Day 3 :
Keynote Forum
Ranendra Hajong
NEIGRIHMS, India
Keynote: Spontaneous inguinal enterocutaneous fistula as a complication of incarcerated Richter’s hernia - Report of two cases
Time : 09:00-09:30
Biography:
Ranendra Hajong is an Associate Professor in General Surgery at NEIGRIHMS, India. He has around 40 publications in various indexed journals and has presented papers in various scientific forums. His activities involve teaching undergraduate and postgraduate medical students, patient care services and research.
Abstract:
Rarely inguinal hernia may present with rare complication of spontaneous faecal fistula. Non-availability of proper medical care and unawareness of the condition are the major factors having potential for transformation of a relatively benign condition of inguinal hernia into complicated state of incarceration and strangulation. Case 1: A 50 year old female patient presented with passage of faecal material from the left inguinal region since the last one week. It was preceded with the history of a painful swelling in the same region about two weeks back for which incision and drainage was done. Magnetic resonance imaging showed features of left sided direct inguinal hernia with intact femoral canal. The patient did not opt for any surgical intervention, so was managed conservatively. Case 2: A 53 years old man presented to us with history of on and off discharge of yellowish debris from the left groin region since the last three years. Contrast fistulogram with urografin showed communication of the cutaneous opening with the jejunal loops. Magnetic resonance fistulogram confirmed the diagnosis. Patient underwent lower midline laparotomy. Mid-jejunum was found to be communicating with the fistula in the left iliac region which was dismantled and jejunum was repaired primarily. The fistulous tract was laid open and curetted. Postoperatively the patient developed SSI and was discharged on 14th postoperative day. Richter’s hernia is an uncommon condition in which only a circumference of the antimesenteric bowel wall is incarcerated within the hernia sac leading to ischemia, gangrene and perforation of the hollow viscus. It has an early misleading presentation with tendency to early strangulation and the lack of obstructive symptoms which may lead to delay in diagnosis and hence increased mortality. Any part of intestine may get incarcerated but most commonly involves distal ileum, caecum and sigmoid colon. As only a segment of bowel is involved, luminal continuity is maintained, thus there is only partial intestinal obstruction with minimal clinical signs.
Keynote Forum
Nahla Gomaa
University of Alberta, Canada
Keynote: A snapshot on the competency-based medical education in surgical specialties at Faculty of Medicine, University of Alberta, Canada; Where to start?
Time : 09:30-10:00
Biography:
Nahla Gomaa has interest in Para-surgical leadership by studying Quality Assurance in Medical Education. With her fellowship at the University of Iowa, USA, and working in other international medical institutes, she became interested in surgical education. Since her appointment as an Assistant Professor at University of Alberta, Canada, she has spearheaded a number of leadership and students-lead projects. She is representing the Department of Surgery in the Faculty Development Committee, and Strategic Planning at the Faculty level, specifically Competency-Based Medical Education (CBME). She is currently a member of the international collaborators of CBME, and serving on the Human Research Ethics Board (HREB) at University of Alberta.
Abstract:
The University of Alberta as well as many Canadian universities is starting Cohorts of competency-based medical education (CBME)-training of residents soon. The last couple of years were spent on intensive resource preparation for this initiative. Grand rounds for faulty development and open sessions for questions and answers have been running. The Royal College of Canada has provided a parallel intensive training for the program directors and a tremendous support with the e-portfolio. Where are we heading in the coming decade of medical education with this initiative? Is it going to change the face of surgical training, and what are the expectations of our surgical educators? This is a short talk about the conceptual framework of competency by design (CBD) and CBME, efforts that have been put into this change in medical education, and some questions waiting for answers.
- Orthopaedic Surgery | Oral & Maxillofacial surgery | Perioperative Care and Anaesthesiology| Otorhinolaryngology Surgery | Advancements in Surgery | Plastic Surgery
Location: London
Chair
John S Jarstad
University of Missouri School of Medicine, USA
Session Introduction
Marcus Vinicius Danieli
Botucatu Medical School, Brazil
Title: The chondral tissue and PRP: Theory to support the use
Time : 12:00-12:25
Biography:
Marcus Vinicius Danieli completed his Graduation in Medicine and Residence in Orthopedics at Botucatu Medical School. He focuses on Knee Surgery. He is an active member of the Brazilian Society of Knee Surgery (SBCJ); International Society of Arthroscopy, Knee Surgery and Sports Medicine (ISAKOS); and the International Cartilage Repair Society (ICRS).
Abstract:
The hyaline cartilage structure is very complex with few cells and without blood and lymphatic vessels or nerves. This makes the healing potential very limited. Knee cartilage injuries are very common, and its treatment is a major challenge. Surgical options available nowadays like chondroplasty, microfractures, mosaicplasty and autologous chondrocyte transplantation still doesn’t have satisfactory results, mainly in long term. Platelet-Rich Plasma (PRP) has been used in orthopedics since 90’s in order to stimulate tissue healing, because of its potential to concentrate platelet derived growth factors in the target place. The goal of the PRP application is to stimulate a better healing environment. PRP has been used in cartilage to treat steoarthritis and to support treatment techniques for chondral injuries. However, the literature is still doubtful regarding the surgical results with PRP application in chondral injuries.
Rajneesh Kumar
Punjab Institute of Medical Sciences, India
Title: Retained foreign bodies - A rare case of removal of surgical blade as retained foreign body from abdomen 5 years after surgery
Time : 12:25-12:50
Biography:
Dr.Rajneesh Kumar M.S; FAIS; FLCS; FMAS; FIAGES; FICS. is an Associate Professor in the Punjab Institute of Medical Sciences [PIMS], India.
Abstract:
Foreign bodies forgotten or missed in abdomen include cotton sponges, artery forceps or other instruments, pieces of broken instruments or irrigation sets and rare tubes. Presence of retained surgical blade as foreign body is uncommon and significant patient safety challenge. Most common etiologies for presence of such foreign bodies are accidental, traumatic or iatrogenic. Most common surgically retained foreign body is the laparotomy sponge. We report the management of a case with a rare foreign body in the abdomen i.e. surgical blade and repair of congenital diaphragmatic hernia. A 38 years female reported to us with X-ray lumbo-sacral spine showing radio-opaque object in abdomen. We further investigated the patient and CT scan abdomen revealed–A metallic foreign body in the left hypochondrium just beneath the left lobe of liver; it was seen in close proximity to the transverse colon gut loops and left diaphragmatic eventration hernia–herniation of stomach, large bowel loop and omental fat into left hemithorax. Traditionally, diaphragmatic hernia was repaired by laparotomy and foreign body was removed after exact localization on C-arm.
