Notes

The Impact of Extreme Temperature Events on Emergency Sectors in Canadian Private hospitals.
Median FK IPV was numerically higher at 6 months (37.3% vs 26.8%, P= .11) and significantly higher at 12 months (57.8% vs 30.9%, P= .01) for patients on PI-based regimens. Lastly, inferior graft function was observed in PI-based patients.

Our data suggest that PI-based ART is associated with a higher degree of FK IPV, which may contribute to worsening graft function. PK11007 Larger studies are warranted to determine the impact of PI-based ART on FK IPV and graft outcomes in this population.
Our data suggest that PI-based ART is associated with a higher degree of FK IPV, which may contribute to worsening graft function. Larger studies are warranted to determine the impact of PI-based ART on FK IPV and graft outcomes in this population.
It is still unclear whether mycophenolic acid (MPA) doses should be adjusted for older patients. Therefore, we compared the pharmacokinetics of MPA, mycophenolic acid glucuronide (MPAG), and free MPA (fMPA) between older and younger renal transplant recipients.

We included 12 patients<60 years and 6 patients >60 years within the first year after renal transplantation, who were receiving enteric-coated mycophenolate sodium, tacrolimus, and steroids. Blood samples were collected up to 12 hours after drug administration.

MPA and fMPA pharmacokinetics were similar for patients<60 and >60 years; however, the MPA area under the concentration-time curve from 0 to 12 hours (AUC
) was 1.2-fold lower in the older patients. MPAG pharmacokinetics were more than 1.5-fold higher in patients >60 years, which might be related to deteriorated renal function in older people. Moreover, the mean (MPAG AUC
)/(MPA AUC
) ratio was more than 2-fold higher in patients >60 years. The second maximal MPA concentration was more frequently observed in patients<60 years, although all patients received tacrolimus. The percentage of patients with MPA concentration before the next drug dose (C
) and AUC
within and below target was the same in both groups. All patients >60 years had MPA AUC
>30 μg·h/mL within 22 to 114 days after transplantation.

MPA therapeutic monitoring should be recommended in enteric-coated mycophenolate sodium--treated patients >60 years because MPA AUC
exceeded the recommended value in half of the studied patients.
60 years because MPA AUC0-12 exceeded the recommended value in half of the studied patients.
At our institution, peripherally inserted, 8.5-French rapid-infusion catheters (RICs) are placed for high-flow administration of intravenous fluids and blood products during liver transplant (LT). We sought to estimate the incidence of RIC placement-associated complications in LT patients.

Electronic health records of all patients who underwent LT from January 2008 through December 2017 were retrospectively reviewed. RIC-related complications were deemed clinically significant if they required surgical consultation or intervention due to infiltration. Univariable and multivariable logistic regression analyses were used to evaluate associations between patient characteristics and RIC complications.

In total, 839 LT patients who received RICs were identified; of these, 14 (1.67%) had RIC-related complications, and 7 (0.83%) required surgical consultation. No patients needed fasciotomy or wound débridement due to a RIC complication, and no patients had permanent sequelae. In the multivariable logistic regression analysis, only an increase in international normalized ratio (INR) from 1.4 to 2.2 (equivalent to the interquartile range of observed INR values) increased the odds of complications due to RIC placement (odds ratio [95% CI], 1.98 [1.10-3.56]; P= .02).

We observed a low incidence of perioperative RIC-related complications (1.7%). No patients had permanent RIC-related complications.
We observed a low incidence of perioperative RIC-related complications (1.7%). No patients had permanent RIC-related complications.Vasoplegic syndrome can occur after reperfusion in liver transplantation. Generally, vasopressor infusions along with volume resuscitation are used to combat this process. There are case reports of the use of hydroxocobalamin to improve vasoplegia in liver transplant and cardiac surgery. In this case report, we describe a patient who received hydroxocobalamin for a simultaneous liver-kidney transplant. Use of this medication facilitated a prompt decrease of very high-dose vasopressor infusions and allowed completion of the kidney transplantation portion of this case. To our knowledge, use in combined liver-kidney transplant has not been described. In light of the dearth of medications to improve vasoplegia outside of vasopressor infusions, the use of hydroxocobalamin as a therapeutic intervention may gain importance.
Intracardiac thrombosis incidence during orthotopic liver transplantation is estimated at 0.36% to 6.2% with mortality up to 68%. We aimed to evaluate risk factors and outcomes related to intracardiac thrombosis during orthotopic liver transplantation.

A comprehensive retrospective data review of 388 patients who underwent orthotopic liver transplantation at an urban transplant center from January 2013 to October 2016 was obtained.

Six patients were found to have documented intracardiac thrombosis; 4 cases were recognized during the reperfusion stage and 1 during pre-anhepatic stage. All allografts were procured from decreased donors with a median donor age of 44 years (interquartile range, 35.25-49.75) and the cause of death was listed as cerebrovascular accident in 5 donors. Preoperative demographic, clinical, laboratory, and historical risk factors did not differ in patients with thrombosis. None had a prior history of trans-jugular intrahepatic portosystemic shunt or gastrointestinal bleeding. Threeing; however, using both thrombolytics and heparin could achieve better results.
The fraction of inspired oxygen (FiO
) administered during general anaesthesia varies widely despite international recommendations to administer FiO
0.8 to all anaesthetised patients to reduce surgical site infections (SSIs). Anaesthetists remain concerned that high FiO
administration intraoperatively may increase harm, possibly through increased oxidative damage and inflammation, resulting in more complications and worse outcomes. In previous systematic reviews associations between FiO
and SSIs have been inconsistent, but none have examined how FiO
affects perioperative oxidative stress. We aimed to address this uncertainty by reviewing the available literature.

EMBASE, MEDLINE, and Cochrane databases were searched from inception to March 9, 2020 for RCTs comparing higher with lower perioperative FiO
and quantifying oxidative stress in adults undergoing noncardiac surgery. Candidate studies were independently screened by two reviewers and references hand-searched. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias tool.
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