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SURGICAL AND ANESTHETIC OUTCOME USING AMICAR AND NaCO3: AFTER CRYOTHERAPY AND CRYOTHERAPY WITH WEDGE RESECTION OF HEPATIC MALIGNANCIES

KERKAR, P. MD; LITTRUP, P. MD; KULKARNI, B. MD; AKHTAR, A. MD; FULEIHAN, S. MD; WEAVER, D. MD

doi: 10.1097/00000539-199802001-00039
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Anesthesia/OR Economics
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DEPT. OF ANESTHESIA, RADIOLOGY AND SURGERY, HARPER HOSPITAL, WAYNE STATE UNIVERSITY, DETROIT.

Abstract S39

The previous studies have demonstrated that cryoablation of hepatic malignancies causes postop thrombocytopenia and hepatic wedge resection results in more intraoperative bleeding [1]. This study looks at the effect of amicar and sodium bicarbonate on perioperative bleeding, postop coagulopathy and renal function until patient discharge from hospital.

METHODS: Thirty seven consecutive adult patients of ASA II and III were divided in two groups. Group 1 had cryoablation and group II had cryoablation with wedge resection. Patients in both the groups had i.v. amicar and NaHCO3 during intraop and 2 hours postop periods. The dose of amicar was 5 gm loading dose after induction of anesthesia and one gm/hr there after. NaHCO3 i.v. infusion was maintained between 1 to 3 mEq/Kg so as to maintained blood pH of 7.4 and above. Anesthesia was induced with pentothal, fentanyl 1-2 mcg/kg and succinylcholine, and maintained with atracurium, fentanyl and isoflurane.

RESULTS: Table 1 and Table 2 gives the demographic data and blood results. Fibrinogen, fibrinogen degradation product, serum glucose, blood urea nitrogen and serum creatinine were within normal limits in both the groups. In group I mean blood loss was 475 (+/- 303) ccs. and five (25%) patients had blood transfusion to maintain Hb above 9 gm percentage. Four (20%) of these five patients received one unit (350 mls) of blood transfusion and one (5%) patient who had preoperative Hb of 9 gm% had 3 units of blood transfusion. In group II mean blood loss was 1554 (+/- 1016) ccs and eleven (65%) patients had blood transfusion (Average blood transfused 1070 (+/- 711) ccs. One female patient in gp II had persistent thrombocytopenia of less than 90,000/mm3 and lasted for 7 days. She was treated with multiple platelet transfusion (25 units) and hospital stay was prolonged to II days. Discharge days for group I was 6.25 (+/- 1.8) and group II 7.25 (+/- 2.01) days.

Table 1

Table 1

Table 2

Table 2

CONCLUSION: The mean blood loss in the study published by Goodie et al was 926 mls after cryoablation [2]. Amicar had reduced the blood loss in group one as compared to previous study [2]. Urine myoglobulin levels were high in both the groups (25 to 38% of patients) for first 24 hrs. (Table 3) and normalized without altered renal function. We feel use of amicar has reduced the blood loss in group I and not in group II, while infusion of NaHCO3 has maintained the blood pH above 7.4 and none of the patients in either group had abnormal renal function.

Table 3

Table 3

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REFERENCES

1. G.I. Cancer 1995;0:1
2. Anesth Interns Care 1992; 20:491
© 1998 International Anesthesia Research Society