Nikitha Rajaraman
University of Glasgow, Scotland
Title: Tongue-- tied: Management in pierre robin sequence, a case report
Time : 12:50-13:15
Biography:
Nikitha Rajaraman is a 4th year medical student from the University of Glasgow. She is a highly motivated in pursuing her career in the surgical specialities. She has completed modules and electives in General,Plastic, Upper GI and Vascular Surgeries, and has completed various audit projects in the process. She has also contributed to national audits. She was recently awarded the top poster prize at the 8th Surgical Undergraduate Conference 2017 conducted in the Royal College of Physicians and Surgeons of Glasgow. She was also awarded Senior Elective award by the university as a recognition for her efforts towards a surgical career.
Abstract:
Pierre Robin Sequence (PRS) is a rare congenital condition of facial abnormalities, defined by a triad of micrognathia, retroglossoptosis and airway obstruction. PRS may have varied presentations due to associations with syndromes. Hence, the consensus in management remains elusive, with no definitive treatment protocols. We describe a case from a resource-†scarce setting that highlights the use of a less commonly performed surgical procedure which is simpler and cheaper than the gold-†standard surgery in PRS. An 18-†month-†old boy with PRS presented to A&E with airway obstruction and hypoxia due to retroglossoptosis. He was resuscitated immediately and intubated. Gold-†standard treatment was surgery: Mandibular Distraction Osteogenesis (MDO). However, as the patient was unable to afford the surgery, a cheaper procedure called tongue-†lip adhesion (TLA) was performed. The procedure involved pulling the base of the tongue anteriorly and tying to the hyoid bone. This maintained airway patency and patient was extubated. Mother was given feeding and child positioning advice. It is expected that the mandibular growth will eventually catch up with the tongue growth. The surgical procedures used to relieve airway obstruction in PRS include TLA, MDO and tracheostomy. In this case, TLA was chosen due to affordability issues. Three different TLA techniques, previously described in the literature for PRS, were discussed. Given the nutritional status of the patient, we decided to avoid extensive dissection. We required a technique that would not restrict mobile segments of the tongue, to allow for normal speech development and feeding. In addition, sutures on the tongue should not be damaged by biting, in the teething child. Lapidot and Ben-†Hur technique (briefly described in the case) satisfied above-†mentioned requirements and was hence chosen. Overall, this case is of great value in exploring different surgical techniques for PRS management, not widely explained in the literature.
Yaacov Gozal
Hebrew University of Jerusalem, Israel
Title: Anesthesia and neurodevelopment in children
Time : 14:00-14:25
Biography:
Yaacov Gozal is an Associate Professor of Anesthesiology at the Hebrew University, Jerusalem. He is the Chair of the Department of Anesthesiology, Perioperative Medicine and Pain Treatment and Director of the operating rooms at Shaare Zedek Medical Center, Jerusalem, Israel. He has published more than 100 peer reviewed papers and serves as an Editorial Board Member of the Journal of Pharmacology and Toxicology.
Abstract:
Each year, millions of infants and children undergo surgery, diagnostic and interventional procedures under anesthesia and sedation. Concern has been raised about the effect of anesthetic drugs on brain development. It has been shown that these medications affect the developing brain of different non-human species. It usually results in behavior, learning and memory abnormalities. The different human studies suggest that similar problems may occur in young children exposed to these drugs. However, recent large scale prospective studies did not find correlation between anesthesia exposure and poor neurodevelopmental outcome. Future research may clarify this important issue.
Turgut Donmez
Lutfiye Nuri Burat State Hospital, Turkey
Title: Thyroid surgery, IONM and sugammadex sodium relationships: Benefits in sugammadex Sodium using for IONM
Time : 14:25-14:50
Biography:
Turgut Donmez was graduated from Istanbul University Cerrahpasa Medical Faculty in 1997 and completed his Residency in General Surgery in 2003 in the same faculty hospital. He has been working at Lutfiye Nuri Burat State Hospital. He has expertise in laparoscopic and thyroid surgery.
Abstract:
Statement of the Problem: One of the most important complications in thyroid surgery is vocal cord paralysis as a result of recurrent laryngeal nerve (RLN) injury. While unilateral injury of the nerve can be tolerated by the patients, bilateral nerve paralysis might results in as severe complications as death. The surgeon must use a strictly standardized intra operative neuro monitoring technique (IONM) to succeed a good, well-quality monitoring and safe-surgery in order to prevent injury to RLN and save its functions. But, the half-life of general anesthetic drugs with neuromuscular blockade effect which are used during operation are closely related to affectivity and reliability of IONM. We aimed to detect nerve conduction by using TOF-Guard neuromuscular transmission monitor and provide a more reliable IONM after administering sugammadex sodium (bridion) which antagonizes neuromuscular blockade of the anesthetic drug.
Methodology & Theoretical Orientation: 20 patients who underwent total thyroidectomy operation in our surgery department between January 2017 and March 2017 were involved into the study. All the patients were intubated following anesthesia induction with propofol 1.5 mg/kg; rocuronium 0.6 mg/kg; remifentanil 0.25 microgram/kg/min and mechanically ventilated at Vc mode. Anesthesia maintenance was provided with remifentanil of 0.25 microgram/min, sevoflurane of 0.8 mac, and air-o2 combination of 4 lt/min. Following the intubation, the TOF-Guard neuromuscular transmission monitor
was placed on left hand and TOF was measured and recorded. 100 mg of bridion was administered intravenously just before the surgeon start thyroid gland resection. Following bridion injection, TOF response at 1st, 2nd, 3rd and 4th minutes were measured and recorded. If the response was over 90%, then the surgeon was let to use neuromuscular monitoring device. Vocal cord examinations were done in all the patients by an ear-nose-throat specialist on the 1st post-operative day. Age, gender, recurrent laryngeal nerve conduction speed before and after excision, BMI, surgery time, hospital stay duration, nerve conduction response duration following drug injection and complications were analyzed.
Findings: None of the patients developed nerve-related complications. The mean age was 47.6±11.82 years and mean BMI was 28.745±3.20. The mean operation time was 52.65±5.51 min. There wasn’t any significant difference in neither right nor left RLN monitoring values before and after surgery. Following the drug injection, the TOF guard nerve conduction response values were found 23.5±4.90; 69.5±6.86; 88±4.1 and 100, on 1st, 2nd, 3rd and 4th minutes, respectively.
Conclusion: The use of an anti-muscle relaxant drug and detecting the presence of nerve conduction with TOF-guard nerve monitor can provide a more reliable IONM and more safe surgery.
Emilio Vicente
San Pablo University, Spain
Title: The role of robotic-Assisted pancreatic surgery: Lessons learned from our initial experience
Time : 14:50-15:15
Biography:
Emilio Vicente has completed his Residency in General Surgery. He is currently the Director of the General and Digestive Surgery Service at Sanchinarro University Hospital and Clara Campal Oncological Center and; Chairman of the Surgery Section at Faculty of Medicine, San Pablo University. His other professional positions include: Digestive Viscera Transplant Program Director at Ramón y Cajal Hospital (Madrid, Spain); Chief of the General Surgery Section at Ramón y Cajal Generalb Hospital, Spain and; Professor of surgery at Alcalá Uni-versity, Spain.
Abstract:
Minimally invasive surgery (MIS) has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. Laparoscopic pancreatic surgery has not gained broad acceptance due to the complexity of the procedure, the accuracy required to perform the operation, and the steep learning curve involved. Indeed, the procedure has only achieved widespread consensus for distal pancreatectomy. In the field of major pan-creaticoduodenectomies, the laparoscopic approach is still considered to be an ex-tremely demanding method due to the challenge of reconstruction. The develop-ment of the robotic platform has overcome many of the disadvantages of traditional laparoscopy. Robotic surgery (RS) gives the surgeon a three-dimensional stereo-scopic view of the operating field and restores hand-eye coordination that is often lost in traditional laparoscopy when the camera is offset to the plane of dissection. Given the limitations of current laparo-scopic technology and the need for meticu-lous vascular control as well as complex reconstruction in pancreatic surgery, we hypothesized that RS would be particular-ly a good option for these procedures. We now report our experience with 50 consec-utive robotic-assisted pancreatic resections. We evaluate the safety, feasibility and versatility of this platform in the hands of dedicated, high volume hepato-pancreato-biliary (HPB) surgeons.
Tanja Anguseva
The Special Hospital for Surgical Diseases “Filip Vtoriâ€, Macedonia
Title: Surgery in septic patient with acute aortic endocarditis - Case report
Time : 15:15-15:40
Biography:
Tanja Anguseva is Subspecialist cardiologist in Special Hospital for surgical diseases ZanMitrev. Scientific work titled “SyScheechan”, Clinic of Obstetrics, Faculty of Medicine, Skopje. Graduation at the Faculty of Medicine within Ss. Cyril and Methodius Skopje, Macedonia. Doctor – general practitioner, Military Outpatient Clinic, Veles. Specialization in internal medicine at the University Ss. Cyril and Methodius.Assistant at the Department of Hemodialysis - Department for Internal diseases, Military Hospital,Skopje. Postgraduate studies at the Clinic of Cardiology, Faculty of Medicine, Skopje. Topic: Immunoactivity of patients in end-stage ischemic heart failure. Intensive Care Unit – Department of Internal Diseases, Military Hospital, Skopje. Coronary (cardiac) stress test, Echocardiography, 24-hour ECG and ABP Holter monitoring – Department of Internal Diseases, Military Hospital, Skopje. Doctor in charge at the Intensive Care Unit, PHI FILIP VTORI, Skopje.
Abstract:
Objective: Despite antibiotic treatment, active infective endocarditis continues to be a devastating and often fatal condition, which needs to be treat with urgent life threatening , high-risk surgery.Essential adequate debridement of the infective material is followed by repairmen (excisement of the vegetations) or replacement of the valve . The postoperative intensive care treatment usually is faced with septic shock patient with predicted high mortality rate.
Case Report: A 37years old patient was admitted to our unit with an acute endocarditis of the aortic valve, diagnosed by transoesophageal echo (TEE) with a great vegetations on the right and non- coronarial cusp with a aortic regurgitation +2 as well as left ventricle failure.Biochemistry was positive for infection (neutrophilia in blood, increased CRP and procalcitonin) and positive blood culture for staphulococcusepidermidis MR. Patient had been treated with Linezolid according to antiniogram. After 10 days he developed pulmonary edema, due to high grade aortic regurgitation due to rupture of the non-coronarial cusp (confirmed on 3D TEE) and in a septic shock under catecholamine he was operated. Intraoperativelly his aortic valve was completely destroyed with a lot of vegetations and rupture of the non coronarial cusp. Patient got a mechanical prosthesisSorin 25mm. After surgery he was high fevered, on high dosage of catecholamine and positive biomarkers for infections. On a first postoperative day he was put on antibiotics according to antibiogram and on CRRT treatment with Oxiris filter on Prisma-flex machine. After forth hour hemodynamic stabilization was notified, due to which catecholamine had been excluded second postopoperative day, and patient dieresis had been normalized. Patient had been extubated after 7 days. After 2o days he had been discharged at home.
Conclusions: Surgery in acute endocarditis is a high risk procedure which can be performed with a better haemodynamic stability and less postoperative complications, if patient is treated with adequate antibiotics as well as CRRT- Oxiris filter to remove the endotoxins.
- Are our health care systems “patient-centered”? How to run a quality improvement study of the health care system?
Location: London
Chair
Nahla Gomaa
University of Alberta, Canada
- Anesthesia Awareness | Anesthesia |Pediatric Anesthesia |Surgical Anesthesia | Anesthetic Pharmacology | Orthopaedic Surgery
Location: London
Chair
Robert Farrar
Summit Anesthesia Associates, USA
Session Introduction
Giovanna Panarello
UPMC Palermo, Italy
Title: Change of the paradigm: From absolute contraindication to extension of indication – “When appropriateâ€
Time : 11:00-11:25
Biography:
Giovanna Panarello is chief of ICU working as intensivist and infectivologist. She is involved in the critical care of severe respiratory insufficiency due to infection disease and end stage lung disease as treatment provider and in the etiology study and in the implementation of Scientific trial.
Abstract:
Pneumocystis jiorvecii pneumonia is often AIDS exordium opportunistic infection. Evolution in respiratory distress syndrome is common and is potentially reversible but is still burdened by a mortality rate as high as 30% to 40% if managed by conventional treatment mainly based on optimal mechanical ventilation. Since 2009 the use of Extracorporeal Membrane Oxygenation has been shown to be very effective as salvage therapy in case of severe respiratory insufficiency not responsive to conventional therapy. HIV seropositivity has been considered a contraindication to extracorporeal life support. We report two cases of Pnumocystis jiorvecii pneumonia as AIDS exordium opportunistic infection. Both evolved to severe ARDS and were successfully treated with VV ECMO support.
