There is a learning curve for every new echocardiographic application. Physicians must spend sufficient long time and effort for being expert in these new techniques”.1 In the new era of cost containment, because of lower cost and the potential to provide definite information, comprehensive and appropriate echocardiography is mandatory.

Doing such studies should eliminate Inhibitors,research,lifescience,medical further need for more expensive and potentially harmful examinations in the majority of patients and should have a big influence on cost-effectiveness of patients’ care. Conclusion Echocardiography is an essential part of practice in cardiology. Such as other technologies, this technology has many pros and cons. The major disadvantage is its need for a learning curve for providing quantitative examinations and interpretations. Its principal advantage is its outstanding versatile technology. Properly performed examinations in the right patient for the right reason, would be highly cost-effective. Conflict of Interest: None declared
Severe hyperkalemia during orthotopic liver transplantation, Inhibitors,research,lifescience,medical is very dangerous, and needs vigilant monitoring of serum potassium and acute management

of the hyperkalemia.1,2 The causes of hyperkalemia during different stages are; 1) extracellular shift in exchange for H+ during severe metabolic acidosis in an-hepatic phase Inhibitors,research,lifescience,medical and reperfusion of the graft liver, and 2) exogenous potassium due to blood selleckchem transfusion or entry of the preservative fluid University of Wisconsin (UW) solution into systemic circulation during reperfusion of the graft liver.2 However, this morbid hyperkalemia is more common in the early reperfusion Inhibitors,research,lifescience,medical phase than at other times during liver transplantation.3 Although hyperkalemic episodes occurring immediately after reperfusion of new transplanted liver are most frequent and Inhibitors,research,lifescience,medical substantial, hyperkalemia in other phases

during orthotopic liver transplantation is also hazardous and serious.2,3 For a short duration (about 3-5 min) after reperfusion of the graft liver, patients usually develop hyperkalemia. The main sources of this hyperkalemia are preservative fluid (UW solution), which contains high concentration of potassium, and severe acidosis following almost reperfusion, which can mobilize intracellular potassium from all of the tissues.2 However, hyperkalemia before reperfusion during liver transplantation anesthesia is not common. The two independent risk factors for pre-reperfusion hyperkalemia during liver transplantation are high baseline potassium concentration and red blood cell (RBC) transfusion.3 Baseline potassium is the first potassium level in operation room. An insulin protocol, in which separated doses of the regular insulin is administered together with blood transfusion in patients with high baseline K, has been used to prevent hyperkalemia due to blood transfusion.4 Herein in we present a case that developed hyperkalemia without blood transfusion during pre-anhepatic phase of liver transplantation.