Citations

The 24th Joint Annual Congress of the International Liver Transplantation Society in association with European Liver and Intestine Transplant Association and Liver Intensive Care Group of Europe was held in Lisbon, Portugal from May 23 to 26, 2018. More than 1200 participants from over 60 countries including surgeons, hepatologists, anesthesiologists and critical care intensivists, radiologists, pathologists, organ procurement personnel, and research scientists came together with the common aim of improving care and outcomes for liver transplant recipients. Over 600 scientific abstracts were presented. The principal themes were living donation, use of marginal liver donors, machine preservation, disease-specific immunosuppressive regimen, malignancies, and advances in pediatric liver transplantation and liver transplant anesthesia. This report presents excerpts from invited lectures and select abstracts from scientific sessions, which add to current knowledge, and will drive clinical practice and future research.

Purpose B0 eddy currents are a subtle but important source of artifacts in spiral MRI. This study illustrates the importance of addressing these artifacts and presents a system response‐based eddy current correction strategy using B0 eddy current phase measurements on a phantom. Methods B0 and linear eddy current system response measurements were estimated from phantom‐based measurement and used to predict residual eddy current effects in spiral acquisitions. The measurements were evaluated across multiple systems and gradient sets. The corresponding eddy current corrections were studied in both axial spiral‐in/out TSE and sagittal spiral‐out MPRAGE volunteer data. Results Correction of B0 eddy currents using the proposed method mitigated blurriness in the axial spiral‐in/out images and artifacts in the sagittal spiral‐out images. The system response measurement was found to yield repeatable results over time with some variation in the B0 eddy current responses measured between different systems. Conclusions The proposed eddy current correction framework was effective in mitigating the effects of residual B0 and linear eddy currents. Any spiral acquisition should take residual eddy currents into account. This is particularly important in spiral‐in/out acquisitions.

Background There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20). Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure.

BACKGROUNDIntraoperative plasma transfusion is common, yet little is known regarding its effects on perioperative coagulation tests or clinical outcomes.STUDY DESIGN AND METHODSThis is a retrospective cohort study of adults receiving intraoperative plasma transfusion at a single center from 2011 to 2015. Relationships between plasma transfusion volume, changes in coagulation test values, and clinical outcomes, including a primary outcome of early postoperative red blood cell (RBC) transfusion, were assessed with multivariable regression analyses. Secondary outcomes included hospital mortality, intensive care unit (ICU)‐ and hospital‐free days, intraoperative RBC transfusions, and estimated blood loss.RESULTSA total of 3393 unique patients were included, with median (IQR) transfusion of 2 (2‐4) units. In multivariable analyses, higher plasma volumes were associated with worse outcomes, with each 1 mL/kg increase associated with increased odds for postoperative (1.02 [1.01‐1.03], p < 0.001) and intraoperative RBCs (1.17 [1.16‐1.19], p < 0.001) and fewer ICU‐ and hospital‐free days (mean difference [95% CI], –0.08 [−0.12 to −0.05], p < 0.001; and −0.09 [−0.13 to −0.06], p < 0.001, respectively). Greater decreases in international normalized ratio (INR) following plasma transfusion were associated with decreased odds of postoperative RBCs (0.35 [0.25‐0.47], p < 0.001), decreased mortality (0.50 [0.31‐0.83], p = 0.007), and increased mean ICU‐ (1.31 [0.41‐2.21], p = 0.004) and hospital‐free days (1.15 [0.19‐2.10], p = 0.018).CONCLUSIONIn patients receiving intraoperative plasma transfusion, higher transfusion volumes were associated with inferior clinical outcomes; however, greater improvements in INR were associated with improved outcomes. Future prospective studies are necessary to better define these relationships and to explore plasma transfusion triggers beyond the limitations of INR.

Myeloproliferative neoplasms (MPNs) are rare hematological malignancies with a significant symptom burden often left unresolved despite recent advances in pharmacological therapy. Yoga is a nonpharmacological strategy that has been shown to improve symptoms in other cancers and may be effective for improving symptoms in MPN patients. Online yoga helps address many of the commonly reported barriers of cancer patients to in-person interventions and may make yoga more accessible to MPNs. An exploration of MPN patient perceptions of participation in online yoga is needed to tailor interventions to patient needs and inform future studies. The purpose of this study was to explore the perceptions of MPN patients participating in a 12-week online yoga intervention. This article represents the combined qualitative interview data from two studies. Participants were asked to complete 60 min/wk of online, home-based yoga and were asked to participate in a 15- to 20-minute phone interview postintervention. The qualitative data was coded in NVivo 11 for content analysis. The total sample included 39 MPN patients. Online yoga was well accepted and liked among these patients. They reported physical (eg, improved sleep, reduced fatigue) and mental (eg, reduced stress) health benefits and liked the convenience of being able to do yoga at home. Online yoga provides a feasible and attractive format through which to deliver a nonpharmacological intervention among MPN patients. Randomized controlled trials are needed to confirm the effects of online yoga on MPN patient symptoms. The qualitative findings presented here help inform the development of these future trials.

Airway fires in the surgical suite are catastrophic and deadly. When there is a combination of an endotracheal (ET) tube filled with oxygen and an ignition source such as a laser, the standard ET tube acts like a blowtorch in the patient’s trachea. These tubes can be ignited at oxygen levels as low as 26% [1]. Laser safety programs should incorporate measures to isolate the triad that is present in all Operating Room (OR) fires: a source of oxygen, fuel, and ignition. Although safety hazards are inherent when lasers are used in the OR, they can be significantly reduced, if not eliminated, if proper procedures are implemented and adhered to whenever a laser is utilized in the OR. This article reviews the safety hazards and the implementation of a “Laser Time Out” to allow for the safe use of lasers in the Operating Room.

A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.

An infant with complex congenital heart disease suffers a prolonged cardiac arrest with minutes of anoxia. He is left with severe brain damage and profound neurologic impairment. He no longer responds to caregivers. Much of the time, he cries and grimaces as if in pain. He has required increasing sedation to control these symptoms. His parents live hours from the hospital and seldom visit. When their infant’s situation is explained to them over the telephone, they request that doctors “do everything to keep him alive.” His bedside caregivers report high levels of moral and psychological distress and frequently discuss J.S.’s “suffering.” An ethics consultation is requested, asking whether it is permissible to withdraw life support despite the parents’ request that therapy continue.