Browsing by Author "Kerner, V."

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Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 1]
(College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Wijesuriya, N.; Rodrigo, U.; Mudalige, A.; Fernando, M.; Hettiarachchi, D.; Dissanayake, J.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; de Silva, J.; Siriwardana, R.; WIjesuriya, R.; Liyanage, C.
ABSTRACT: Cirrhosis with end stage liver disease (ESLD) is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation is the only curative treatment for patients with ESLD. The complex multisystem involvement and unique cardiovascular profile characteristic of ESLD present formidable challenges during liver transplantation. Management of the rapid and varied hemodynamic changes during surgery requires an in depth understanding of the physiological effects of each intervention. Based on the current literature and the experience gained at our center during the management of 50 liver transplants, we present optimization strategies and perioperative hemodynamic interventions which we use to ‘Fast track’ recovery following liver transplantation. KEYWORDS: Liver transplantation, cirrhosis, non-alcoholic fatty liver disease, alcohol related liver disease
Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2]
(The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.
Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.
Novel technique for uninterrupted confirmation of endotracheal tube position for awake fiberoptic intubation
(Elsevier B.V, 2020) Kerner, V.; Gunetilleke, B.; Fernando, R.
Misplacement of an endotracheal tube in a patient with a difficult airway is catastrophic. Currently used techniques do not permit simultaneous bronchoscopic and capnographic confirmation of tube placement. We report a novel technique for seamless monitoring of the endotracheal tube position in the tracheobronchial tree during Awake Fibre Optic Intubation (AFOI). The simple modification described improves the safety profile of AFOI in several ways. The modification allows an overlap between the bronchoscopic viewing of the endotracheal tube in the trachea and the appearance of the typical wave on the capnograph. It only requires an endotracheal tube connected to a catheter mount. The bronchoscope is then introduced via the port on the catheter mount. The tube-catheter mount unit is secured to the scope (Figure 1). A ventilator circuit with attached capnograph adapter is connected to the catheter mount once the endotracheal tube is advanced into the trachea. Ventilation is then initiated. Appearance of the characteristic wave on capnograph confirms the correct position before the extraction of the bronchoscope Migration of the tube into the oesophagus is unnoticed until the bronchoscope is completely removed from the trachea in 5±10% of AFOIs1,2. Displacement of endotracheal tube into the oesophagus despite the bronchoscope tip being positioned in the trachea has been described3. Resistance that is felt as the tube is advanced over the mid part of the scope looped into the oesophagus may be misinterpreted as the tube tip impinging on the arytenoid cartilages3. The tube slides into the oesophagusas the scope is extracted. This usually occurs before capnographic confirmation is possible3. The technique we propose will be useful since ventilation is initiated with the scope in-situ. Loss of the capnographic trace is evidence of misplacement of the tube, though the bronchoscope is within the trachea. We propose this should be the standard of care and should be included in the AFOI training protocols.