Biography:
Robert Farrar is currently the Chairman of Summit Anesthesia Associates in Summit, NJ. He was the Vice President of Medical Affairs for Somnia Anesthesia. He has 30 years’ experience as an Anesthesiologist as well as 25 years’ experience with development and implementation of quality systems. He served as Director of Cardiothoracic Anesthesiology at Lower Bucks Hospital in Bristol, Pennsylvania and Chairman of Anesthesiology at Easton Hospital in Easton, PA. He previously worked at Atlantic Care Health System and Jersey City Medical Center. He also served a senior staff anesthesiologist at Henry Ford Hospital in Detroit, MI where he was a Member of both the Cardiothoracic and Critical Care Divisions. He received his Medical Degree from the Catholic University and his Law Degree from the University of Detroit/Mercy. He completed a residency in Anesthesiology at UMDNJ and a fellowship in cardiovascular anesthesiology at Loyola/Chicagoaosj244@yahoo.com
Abstract:
The impaired healthcare professional is one who is unable, to practice medicine according to accepted standards as a result of substance abuse, behavioral problems, mental illness or cognitive decline. Substance abuse is exacting a tremendous toll on the health care community as well as society at large. The prevalence of substance abuse among healthcare workers parallels that of the general population with a variance noted for the types of substances used. Impaired providers generally manifest their illness in one of three ways: overt intoxication, self-declared or the high index of suspicion. While the first 2 categories are readily identified, the high index category poses the greatest challenge for identification, intervention and treatment. The key factor needed to identify the impaired provider in the high index category is to recognize a series of irregular behaviors that are out of sync with the norm. While none of these behaviors by themselves are dispositive of impairment, together they form the basis for the performance of an intervention. A check list and careful documentation are essential. The goals of an intervention are to assure patient safety, provide for the wellbeing of the provider and minimize exposure of the organization. During the intervention, the healthcare worker is confronted with objective evidence of the problem. This may not be received well since impaired providers are intelligent, have much at stake and (almost) invariably are in denial. Ultimately, they are offered a choice to either get into treatment through the state medical society’s Physician Impairment Program; or, have their case turned over to the medical board. Most choose the treatment option since it provides a mechanism for preserving their career. Treatment consists of inpatient therapy followed by outpatient therapy. Some providers are eventually able to reenter medical practice at some point but need to be followed closely.
Nadia Najafi
University Hospital Brussels, Belgium
Title: Procedural sedation and analgesia for pediatric endoscopy procedures: The good, the bad and the ugly
Time : 11:50-12:15
Biography:
Nadia Najafi is the Belgian representative at the European Society for Paediatric Anaesthesiology. She is specialized in paediatric anaesthesiology, paediatrics, and paediatric intensive care medicine. She developed her expertise in improving safety of children undergoing general anaesthesia and procedural deep sedation and analgesia both in and outside of operating rooms.
Abstract:
Gastrointestinal endoscopic procedures in children cause fear, pain and distress. Deep sedation or general anaesthesia is most likely required to overcome these inconvenience, and to provide high quality procedures for endoscopists as well as a maximum safe environment for children. However, providing deep sedation for these procedures may be challenging due to the comorbid conditions of the child, gastrointestinal pathology requiring endoscopy, and potentially sedation- or anaesthesia related adverse respiratory events. In addition, the anatomical considerations of gastrointestinal tract interfering with both the respiratory abilities and the small caliber of the pediatric airway may become an issue while performing endoscopy in children. Anesthesiologists have been traditionally assigned to provide general anaesthesia or deep sedation in children at risk for developing adverse events. Careful pre-procedural assessment, identification of children potentially at risk for sedation or anaesthesia-related complications, vigilant monitoring during and after the procedure are some of the key elements of a successful sedation strategy. Both cautious selection of anesthetic drug and the dosage administered may also help reducing the adverse events. In addition, safety measurements should always be taken and a careful plan for treating complications should be in place. Moreover, a multidisciplinary approach and communication between anesthesiologists and pediatric gastroenterologists is of utmost important in improving the outcome of children. During the entire sedation process, the predictors of both successful and failed sedation will be discussed.
Abdulaleem Alatassi
King Abdullah Specialized Children Hospital, Saudi Arabia
Title: Pediatric anesthesia lagging behind in comparison to other subspecialty in anesthesiology
Time : 12:15-12:40
Biography:
Abdulaleem Alatassi is the Chairman of the Pediatric Anaesthesia Fellowship Scientific Committee at the Saudi Commission for Health Specialties. He is a consultant in Anesthesia and Intensive Care Unit at King Abdulaziz Medical City. Abdulaleem Alatassi holds the position of Deputy Director-Operative Room Services at King Abdulla Specialized Children Hospital. Between 2012-15 he was the Head of Pediatric Anesthesia Section at King Abdulaziz Medical City in Riyadh, Saudi Arabia
Abstract:
Statement of the Problem: In this presentation i will review few areas in pediatric anesthesia to emphasize on the latest evidence based practice which includes:
1. Rapid sequence induction and cricoid pressure in pediatric anesthesia.
2. The difference in airway anatomy between pediatrics and adult.
3. The type of endotracheal tubs we should use in pediatrics.
4. Revising the current threshold for blood transfusion.
5. Highlighting the approach to achieve homeostasis in pediatric patients.
6. Looking into the possibility of regional anesthesia in awake pediatric patients. 7. Looking into the role of ultrasound in pediatric anesthesia caudal blocks.
Ray Murtagh
Australian Anaesthesia Allied Health Practitioners, Australia
Title: What makes anaesthesia successful and safe
Time : 15:00-15:25
Biography:
Ray Murtagh has worked in the field of Anaesthesia for the last 35 years and is currently employed in Australia as an Anaesthesia Allied Health Practitioner. He has specialized in paediatric Anaesthesia and is currently the specialist Anaesthesia assistant for all paediatric anaesthesia at his facility. He completed his dip AOTT at the Royal Prince Alfred Hospital Sydney in 1982 and has since worked in several hospitals throughout the Eastern Seaboard of Australia. Ray has been the President of ASAPO (Australian Society of Anaesthesia Paramedical Officers), now AAAHP (Australian Anaesthesia Allied Health Practitioners) of whom he is now registrar. Ray has witnessed many first-hand crisis in Anaesthia and considers this topic of vital interest to those who work in the field.
Abstract:
During the past 40 years, there has been continual speculation and discussion on the safety and success of Anaesthesia. Over the last 40 years we have also seen many improvements in Anaesthesia, i.e.
1) Computerised monitoring of patients.
2) Improved modes of TIVA Anaesthesia.
3) Changes in gas flow rates for Anaesthesia.
4)Development and implementation of brainwave monitoring for anaesthetized patients.
