Anestesiologia
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- Serum potassium concentrations after suxamethonium in patients with familial amyloid polyneuropathy type IPublication . Viana, JS; Neves, S; Vieira, H; Bento, C; Perdigoto, R; Furtado, ALBACKGROUND: Suxamethonium produces an abnormal increase in serum potassium in some neurological diseases and some authors have suggested that it is safer not to use this drug in patients with familial amyloid polyneuropathy (FAP). However, there are no data previously reported to support this hypothesis. The aim of this study was to evaluate the magnitude of the potassium increase produced by suxamethonium in FAP type I. METHOD: Twenty-one FAP Met 30 patients anaesthetised for liver transplantation were studied. Age was 34.9 +/- 6.9 years (mean +/- SD), time elapsed from first symptom 5.5 +/- 3.2 years and weight was 14 +/- 9% below ideal body weight. Anaesthesia was induced with thiopentone and low-dose fentanyl. Samples for blood gas and 5 min after 1 mg/kg of suxamethonium was given for tracheal intubation. RESULTS: Before induction serum potassium levels were 3.8 +/- 0.4 mmol/L. One minute after suxamethonium, values were 3.8 +/- 0.4 mmol/L and 5 min after 4.3 +/- 0.5 mmol/L. The maximal increase observed was 1.6 mmol/L (from 3.4 mmol/L to 5.0 mmol/L). CONCLUSION: The average increase in plasma potassium concentrations observed in FAP patients after suxamethonium was similar to the increase observed in a normal population by others. Our study can exclude the hypothesis that an anomalous increase in potassium would be a typical and frequent response to suxamethonium in FAP met 30 patients. However, we cannot exclude that a dangerous rise in serum potassium may exist in a certain percentage of FAP patients.
- Sequential liver transplantationPublication . Furtado, AL; Tomé, L; Oliveira, FJ; Furtado, E; Viana, JS; Perdigoto, R
- Haemodynamics during liver transplantation in familial amyloidotic polyneuropathy: study of the intraoperative cardiocirculatory data of 50 patientsPublication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Elvas, L; Coelho, L; Ferrão, J; Tomé, L; Perdigoto, R; Craveiro, AL; Providência, LA; Furtado, ALBACKGROUND: Circulatory instability frequently complicates liver transplantation for familial amyloidotic polyneuropathy (FAP) and may be a source of surgical morbidity and mortality. OBJECTIVE: To evaluate FAP intraoperative haemodynamic data and their relation to the duration of surgery, and need for anaesthetic drugs. RBC and sympathomimetic amines. SETTING: Clinical study during a four year period. PATIENTS (mean +/- SD): Group I included 50 consecutive FAP ATTR Met 30 recipients of first transplantation. Age was 35.3 +/- 7.1 years, neurological score 34.3 +/- 13 in 100 and time elapsed from first symptom 5.0 +/- 2.7 years. Group II (control), not different concerning age and sex, included 51 patients transplanted during the same period with other pathologies. METHOD: Anaesthetic protocol, monitoring and surgical techniques were similar in both groups. Data of the two groups were compared either by the Student's t-test or Fisher's exact test. RESULTS: Low values of systemic vascular resistance index were observed in both groups, with no differences between them. Systemic arterial pressures were usually lower in group I, because cardiac index and heart rate were also significantly lower, although within normal values. However, in group I, isoflurane (a vasodilator anaesthetic) was used during less time (p < 0.05) and in lower concentrations (p < 0.01) and phenylephrine was necessary in 26% of patients vs 0 patients in group II (p < 0.001). CONCLUSION: FAP patients presented a different intraoperative behaviour when compared to other patients submitted to liver transplantation. From a clinical point of view, the authors stress: 1--As a result of autonomic dysfunction, the administration of anaesthetic drugs to FAP patients always presents the risk of producing significant hypotension; even the use of ketamine does not prevent hypotension; 2--Safety is ensured by beat-to-beat surveillance of arterial pressures and the capacity to act immediately to support circulation; 3--These patients seem to be very sensitive to decreases in the pre-load; 4--Hypotension is also frequent with an adequate pre-load, usually as the result of low SVR; an infusion of a vasoconstrictor drug emerges as the most frequent treatment requested and our experience supports it as an effective one.
- Maximum sharing of cadaver liver grafts composite split and domino liver transplantsPublication . Furtado, AL; Oliveira, FJ; Furtado, E; Geraldes, B; Reis, A; Viana, JS; Bento, C; Vieira, H; Neves, S
- Requirements of circulatory support during liver transplantation: are patients with familial amyloidosis different from other patients?Publication . Viana, JS; Bento, C; Vieira, H; Neves, S; Seco, C; Perdigoto, R; Craveiro, AL; Furtado, AL
- Thrombelastographic evidence of hyperfibrinolysis during liver transplantation for familial amyloidotic polyneuropathy ATTR met 30Publication . Viana, JS; Pereira, MG; Lozano, L; Vieira, H; Palmeiro, A; Lourenço, M; Tavares, CA; Seco, C; Neves, S; Bento, C; Perdigoto, R; Ferrer-Antunes, C; Craveiro, AL; Furtado, AL
- Local immunosuppression in clinical small bowel transplantation (report of two cases).Publication . Furtado, AL; Perdigoto, R; Oliveira, FJ; Geraldes, E; Furtado, E; Tomé, L; Mota, O; Ferrão, J; Viana, JS; Bento, C; Vieira, H; Neves, S
- Sequential liver transplantation: 27 cases in 25 patientsPublication . Tomé, L; Ferrão, J; Furtado, E; Geraldes, J; Mota, O; Oliveira, F; Perdigoto, R; Viana, JS; Cipriano, MA; Furtado, AL
- Intraoperative management of liver transplantation for familial amyloid polyneuropathy Met30: what has changed in the last 10 years?Publication . Viana, JS; Vieira, H; Bento, C; Neves, S; Seco, C; Furtado, AL
- Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosisPublication . Viana, JS; Furtado, E; Romero, A; Furtado, AL