) is an important cause of hemodynamic deterioration during orthotopic liver transplantation (OLT). We retrospectively studied 94 patients who had undergone OLT in an effort to establish whether the hemodynamic response to clamping of the inferior vena cava (IVC) could be used to predict hemodynamic behavior on reperfusion of the grafted liver. PRS was defined as a decrease in the mean arterial pressure of more than 30% below the baseline value for more than 1 min during the first 5 min after reperfusion of the graft. The patients were divided into two groups: those who developed PRS (PRS group) and those who did not (non-PRS group). We analyzed hemodynamic response before (dissection stage) and after (anhepatic stage) clamping of the IVC. Based on multivariate analysis methods (logistic regression), the percentage of change in the vascular resistance index from before clamping to after clamping of the IVC was an indicator of the risk of developing PRS, with an adjusted odds ratio of 1.04 for each unit of change (ENTER method, P = 0.01). In the non-PRS group, clamping of the IVC was followed by a 47.1% decrease in the cardiac index, compared with a 27.9% decrease in the PRS group (P < 0.05). The systemic vascular resistance index (SVRI) increased by 49% in the PRS group, as opposed to 85.7% in the non-PRS group (P < 0.05). PRS occurred in only 17.5% of patients in whom the SVRI increased by more than 50%. We conclude that the integrity of the vasoconstrictive response (increase in the peripheral vascular resistance greater than 50%) as measured immediately after clamping of the IVC correlates with occurrence of PRS.

Adult↗
PubMed1995

[The liver transplant program of the Hospital General Universitario Gregorio Marañón: an analysis of the first 100 patients].

During a 3-year period between 1990 and 1993, 100 patients received orthotopic liver transplantation at the "Gregorio Marañón" University General Hospital. The mean age of the patients was relatively high (46.9 +/- 10 years), with an important number of cirrhotic patients (91%). The rate of primary liver failure was relatively low (4.5% of transplantations) although 12 cases with more than 55 years were included in the present series. Eleven retransplantations were performed, 8 for early failure of the graft and 3 for chronic failure. Postoperative complications of the graft were vascular in 9 cases, biliary in 17 cases, and acute rejection (cellular) in 70 patients, although only 50 of these patients required treatment with steroid boluses. Infections were diagnosed in 60 cases with 80% of major infections, 6 of them caused by Aspergillus fumigatus that were lethal in all the cases. Postoperative survival was 82%, 72%, 69% and 69% at 1 month, 6 months, 1 year and 2 years respectively.

Adult↗
PubMedDate not supplied

[Internal jugular vein catheterization performed by resident and staff physicians].

OBJECTIVES: To analyse complications in the catheterization of the internal jugular vein using the Boulanger technique and to establish a rating of difficulty and risk when the procedure is carried out by physicians in training. MATERIAL AND METHODS: This was a prospective study of 296 internal jugular vein (IJV) catheterizations by the Boulanger technique carried out by physicians in training (group R2 and group R3-4) or by departmental staff physicians (group staff). Time taken for venous catheterization, rate of success and complications were recorded for each physician performing the procedure. RESULTS: The complication most often observed (11.4%) was puncture of the carotid artery (14.3% group R2, 10% group R3-4 and 8.2% staff), followed by arrhythmia upon insertion of the metal guide (1.6%). There were no instances of pneumothorax or hemothorax, nor any other of the early complications considered infrequent. Success ranged from 68.8% for group R2 to 85.7% for staff. Mean time used in group R2 was 238.7 seconds, while for staff it was 118.3 seconds. CONCLUSION: We suggest that the Boulanger technique for catheterization of the internal jugular vein is a good one and is not particularly hazardous when performed by resident physicians in training.

Adolescent↗
PubMedDate not supplied

[Intracavitary electrocardiography. A useful method for checking the correct localization of central venous catheters].

A placement technique for central venous catheters (CVC) using the intracavitary electrocardiography (ICECG) as well as three different connection systems of the CVC to the electrocardiographic monitor are described. The aim of the present study was to evaluate the correct placement of the CVC by this technique with posterior radiologic confirmation being carried out. The study was undertaken in 30 patients connecting a CVC to a negative electrode of the standard lead II and the positive to the left leg. The CVC was advanced and the changes in the morphology of the "P" wave as it passed along the superior vena cava (SVC) to the right auricle (RA) were observed. In 28 of the 30 patients (93.3%) a biphasic "P" wave (right auricle) was achieved with the CVC being thereafter withdrawn until the SVC (this location was radiologically confirmed posteriorly). In 2 patients (6.6%) a biphasic "P" wave was not obtained and an abnormal position of the CVC was radiologically demonstrated at surgery (one in the ipsilateral subclavian vein and the other had a ring within the right subclavian vein impeding progression). The mean time used in the performance of this technique was 220 +/- 40 s. It is concluded that intracavitary electrocardiography is a simple, easy to learn and perform technique which does not delay surgical procedure and it is a reliable method for placing the end of the CVC.

Catheterization, Central Venous↗