5) Development of new and improved Anaesthesia medications.
6) Improved training of Anaesthesiologists and their Assistants.
7)More research into difficult airway management and other clinical crisis. With these advances and so-called improvements, what can we say, without a doubt, makes Anaesthia Successful and Safe? I propose to discuss in detail these advances and hopefully demonstrate the real reason as to What Makes Anaesthesia Successful and Safe. For a patient to die on the operating table is rare — but for patients with serious problems in their medical history, post-traumatic stress after a long operation can under some circumstances lead to death. Complications relating to anaesthesia are rare, and can usually be brought under control very quickly.
Arvid Steinar Haugen
Haukeland University Hospital, Norway
Title: WHO surgical safety checklist use in the operating theatres – Effectiveness and sustainability
Time : 15:25-15:50
Biography:
Arvid Steinar Haugen has his research expertise in surveys and clinical quality improvement trials of patient safety interventions with focus on surgical safety checklists, since 2008. He has clinical experience as a nurse anaesthetists since 1999 at Haukeland University Hospital, Bergen, Norway. His research include further trials on safety checklists in surgical wards, handover protocols, discharge checklist from medical wards and development of checklists for patients to use. He was awarded with the European Society of Anesthesiologists’ Baxter Prize in 2015 for the publication: Effect of the World Health Organization Checklist on Patient Outcomes: A Stepped Wedge Cluster Randomized Controlled Trial. Ann Surg. He is currently a visiting senior Post-Doc Researcher at the Centre of Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, Health Service & Population Research Department, Kings College London, UK.
Abstract:
Statement of the Problem: WHO Surgical Safety Checklist has become mandatory to use in most countries (WHO, 2009). Initial studies reported large reductions in both mortality and morbidity (Haynes et al 2009), though a large scale Canadian study raised concern about quality of the implementation and actual use of the checklist (Urbach et al 2014, Leap 2014). In recent studies, a stepped wedge RCT in Norway reported significant reduction of morbidity (43%) and length of stay (19 hours) (Haugen et al 2015), and further mortality was reduced in U.S. South Carolina Hospitals by 22% (Haynes et al 2017). In an invited commentary in JAMA Surgery Berry et al (2016) stated that the checklist will not work if you do not use it. The purpose of this study is to describe the experience on how to obtain a high compliance and sustainable use of the checklist.
Methodology & Theoretical Orientation: A review of research results and experiences on implementation of the WHO SSC in a stepped wedge cluster RCT and qualitative studies in Norwegian hospitals is combined with compliance rates from January 2014 to April 2017.
Findings: The results from our stepped wedge cluster RCT boosted attention to perform the SSC in our hospitals. Health trust and management focus on compliance combined with multi-disciplinary tailoring of the SSC, contributed over time to sustainable and increased actual use of the SSC (Fig 1).
Conclusion & Significance: Effectiveness and sustainable use of the SSC is depending on multidisciplinary surgical teams to play an active part in tailoring the checklist, and of managers being accountable for the compliance rates.
Gabor Kiss
University Hospital Felix Guyon, France
Title: Ethical, general and technical issue in anaesthesia for awake thoracic surgery in high risk patients
Time : 16:20-16:45
Biography:
Gabor Kiss studied at the Free University of Brussels VUB (Belgium) and he completed his residency training in anesthesiolgy at the ULB Erasme Hospital in Brussels. He also trained in the UK and did his ICU fellowship in Australia. He worked in Brussels as a consultant in Anesthesia. Since 2003 he is a consultant in Anesthesia for Adult Cardiothoracics and Vascular Surgery and its postoperative Intensive Care Unit working in the French Public Health System. He is currently based at the French Reunion Island and attached to the department of Cardiothoracics and Vascular Surgery and its ICU at the University Hospital of Saint Denis.
Abstract:
Given the increasing numbers of complex and high risk patients requiring thoracic surgery, awake thoracic surgery (ATS) could be an option in frail patients especially those with high risks for ventilator dependency to reduce morbidity and mortality. Several papers conclude that ATS was superior to surgery under general anaesthesia in terms of reduced operating room time, better perioperative outcomes, reduced incidence of postoperative respiratory infections and acute respiratory distress syndrome, lower mortality rate, generally less complications, less need for nursing care, lower costs and shorter hospital stays. ATS may allow a fast-track protocol avoiding the intensive care unit. In spite of its benefits, ATS is ethically still widely debated and therefore there remains an urgent need to provide more evidence base medical facts to the current discussion. ATS is technically extremely challenging for the anesthesiologist and requires careful patient selection, thorough anesthetic preparation, high vigilance during the perioperative period, knowledge about potential perioperative difficulties and management of its complications.
Ghassem Attarzadeh Yazdi
Hormozgan University of Medical Sciences, Iran
Title: Role of BK channels in anesthesia
Time : 16:45-17:10
Biography:
Ghassem Attarzadeh worked as an Assistant Professor, Physiology Department, Hormozgan University of Medical Sciences, 1996, Iran. He pursued PhD in Neuroscience, Department of Neuroscience, University of Edinburgh (2002-06). He completed MSc in Human Physiology from Tarbiat Modarres University-Tehran- Iran (1992-95). B.Sc. of Biology: Ferdowsi University-Mashad-Iran, 1984-89. Hormozgan University of Medical Sciences, Department of Physiology, lecturer, 1995-2002.
Abstract:
Millions of people suffer from pain worldwide, and annually, great economic costs are imposed on societies for pain relief. Analgesics such as alpha-2 adrenergic receptor agonists, which have low risk of complications, can be effective in assuaging pain and reducing costs. According to former studies, potassium channels play an important role in the analgesic mechanism of these receptors. This study aimed to determine the role of BK potassium channels in analgesia induced by alpha-2 adrenergic receptors. This study was performed on 56 male Wistar rats weighing 250-300 g that were divided into seven groups of eight rats. We administered 0.7 mg/kg intraperitoneal (IP) injection of clonidine, 1 mg/kg IP injection of yohimbine, and 5 mg/kg intracerebroventricular (ICV) injection of yohimbine. Iberiotoxin at a dose of 100 nm was also injected ICV. Normal saline and DMSO were applied as solvents. Pain severity was evaluated using formalin test at a concentration of 2%. The chronic pain induced by formalin injection was relieved by IP injection of 0.7 μ /kg clonidine. Moreover, 5 μg/kg and 1 μg/kg ICV administration of yohimbine with mean chronic pain scores of 2.29±0.13 and 2.09±0.07, respectively, could significantly inhibit analgesic effect of clonidine with mean chronic pain score of 1.55±0.14 (p<0.001). ICV injection of iberiotoxin with mean chronic pain score of 2.33±0.16 at a dose of 100 nm significantly diminished analgesic effects of clonidine. Alpha-2 adrenergic receptor agonists could induce analgesia in the animals, and the antagonist of this receptor inhibited the analgesic effect of agonists of these receptors. BK channel inhibition prevented analgesic effect of adrenergic receptor agonists, as well.
