[HSF] postop hepatorenal insufficiency

[Nasser F. Abou'Seada]

Ed ... would you elaborate more on albumin by drip ? do you keep it over the
hour ??? .. any special reason why not by direct infusion ?
also ... how much vasopressin do you use ?

NFA

On 5/9/07, Edward Bender <ebender001 at charter.net> wrote:
>
> Wait it out, but check an echo to make sure your valves are
> functioning well - including the un-mentioned tricuspid.  I also
> usually start my typical cocktail of low dose dopamine, low dose
> vasopressin, lasix/albumin drip, and iv diuril.  Tincture of time
> should do the trick, and, in the absence of structurally correctable
> abnormalities, that is all you can do.
>
> Ed Bender, MD
>
> On May 9, 2007, at 12:59 AM, erdinç naseri wrote:
>
> >
> > Opinion requested,
> > 37 y/o male Bicuspid aorta and root 5 cm,ascending aorta 5.3
> > cm,Mitral regurg,EF 15-20%
> > OPerated:aortic button modification of bentall+ mitral ring
> > annuloplasty,Continous antegrade cold hyperkalemic blood crpl for
> > most of the operation,weaned from CPB with IABP( inserted in the
> > 3.rd trial for weaning) and high dose inotropic support(CPB time
> > 230 minutes).Moderate oozing from the root( no bioglue) and
> > unfortunately mechanical failure of the only CATS(autotransfusion)
> > available.+ units of FFP and 4 units of whole blood( Htc 21 when
> > weaned from CPB)packed with sponges and closure of the skin and
> > taken to ICU.gradual weaning from inotrops in 20 hours.
> > Postop1.st day morning:Creatinin 1.4,AST470,ALT 290,ABG perfect
> > Open in the ICU and took the sponges and culture of
> > mediastinum .uneventful and finished in 20 minutes.
> > Repeat lab on evening:CRE 3.2,AST 4900 ALT9048,INR2.1,ABG:PO2 67
> > (FIO2 %70),Left atrial pressure 18 mmHg,BP 110/80( no
> > inotrops),renal shut down in hours and unremitting fever( despite
> > everything).Stared peritoneal dialysis but doesnt work. started
> > CVVHDF( good function)
> > POstop 2.nd day( today):hemodynamics stable( no inotropes),Dopamine
> > (3 micro),PO2 70(FIO2 %80,pressure support ventilation) still
> > oliguric(40 cc/6 hrs),Cre 3.8,AST 1270,ALT5342,He is awake but
> > sedated and paralysed.no growth in cultures
> > erdinc
> >
> >
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC