[Anesthetic management of adult patients under orthotopic liver transplantation].

OBJECTIVE

To study the perioperative changes of and anesthetic management for patient under orthotopic liver transplantation (OLT).

METHODS

General anesthesia or general anesthesia combined with epidural block anesthesia was conducted. During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was used. Hemodynamics, respiratory function, blood gas, blood biochemistry, coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored during the operation. According to the characteristics of pre-anhepatic phase, anhepatic phase and neohepatic phases, corresponding anesthetic management measures were supplied.

RESULTS

(1) Forty-four patients tolerated the operation. One patient died of massive blood loss intraoperatively. 2 000 approximately 4 000 ml of blood was transfused to 29 patients, 4 000 approximately 6 000 ml to 7 patients and more than 6 000 ml to 8 patients. (2) During the anhepatic phase hemodynamics in 44 patients remained stable. However, in the fifteen minutes' primary stages of anhepatic phase and in neohepatic phase, transient circulatory instability occurred. Blood volume expansion was applied immediately and succeeded to correct the instability. (3) No patient, except one with massive blood loss showed obvious acid-base disturbance occurred during OLT. (4)The main electrolytic change during perioperative phase was hypocalcemia. (5) During the operation a marked change in body temperature took place. (6) Disturbance of coagulation function to a certain degree occurred. (7) The blood glucose level was higher than normal during OLT, and gradually decreased during the neohepatic phase.

CONCLUSIONS

Attention should be paid to the anesthetic management and monitoring during different phases of OLT. Appropriate treatment helps to keep the blood gas, blood biochemistry and coagulation function remain normal and stable. Use of EVVB during anhepatic phase can be helpful to keep hemodynamics stable and prevent obvious acidosis and hyperkalemia. Supplementation of coagulation factors, and proper use of hemostatic drugs and protamine to neutralize heparin were needed. Anti-rejection drugs were necessary during OLT.