- Transplantation Surgery | Cardiothoracic Surgery | General Surgery and its Specialties | Oral & Maxillofacial Surgery
Location: London
Chair
Nahla Gomaa
University of Alberta, Canada
Session Introduction
Chamila Pilimatalawwe Wijekoon
Sri Jayewardenepura General Hospital, Sri Lanka
Title: Issues with renal transplantation in lower-middle-income countries like Sri-Lanka
Time : 10:00-10:25
Biography:
Chamila Pilimatalawwe Wijekoon is a Consultant Anaesthesiologist at Sri Jayeawardenepura General Hospital, Sri Lanka. After her Post-graduate qualification in Anaesthesiology, she underwent further training at the Royal Victoria Infirmary and Freeman hospital in Newcastle Upon Tyne, UK. She has been a Consultant since 2011. Her interests are Anaesthesia for Kidney transplantation, where she has played a leading role in establishing the deceased donor programme in Sri Lanka, and Cardiac Anaesthesia. She is also a Council Member of the College of Anaesthesiologists and Intensivists of Sri Lanka.
Abstract:
The burden of Chronic Kidney Disease (CKD) continues to rise globally with an estimated 500 million people suffering worldwide, of whom majority live in LMIC like Sri-Lanka. Estimated 60,000 (0.3%) of the population of Sri Lanka suffer from CKD with nearly 3000 in end-stage renal failure (ESRF). Despite the rise in trends of CKD, the causes are yet to be clearly defined due to variability in quality of reporting, inconsistent methods of defining and absence of a centralized reporting system. Although the etiology of the disease is heterogeneous, prevalence of chronic kidney disease of unknown etiology (CKDu), is unique to countries such as Sri-Lanka. Since the first reporting of this group of patients in 1990 the incidence has escalated dramatically. In Sri-Lanka CKDu is mainly seen in the north central and northwest provinces, affecting more than 15% of its population mainly in the 20-30- year age group. They are predominantly agricultural workers with a male preponderance. Etiology may be attributed to quality and presence of arsenic and cadmium in the water, and frequent droughts affecting these areas. CKD has become a huge burden to the country with 4% of the public health budget being spent on non-curative aspects of CKD alone. In 2007 there were only about 180 dialysis machines in the entire country when the requirement was over 1000. Renal transplantation is probably the more tenable longterm treatment option for ESRD in LMIC as it is both cheaper and provides a better outcome for these patients. In Sri-Lanka less than 5% of this group receives a transplanted kidney. Besides the technical challenges of surgery and consequences of immunosuppression, LMIC like Sri-Lanka have the need to improve the deceased-donor program, which is currently at its infancy due to an ill-defined
legal framework, taboos, and multicultural, multi-religious believes.
Kanishka Indraratna
Sri Jayewardenepura General Hospital, Sri Lanka
Title: A proposed strategy for enhanced recovery after cardiac surgery
Time : 10:25-10:50
Biography:
Kanishka Indraratna is the Senior Consultant Anesthesiologist at Sri Jayewardenepura General Hospital, Sri Lanka. After his Post-graduate examinations, he was further trained in England. Subsequently he did a long term locum consultant appointment at St. Bartholomews Hospital and the Royal London. His research interests include “Cardiac anaesthesia, neuro anaesthesia, and critical care”. He is also the President of the College of Anaesthesiologists and Intensivists of Sri Lanka.
Abstract:
While there are established strategies and guidelines for enhanced recovery after general surgical procedures, there is no such strategy for cardiac surgery. This is probably because of the complexity of the procedure and the wide range of complications which can occur. To achieve enhanced recovery, the aims should be to have a conscious, rational, alert patient as soon as sedation is reduced, hemodynamically stable, pain free, without other complications, and ready to be mobilized. Multi organ complications and problems are quite common after cardiac surgery such as myocardial infarctions 22%, delirium 46% and AKI 30%. Pre-operative optimization of correctable factors, optimal amount of anesthetic and analgesic, goal directed fluid therapy, maintenance of cerebral perfusion are strategies to be employed. For this, monitoring of cardiac output, fluid status, depth of anaesthesia, cerebral function, cerebral oximetry, cardiac function, coagulation function, level of Hb, in addition to usual routine monitoring would be required. Adequate pain relief and optimal sedation, physiotherapy, early mobilizations are required in the post-operative period.
Rosalee Zackula
Kansas School of Medicine-Wichita, USA
Title: Methodological evaluation of in-hospital mortality as an indicator of treatment effectiveness
Time : 11:20-11:45
Biography:
Rosalee Zackula is a Statistician with expertise in research design, measurement, and data analysis. She is a Senior Research Analyst in the Office of Research at the University of Kansas School of Medicine-Wichita. As a Research Consultant, she works across all departments to design and conduct research with Anesthesiology, Family and Community Medicine, Obstetrics and Gynecology, Preventive Medicine, Psychiatry, Radiology, and Surgery.
Abstract:
Using in-hospital mortality as an outcome for comparing treatment in a trauma population is misleading and may put patients at risk. Researchers in many medical specialties, including surgery, often utilize this measure as a marker of treatment equivalence. However, mortality does not always relate to quality of care, and treatment equivalence is only one aspect associated with patient outcomes. Perhaps a more important factor is treatment efficacy. Complex factors influence whether a treatment is effective. Patient status prior to trauma (age, BMI, co-morbidities, access to care), nature of trauma (mechanism of injury, injury severity), time to treatment, medical intervention (hospital and physician type, procedures), quality of care (length of stay, hospital acquired complications, radiation exposure), and post-intervention care (access), all contribute to treatment outcome (mortality and/or quality of life). Further, a measure of time from trauma event to a mortality outcome, specifically in- hospital, demonstrates why using trauma-related deaths could be biased. For example, the in-hospital and 30-day rates of mortality may differ substantially and favor hospitals with shorter lengths of stay. Our current research interests include evaluating methodological issues associated with treatment comparison that include measures of efficacy, along with statistical measures of equivalence. We critically appraised unpublished and published articles that suggested trauma centers were equivalent based on in-hospital mortality. Findings included: issues with statistical methodologies and misinterpretations of results and lack of quality indicator evaluation. Subsequently, we are conducting a systematic review and meta-analysis of recent literature related to pediatric trauma outcomes. This work will contribute to best practice research methodology for evaluating trauma care. Specifically, we will discuss alternative measures and methods for determining treatment efficacy that may reduce risk to patients.
