BACKGROUND: In liver transplantation, an increase of serum potassium [K+] after reperfusion is related to components of the preservation solution. However, the histidine-tryptophan-ketoglutarate (HTK) solution, which is now popularly used, has a twelve times lower [K+] as compared to the UW solution. This retrospective study was performed to compare the use of the UW solution with the HTK solution for changes in the serum [K+] during the early reperfusion period in liver transplantation recipients. METHODS: Anesthesia medical records of 366 liver transplant patients were reviewed and patients were enrolled in one of the two groups; recipients who received a transplanted liver preserved with the UW solution (UW group), and recipients received a liver preserved with the HTK solution (HTK group). Serum [K+] changes 5 min before, 5 min after, and 20 min after reperfusion for recipients in each group were compared. RESULTS: In the UW group, [K+] increased 5 min after reperfusion and decreased 20 min after reperfusion as compared to [K+] 5 min before reperfusion (3.93, 4.07, and 3.76 mM in 5 min before, 5 min after, and 20 min after reperfusion respectively; P < 0.001). In the HTK group, [K+] significantly decreased 5 min and 20 min after reperfusion as compared to [K+] 5 min before reperfusion (4.12, 3.79, and 3.75 mM; P < 0.001). CONCLUSIONS: When the HTK solution was used, the serum [K+] 5 min after reperfusion decreased as compared to the [K+] before reperfusion and didn't further decrease until 20 min after reperfusion.
Adenosine ; Allopurinol ; Anesthesia ; Glucose ; Glutathione ; Humans ; Insulin ; Liver ; Liver Transplantation ; Mannitol ; Medical Records ; Organ Preservation Solutions ; Potassium ; Potassium Chloride ; Procaine ; Raffinose ; Reperfusion ; Retrospective Studies ; Transplants

BACKGROUND: Levobupivacaine is known to be less cardiotoxic than racemic bupivacaine but some authors have reported there were no differences in cardiotoxic profiles between two agents. We will investigate the full course to cardiovascular collapse induced by bupivacaine stereoisomers in anesthetized dogs and would find out the differences if any, and explain the causative factors. METHODS: Twenty dogs were assigned to two groups, racemic bupivacaine group (BUP) and levobupivacaine group (LBUP), equally (n=10, each). Under general anesthesia each drug was infused continuously (0.5 mg/kg/min) until cardiovascuar collapse (CVC, MAP=40 mmHg) occurred. During the experiment, hemodynamic data, CO, SVR, PVR, ECG parameters and drug concen tration were gathered and analyzed. RESULTS: Two groups were not different in terms of dose for CVC, plasma drug concentration and time for CVC. MAP maintained initial values during the early period and declined during the late period without any between-group difference. Otherwise CO decreased continuously and significantly higher in LBUP than in BUP throughout. Calculated SVR showed the same feature as CO in opposite direction and was higher in BUP. Correlation test revealed high correlation between CONC and SVR or PVR and between CO and cSvO2. CONCLUSIONS: In assessment of cardiovascular collapse induced by stereoisomers of bupivacaine, monitoring with only MAP can lead to misinterpretation and invasive monitoring including CO or cSvO2 measurement might be needed.
Anesthesia, General ; Animals ; Bupivacaine* ; Dogs* ; Electrocardiography ; Hemodynamics* ; Plasma ; Stereoisomerism

OBJECTIVE: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. METHODS: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). RESULTS: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p < 0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p < 0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p < 0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p < 0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p < 0.05). CONCLUSION: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.
Antiemetics ; Arterial Pressure ; Cholecystectomy, Laparoscopic* ; Electronic Health Records ; Gallbladder ; Heart Rate ; Hemodynamics ; Humans ; Neostigmine* ; Postoperative Nausea and Vomiting ; Respiration* ; Retrospective Studies ; Tachycardia