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Clinical, laboratory and X-ray findings in 34 victims of submersion are presented. Five people died and 29 survived [age range 12-60 years]. Severe hypoxia was found in all patients [mean PO2 of 58 mmHg with some oxygen support]. Arterial blood gas analysis showed significant metabolic acidosis in 19 patients and significant respiratory acidosis in 15 patients. Pulmonary oedema was the most common X-ray finding. Fourteen patients were put on mechanical ventilation on the basis of their clinical picture and blood gases analysis. Clinical and laboratory data are very similar to those reported in international studies

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Background: To review the indications, patients' demographics, and anaesthetic protocol and to analyze perioperative complications of liver transplantation surgery.Methods: Retrospective analysis of 70 cases of LT in the period between June 2004 and October 2020 at King Hussein medical centre. Preoperative factors such as patients' demographics, age, gender, etiology of hepatic pathology, laboratory investigations, model for end-stage liver disease scores, duration of surgery and type of liver donation were recorded. Intraoperative factors such as anaesthetic and surgical protocols, need of blood product transfusions and haemodynamic monitoring were analyzed. Postoperative tracking of patients' complications and outcomes was done.Results: 68 living donor and two cadaveric LT procedures. Male to female ratio was 2.9:1.The age of LT recipients ranged from 3 to 62 years with an average age of 38.45 years. Their body weights ranged from 13 to 100 kg with mean body weight of 67.03 kg. Most common indication was cryptogenic liver cirrhosis (21.4%), followed by cirrhosis due to viral hepatitis B (15.7%). Autoimmune hepatitis was an indication in 11.4% and hepatitis C liver cirrhosis in 10%. All living donors were closely related. Right hepatic lobe graft was used in 85.7% of transplantations. Average red cells concentrate (RCC) transfused (units) was 3.1±3.97 (mean±SD). Duration of surgery (hours) was 12.5±2.4 (mean±SD). Fast track LT with extubation in theatre was done in 37 LT recipients (52.9%). Readmission to operative theatre was needed in 5 recipients (7.14%). Most common long term complications were biliary leak (20%), biliary stenosis (14.2%) and recurrence of primary disease (12.9%).Conclusions: Transplantation from living donors was by far more common in our study population. Majority of recipients were male and cryptogenic liver cirrhosis was the most common indication. Right hepatic lobe graft was used mostly. Biliary leak was the most common postoperative complication. Surgical time duration and blood products transfusion decreased significantly over years since the start of LT program.

Shivering is a well-recognized postoperative complication. The objective of the current study is to evaluate the role of tramadol in decreasing post anesthetic shivering. About 80 patients ASA I and II adult patients, aged between 18-70 years, undergoing general anesthesia were enrolled in this prospective study. They were divided into 2 groups, group 1 (n = 40) received 1 mg/kg of tramadol towards the end of the operation while group 2 (n = 40) received normal saline. Shivering was evaluated during the postoperative period. No difference among patients regarding patient characteristics. In group 1, postoperative shivering was effectively prevented in 36 (90%) and 38 (95%) patient at 15 and 30 min, respectively and none of patients shivered at grade = 3 and grade = 2. However, in group 2, the incidence of shivering was 50 and 57.5% at 15 min and 30, respectively, the difference between 2 groups was statistically significant (p<0.05). Tramadol, when given at the end of the operation can decrease the incidence of shivering.