Sadanori Takeo
Kyushu University, Japan
Title: A new technique for dissecting the pulmonary vessels and handling scissors
Time : 11:45-12:10
Biography:
Sadanori Takeo has completed his PhD at Kyushu University in Immunological Sciences. He was one of the pioneers in Thoracic surgery and VATS surgery in Japan. He and his team were the first to report Original video-assisted thoracoscopic extended thymectomy for thymoma. He later became the Chairman of the Department of Thoracic Surgery at National Hospital Organization Kyushu Medical Center. He has served on the editorial boards of many scientific journals, and on the advisory panels of many academic and government institutions. He is a member of board of the many academic association and has published more than 90 papers in lung cancer and mediastinal tumor fields. He is the Director General of Clinical Department at National Hospital Organization Kyushu Medical Center.
Abstract:
The pulmonary artery (PA) is the weakest vessel in the human body, and many think that it should never be grasped with forceps. We earlier described a technique for safe, rapid dissection of the PA and pulmonary vein (PV) that simply handles scissors in a novel way. Since 2001, this method has been applied in more than 800 cases of segmentectomy, lobectomy, and pneumonectomy during both open surgery and video-assisted thoracic surgery (VATS). It employs Mayo-type scissors for sharp dissection of the PA and PV. Sheaths on the surfaces of the central parts of the pulmonary vessels are dissected using scissors approximately 5 mm long. The vessel is then ligated with 2-0 silk at the same site. The surgeon directly grasps the blood vessel with vascular forceps just distal to the first ligation site and retracts it to the central side. The distal side of the blood vessel is exposed aggressively with Mayo-type scissors by dissecting the sheaths surrounding the vessel with the associated connective tissue including perivascular lymph nodes. These maneuvers are possible when using this novel handling of the scissors (e.g., right-angle forceps for VATS). None of the patients exhibited blood vessel injury. The procedure easily exposes about 2 cm of small vessels and >3 cm of larger vessels. It is useful in most circumstances—e.g., tumor invasion of an area surrounding a blood vessel or with a perivascular enlarged lymph node without direct invasion. Almost all right upper lobectomies (ND2a) are completed within 2 hours (small thoracotomy) to 2.5 hours (complete VATS). Surgery duration can be dramatically shortened when using this method. This technique and the new method for handling the scissors will be demonstrated in a video.
Mein-Woei Suen
Asia University, Taiwan
Title: The influence of the obesity-Related stereotypes on evaluations of different body shapes in high school girls
Time : 12:10-12:35
Biography:
Mein-Woei Suen studied at University of Birmingham. He has been involved with studies related to stereotype threat effects and stereotype boost effects. The subject of research includes: The impact of gender stereotypes on the dominance of men or the dominance of women, the impact of racial stereotypes on the performance of Taiwanese students in mathematics, and the influence of Aboriginal stereotypes on the performance of aboriginal and non-Aboriginal students in school and sports performance. In addition, the relevant academic objectives are as follows: gender, ethnicity, age, and medical care, and so on, and there is an inconsistent influence mechanism between the two effects based on the collating of the literature, such as the academic performance, the athletic performance, the cognitive operation, and so on.
Abstract:
Obesity is an important problem of health in teenagers. The obesity-related stereotypes become more important issue nowadays, which gets the idea that the person is lazy, sporting less, greedy etc. Thus, this study aims to establish an obesity-related stereotypes scale and to examine the effect of the obesity-related stereotypes among Taiwan and Macau senior high school girls. In this research, this pilot study (N=138) selects an appropriate figure scale and the standard and obesity figures were occupied in main experiment. Then, the main experiment (N=221; 103 Taiwan & 118 Macau girls) conduct a Chinese–version obesity-related stereotype scale with three factors (with 13 items), which are: Unwell personal performance (6 items), poor interpersonal perception (4 items), and ―inappropriate life style (3 items). Results show that: girls in stereotype activation condition show high scores of stereotype scores; there is no significant difference between Taiwan and Macau sample; girls with underweight and normal-weights tempt to expect lower body weight rather than standard body weight group, but not with overweight. The senior high school girls have the obesity-related stereotypes. While stereotypes have been activated by using the obesity figures, girls will show obvious stereotype on the scale. There is no difference between Taiwan and Macau girls.
Olivier Lieger
University of Bern, Switzerland
Title: Biomechanical evaluation of different angle-Stable locking plate systems for mandibular surgery
Time : 12:35-13:00
Biography:
Olivier Lieger, MD, DMD, is a faculty in the Department of Craniomaxillofacial Surgery at University of Bern, Inselspital, CH-3010 Bern, Switzerland.
Abstract:
Purpose: To compare the initial stability and stability after fatigue of three different locking systems (Synthes®, Stryker® and Medartis®) for mandibular fixation and reconstruction.
Method: Standard mandible locking plates with identical profile height (1.5 mm), comparable length and screws with identical diameter (2.0 mm) were used. Plates were fixed with six screws according a preparation protocol. Four point bending tests were then performed using artificial bone material to compare their initial stability and failure limit under realistic loading conditions. Loading of the plates was performed using of a servo hydraulic driven testing machine. The stiffness of the implant/bone construct was calculated using a linear regression on the experimental data included in a range of applied moment between 2 Nm and 6 Nm.
Results: No statistical difference in the elastic stiffness was visible between the three types of plate. However, differences were observed between the systems concerning the maximal load supported. The Stryker and Synthes systems were able to support a significantly higher moment.
Conclusion: For clinical application all systems show good and reliable results. Practical aspects such as handling, possible angulation of screw fixation, possibility of screw/plate removal, etc. may favor one or the other plating system.
Harry S Goldsmith
University of California, USA
Title: Success of mental transposition to the brain of Alzheimer patients
Time : 14:00-14:25
Biography:
Harry S Goldsmith is Clinical Professor of Neurological Surgery at the University of California in Sacramento. He has been a Full Professor of Surgery and Neurosurgery since 1970. He has written 260 published papers, has edited four surgical texts, and was the Editor of Goldsmith's Practice of Surgery in twelve volumes from 1976-1988. His main interest at present is in the treatment of Alzheimer's disease and in new treatment for acute and chronic spinal cord injuries using the omentum.
Abstract:
Introduction: The surgical placement of an intact vascularized omental pedicle directly on the human brain can result in a significant increase in cerebral blood flow (CBF). Placing an omental pedicle on the brain of Alzheimer (AD) patients, who are known to have a decreased CBF, may explain the cognitive improvement that has followed this surgical procedure.
