RESUMEN
Serum catecholamine levels and peripheral vascular resistance decrease after brain death. Vasoactive drugs are used to control these hemodynamic changes and to improve perfusion of the organs. These drugs might have a role in rejection or loss of the graft organ. We aimed to investigate the effects of vasoactive drugs used in the cadaveric donor care on post-transplant renal graft functions. In this retrospective study, medical records of 135 cadaveric donors (270 kidneys) and recipients of these kidneys were evaluated. Correlation analysis was done to assess the data for factors that may cause rejection and graft loss. Vasoactive drug (noradrenaline 49%, dopamine 60%, adrenaline 3%, dobutamine 11%) consumption ratio was 85.8% in donor care. Increased number of noradrenaline infusion days was associated with decreased rates of graft rejection and graft loss. This correlation was not found for dopamine. Results of the Pearson correlation analysis test showed a relation between noradrenaline use and decrease in graft loss and graft rejection. Noradrenaline but not dopamine used in cadaveric donor care decreased the graft rejection rate and graft loss, presumably by improving hemodynamic stability and organ perfusion, although we found no special reason.
Asunto(s)
Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Riñón/efectos adversos , Norepinefrina/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Vasoconstrictores/administración & dosificación , Adulto , Muerte Encefálica , Cadáver , Femenino , Rechazo de Injerto/etiología , Humanos , Trasplante de Riñón/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In this study, we examined the correspondence between intensive care unit physicians and the relatives of potential brain-dead donors regarding the decision to donate or the reasons for refusing organ donation. A total of 12 consecutive cases of potential brain-dead patients treated in intensive care units of Marmara University Pendik Education and Research Hospital in 2013 were evaluated. For each of the cases, the Potential Donor Questionnaire, and Family Notification, Brain Death Criteria Fulfilment and Organ Donation Conversation Questionnaires were used to collect the required data. Statistically, descriptive analyses were performed. We concluded that honestly, regularly, and sufficiently informed relatives of the potential brain-dead donor more readily donate organs, with a positive contribution from the intensive care physician.
Asunto(s)
Toma de Decisiones , Familia/psicología , Entrevistas como Asunto , Relaciones Profesional-Familia , Obtención de Tejidos y Órganos , Adolescente , Adulto , Anciano , Muerte Encefálica , Niño , Preescolar , Cuidados Críticos , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Médicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Laryngoscopy and tracheal intubation may cause undesirable increases in blood pressure, heart rate (HR) and intraocular pressure (IOP). Gabapentin has been used effectively to attenuate the pressor response to laryngoscopy and tracheal intubation. We investigated whether the pre-treatment with gabapentin attenuates the IOP in addition to a haemodynamic response to tracheal intubation. METHODS: Sixty ASA I-II patients were randomly allocated into two groups who received either gabapentin (800 mg) or placebo 2 h before surgery. IOP, mean arterial pressure (MAP) and HR were measured before and after the induction of anaesthesia as well as at 0, 1, 3, 5, 10 and 15 min following intubation. RESULTS: IOP and MAP increased from baseline immediately after intubation in the placebo group (P=0.001 and 0.002, respectively). When compared with the placebo group, IOP values of the gabapentin group were significantly lower for the first 15 min after tracheal intubation (P=0.002 at 0 min, P=0.006 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min, P<0.001 at 10 min and P=0.003 at 15 min) while MAP was lower in the first 10 min (P=0.001 at 0 min, P=0.002 at 1 min, P<0.001 at 3 min, P<0.001 at 5 min and P=0.028 at 10 min). These results showed that gabapentin effectively suppresses the increase in IOP secondary to endotracheal intubation and attenuates the increases in MAP. CONCLUSION: It is suggested that gabapentin is a useful adjuvant in order to prevent an increase in the IOP in response to laryngoscopy and tracheal intubation.