Type of preservation solutions (PS) used for organ procurement and static cold storage before liver transplantation (LT) changed over time and are currently in our center mostly HTK and IGL1. Large registries analysis showed a shorter graft survival with HTK. Aim: compare LT outcomes according to PS used. Patients undergoing primary LT between 2013 and 2018 with grafts preserved with HTK or IGL1 solutions were retrospectively reviewed analysing postoperative short and long-term outcomes. 190 patients underwent a first LT, using IGL1 (n=107) or HTK (n=83). Recipients baseline characteristics were similar between both groups whereas HTK group had significantly more national allocation and higher median DRI and ET-DRI scores compared to IGL1 group. HTK had significantly higher rates of early allograft dysfunction (EAD) compared to IGL1 according to Olthoff (66 vs 55% p=0,033), Dhillon (35 vs 21% p=0,046) and MEAF>7 (18 vs 9% p=0,058) definitions. HTK had a significantly higher rate of non-anastomotic biliary strictures (NAS) compared to IGL, respectively 21% and 9% (p=0,042). The 3-year graft survival was higher in IGL1 group (83% vs 69%, p=0.025). At multivariate analysis, male gender, DCD donors, HTK solution and CIT >600 minutes were independent risk factors associated with NAS. Independent risk factors of graft loss were Donor age > 65 years and HTK use. The analysis after propensity score matching showed the same results than in the global cohort of patients. Conclusions: HTK showed to be an independent risk factor of NAS and graft loss compared to IGL1 PS after primary LT.

INTRODUCTION:In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time. BACKGROUND:The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment. OUTLOOK AND CONCLUSION:These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.

Background: Preservation solutions used for organ procurement and transportation before liver transplantation (LT) differ in their electrolytes content and density. The influence of the solution type on liver function recovery and postoperative complications after LT still remains controversial. We aimed to compare the outcomes of patients after LT according to the type of preservation solution. Methods: All patients undergoing LT at our institution were retrospectively reviewed from a prospectively maintained database. Early allograft dysfunction was assessed according to Olthoff's, Dhillon's and MEAF's scores. Postoperative and long-term outcomes were compared between grafts preserved with UW, HTK or IGL-1 solutions. Results: Between 2007 and 2018, 432 LT were performed on 403 patients, divided into IGL-1 (n=111), HTK (n=186) and UW (n=135) groups. The median recipient age at LT was 56 years old and sex ratio 2.1 (291 men, 141 women). No difference was observed between groups according to sex, age, BMI and Child-Pugh scores. The postoperative mortality was similar between groups, such as the rate of biliary fistula and retransplantation for primary non function. Less early allograft dysfunction were observed in IGL-1 compared to HTK and UW groups according to Olthoff's definition (51% vs. 69% and 72%, p<=0.005), and compared to only HTK group according to MEAF score (12% vs. 21%, p=0.044). After a median follow-up of 35 months (shorter in IGL-1 compared to HTK and UW groups: 20 vs. 48 and 92 months, p<0.001), biliary stricture was less frequent in IGL-1 compared to HTK and UW groups (14% vs. 33% and 31%, p<0.005); the median delay for developing biliary stricture was similar between groups, ranging from 4 to 5 months. Conclusions: IGL-1 solution seems to have some benefits on liver function recovery and could reduce the incidence of biliary stricture after LT, compared to HTK solution.

The effectiveness of preoxygenation is given by the functional residual capacity (FRC) increase and by denitrogenation, especially in obese patients.1 2 This RCT has been designed to estimate the effectiveness of the high-flow nasal cannula (HFNC; Fisher&Paykel OptiFlow™) compared with facemask (FM). The effect of the two preoxygenation strategies on FRC, and its consequences, were evaluated during induction of general anaesthesia and apnoea before intubation. Forty patients undergoing bariatric surgery were randomised into two groups and preoxygenated for 3 min (FiO2 100%): FM at 12 L min–1 and PEEP 7 cm H2O, HFNC at 50 L min–1. The apnoea before intubation was extended until a 2% decrease of SpO2 or 600 s. The cannula has been maintained for the HFNC group during the apnoea (70 L min–1). Pulmonary changes were monitored using electrical impedance tomography (EIT; Dräger PulmoVista 500TM). The primary outcome was the change in FRC estimated using EIT (ΔFRCi) during preoxygenation and apnoea. The secondary outcomes were the duration of safe apnoea time, minimum level of peripheral oxygen saturation (SpO2) before intubation, and patient comfort to the interface. Results are shown as mean (standard deviation, sd) or median (25th percentile; 75th percentile).Table 1Outcome variables, FM vs HENC. Data are expressed in median (25% quantile; 75% quantile) or average (sd). FM, facialmask group; HENC, high-flow nasal cannula groupFMHENCP-valueAFRCi PREOX, normalised × TIBASE+0.58 (0.42; 1.39)+0.39 (0.05; 1.65)0.279AFRCi APNEATOT, normalised × TIBASE–1.03 (–1.35; –0.56)–0.63 (–0.82; –0.35)0.040AFRCi APNEAINIT, normalised × T/BASE–1.00 (–1.33; –0.55)–0.63 (–0.81; –0.35)0.040AFRCi APNEAEND10, normalised × TIBASE–1.49 (–1.93; –0.86)–0.80 (–0.96; –0.42)0.003SLOPEAPNEATOT (UI s–1)–13.71 (–20.01 ;–6.95)–2.61 (–4.50; –1.59)<0.001TAPNEA (s)250 (202; 295)600 (296; 600)<0.001SpO2BASE (%)98.3 (1.23)98.2 (1.46)0.642SpO2MAX (%)99.8 (0.49)99.9 (0.31)0.701SpO2MIN (%)93.2 (2.91)97.5 (1.85)<0.001COMFPREOX, VAS 0–53.25 (1.02)4.15 (0.75)0.003 Open table in a new tab The average BMI was 40.6 (sd, 3.79) kg m–2. The normalised ΔFRCi between baseline and preoxygenation (ΔFRCi PREOX) was not significantly different between the two groups, to demonstrate a similar increase in FRC. The normalised ΔFRCi between baseline and apnoea (ΔFRCi APNEATOT) was higher for FM, to demonstrate a decrease in FRC. The SpO2MIN, the minimum value during the apnoea, was considerably lower in FM. The total duration of the apnoea (TAPNEA) was higher for HFNC. Patient comfort (COMFPREOX, scale 0–5) was superior for HFNC (Table 1). In a population at increased risk of hypoxemia, such as obese individuals, the HFNC preoxygenation increases and maintains FRC as the oxygen reserves. This allows us, thanks to apnoeic oxygenation, to manage a difficult intubation with a better safety margin. The comfort of the patient during the preoxygenation is also improved. 1.Murphy C, Wong DT. Can J Anaesth 2013; 60: 929–452.Damia G, Mascheroni D, Croci M, Tarenzi LC. Br J Anaesth 1988; 60: 574–8

(Br J Anaesth. 2015;114(4):548–550) Postpartum hemorrhage causes maternal morbidity during childbirth, and delay in treatment can complicate maternal recovery. Administering fibrinogen is thought to help reduce bleeding during postpartum hemorrhage and a plasma fibrinogen concentration <2 g/L is associated with an increased risk for heavier bleeding. However, there has been no solid evidence to support this assertion. In the study abstracted above, Wikkelsø et al investigated the benefit of fibrinogen concentrate infusion in a large multicenter randomized controlled clinical trial. Surprisingly, the authors found there was no benefit to using fibrinogen. However, some aspects of the trial need to be further considered.

Van Aelbrouck, C.1; Vasquez, Joquera S.1; Faraoni, D.2; Ickx, B.1; Barvais, L.1; Van Obbergh, L.1 Author Information

Optimising the management of hospitalised patients is a major concern. In colorectal surgery, the concept of enhanced recovery has been popularised by means of “fast-track” protocols, aiming at patient's discharge on the second postoperative day. Nevertheless, a strict fast-track protocol has several limitations. It is very demanding for the patient and therefore applicable only to a limited number of patients.

Rivaroxaban is one of the new oral anticoagulants (NOACs). It has many potential advantages in comparison with Vitamin K Antagonists (VKA). It has a predictable anticoagulant effect and does not theoretically require biological monitoring. It is also characterized by less food and drug interactions. However, due to major risks associated with over- and under-dosage, its optimal use in patients should be carefully followed by health care professionals. The aim of this article is to provide recommendations for pharmacists on the practical use of Xarelto in its different approved indications. This document is adapted from the practical user guide of rivaroxaban which was developed by an independent group of Belgian experts in the field of thrombosis and haemostasis.

Cacheux, C.; Faraoni, D.; Van Aelbrouck, C.; Ickx, B.; Huybrechts, I.; Van Obbergh, L. Author Information

Mihalache, E.-C.; Van Obbergh, L.; Cotton, F.; Lucidi, V.; Closset, J.; Ickx, B. Author Information

s and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Transfusion and Haemostasis

BACKGROUND Ketamine 0.15-1 mg kg(-1) decreases postoperative morphine consumption, but 0.5 mg kg(-1) is associated with an increase in the bispectral index (BIS) values that can lead to an overdose of hypnotic agents. The purpose of our investigation was to study the effect of ketamine 0.2 mg kg(-1) administered over a 5 min period on the BIS during stable target-controlled infusion (TCI) propofol-remifentanil general anaesthesia. METHODS Thirty ASA I or II patients undergoing abdominal laparoscopic surgery were included in this double-blind, randomized study. Anaesthesia was induced and maintained with a TCI of propofol and remifentanil. After 5 min of steady-state anaesthesia (BIS at 40) without surgical stimulation, patients received either an infusion of ketamine 0.2 mg kg(-1) or normal saline. The test drug was infused over 5 min. Standard parameters and BIS values were recorded every minute until 15 min post-infusion. RESULTS The baseline mean (sd) value for the BIS was 37 (6.5) for the ketamine group and 39 (8.2) for the placebo group. The highest mean BIS value during the recording period was 41.5 (8.7) for the ketamine group and 40.1 (8.9) for the placebo group. BIS values were not statistically different between the groups (P=0.62); there was no significant change over time (P=0.65) with no group-time interaction (P=0.55). CONCLUSIONS Under stable propofol and remifentanil TCI anaesthesia, a slow bolus infusion of ketamine 0.2 mg kg(-1) administered over a 5 min period did not increase the BIS value over the next 15 min.