Methods: The omentum is surgically lengthened with its blood supply remaining intact. Following this lengthening process the omentum is brought up through a subcutaneous tunnel placed along the chest and neck up to the head. A craniotomy is performed and the dura mater is opened. The omentum is then simply laid on the brain without the need for any anastomoses.
Results: Omental transposition (OT) to the brain allows omental arteries to penetrate directly and deeply into the brain resulting in a marked increase in CBF. Of twenty-five advanced Alzheimer patients who underwent OT to the brain six patients showed no postoperative improvement, ten demonstrated slight changes with nine patients demonstrating marked cognitive improvement.
Conclusion: There is increasing interest that AD is the result of decreased CBF which negatively effects the intra-neuronal mitochondria which directly influences the production of neuronal adenosine triphosphate (ATP) which is the energy source of neurons. The increased CBF originating from the omentum may explain the improved cognition that has followed OT to the brain of AD patients.
Tanja Anguseva
The Special Hospital for Surgical Diseases “Filip Vtoriâ€, Macedonia
Title: Intraoperative 3D transoesophageal valvular evaluation
Time : 14:25-14:50
Biography:
Tanja Anguseva is Subspecialist cardiologist in Special Hospital for surgical diseases ZanMitrev. Scientific work titled “SyScheechan”, Clinic of Obstetrics, Faculty of Medicine, SkopjeGraduation at the Faculty of Medicine within Ss. Cyril and Methodius Skopje, Macedonia. Doctor – general practitioner, Military Outpatient Clinic, Veles. Specialization in internal medicine at the University Ss. Cyril and Methodius Assistant at the Department of Hemodialysis - Department for Internal diseases, Military Hospital, Skopje. Postgraduate studies at the Clinic of Cardiology, Faculty of Medicine, Skopje. Topic: Immunoactivity of patients in end-stage ischemic heart failure. Intensive Care Unit – Department of Internal Diseases, Military Hospital, Skopje. Coronary (cardiac) stress test, Echocardiography, 24-hour ECG and ABP Holter monitoring – Department of Internal Diseases, Military Hospital, Skopje. Doctor in charge at the Intensive Care Unit, PHI FILIP VTORI, Skopje.
Abstract:
The aims of this study were to evaluate the feasibility of real-time 3-dimensional (3D)transesophageal echocardiography in the intraoperative assessment of valvular pathology and to compare this novel technique with 2-dimensional (2D) transesophageal echocardiography.
Methods: 1450 consecutive patients undergoing valvular were studied prospectively. Intraoperative 2D and 3D transesophageal echocardiographic (TEE) examinations wereperformed using a recently introduced TEE probe that provides real-time 3D imaging. Expert echocardiographersblinded to 2D TEE findings assessed the etiology of MR on 3D transesophageal echocardiography.
Similarly, experts blinded to 3D TEE findings assessed 2D TEE findings. Both were compared with theanatomic findings reported by the surgeon.
Results: At the time of surgical inspection, ischemic MR was identified in 12% of patients, complex bileafletmyxomatous disease in 31%, and specific scallop disease in 25%, aortic stenosis in 20% and insuffitienty in 12% of patients. Three-dimensional TEE image acquisitionwas performed in a short period of time (60 _ 18 seconds) and was feasible in all patients. Three-dimensional TEE imaging was superior to 2DTEE imaging in the diagnosis of P1, A2, A3, and bileaflet disease (P _ .05), as well as in aortic stenosis and insuffitienty evaluation ( leaflet morphology).
Conclusions: Real-time 3D transesophageal echocardiography is a feasible method for identifying specific valvular pathology in the setting of complex disease and can be expeditiously used in the intraoperativeevaluation of patients undergoing valvular repair surgery. (J Am Soc Echocardiogr 2009;22:34-41.)
Keywords: Real-time 3D TEE, Mitral valve, Aortic Valve Diagnosis.
Zhi Zhong
Medical University of South Carolina, USA
Title: Role of mitochondrial dysfunction in primary graft non-function after transplantation of marginal liver grafts: Study with novel intra vital confocal/multi-photon microscopy
Time : 14:50-15:15
Biography:
Zhi Zhong is an Associate Professor in College of Pharmacy, Medical University of South Carolina, SC, USA. Her expertise is in hepatic ischemia/reperfusion injury and experimental liver transplantation. She obtained her Doctoral degree at University of North Carolina, Chapel Hill. She has been conducting basic and translational research on the role of reactive oxygen and nitrogen species in mitochondrial dysfunction in various liver injury/diseases and published ~100 papers in the field. She is also a Reviewer and Editorial Board Member of many scientific journals.
Abstract:
Background & Aim: The mitochondrial permeability transition (MPT) has been implicated in liver injury in vivo after ischemia/ reperfusion (I/R). Reactive oxygen and nitrogen species (ROS & RNS) can trigger onset of the MPT. Hepatic I/R occur in organ harvesting, cold storage, and implantation surgery during liver transplantation. This abstract describes studies investigating mitochondrial depolarization caused by the MPT in vivo and its relationship to occurrence of primary non-function after transplantation of marginal liver grafts.
Methods: Fatty liver transplantation was performed in rats and non-heart-beating liver transplantation was performed in mice. Mitochondrial depolarization was monitored using intra vital confocal/multi-photon microscopy, a novel technology that allows direct visualization of mitochondria in living animals.
Findings: Inducible nitric oxide synthase (iNOS) expression, alanine aminotransferase release, total bilirubin, hepatic necrosis, TUNEL-positive cells and cleaved caspase-3 were higher in fatty liver grafts (FG) induced by ethanol treatment than in lean grafts (LG). After implantation, viable cells with depolarized mitochondria were 3-fold higher in FG than in LG. 1400W, a specific iNOS inhibitor, prevented mitochondrial depolarization, decreased graft injury and improved graft survival 3.5-fold. In another study, iNOS expression, mitochondrial depolarization and liver injury and dysfunction were substantially higher in grafts from cardiacdeath donors (CDD) than in grafts from non-cardiac death donors. Mitochondrial depolarization and graft injury in CDD grafts were markedly attenuated by iNOS-deficiency.
Conclusion & Significance: Mitochondrial dysfunction occurs in marginal liver grafts, leading to graft failure after transplantation. Mitochondrial dysfunction in marginal grafts is, at least in part, due to increased iNOS expression and excessive RNS formation. Prevention of mitochondrial dysfunction and inhibition of RNS formation are promising strategies to improve the outcomes of marginal liver transplantation.