Kang J G, Ko J S, Kim G S, Gwak M S, Kim Y R, Lee S-K
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Transplant Proc. 2010 Apr;42(3):854-7. doi: 10.1016/j.transproceed.2010.02.057.
Orthotopic liver transplantation (OLT) patients are known to show decreased intraoperative anesthetic requirements compared with patients undergoing other liver surgeries. The aim of this study was to determine the relationship between inhalational anesthetic requirements and the severity of liver disease among OLT patients.
Fifty patients undergoing first living donor OLT were divided into 2 groups: model for end-stage liver disease (MELD) score<20 (low-MELD group; n=25) versus, MELD score>or=20 (high-MELD group; n=25). Anesthesia was maintained with desflurane and inspired concentration was titrated to maintain the bispectral index between 40 and 50. Neither intraoperative opioid nor epidural or intrathecal analgesia was used. End-tidal desflurane concentration (ETdes) was measured every 5 minutes and averaged in 30-minute intervals. These values were divided into 3 phases: preanhepatic (P 0.5 hour, P 1 hour, and P 1.5 hours), anhepatic (A 0.5 hour, A 1 hour, A 1.5 hours, and A 2 hours), and postreperfusion (R 0.5 hour, R 1 hour, R 1.5 hours, R 2 hours, R 2.5 hours, and R 3 hours). Results were compared between the 2 groups.
The demographic and intraoperative data were similar between the 2 groups. ETdes to maintain comparable anesthetic depth was significantly lower during the preanhepatic and anhepatic phases in the high-MELD than the low-MELD group, but there was no significant difference during the postreperfusion period.
OLT patients with high MELD scores showed less inhalational anesthetic requirements during the preanhepatic and the anhepatic periods than those with low MELD scores.
与接受其他肝脏手术的患者相比，原位肝移植（OLT）患者术中麻醉需求降低。本研究旨在确定OLT患者吸入麻醉需求与肝病严重程度之间的关系。
50例接受首次活体供肝OLT的患者分为2组：终末期肝病模型（MELD）评分<20（低MELD组；n = 25）与MELD评分≥20（高MELD组；n = 25）。使用地氟醚维持麻醉，并滴定吸入浓度以维持脑电双频指数在40至50之间。术中未使用阿片类药物、硬膜外或鞘内镇痛。每5分钟测量一次呼气末地氟醚浓度（ETdes），并以30分钟为间隔进行平均。这些值分为3个阶段：肝前（P 0.5小时、P 1小时和P 1.5小时）、无肝（A 0.5小时、A 1小时、A 1.5小时和A 2小时）和再灌注后（R 0.5小时、R 1小时、R 1.5小时、R 2小时、R 2.5小时和R 3小时）。比较两组结果。
两组的人口统计学和术中数据相似。在肝前和无肝期，高MELD组维持可比麻醉深度所需的ETdes显著低于低MELD组，但在再灌注期无显著差异。
与低MELD评分的OLT患者相比，高MELD评分的OLT患者在肝前和无肝期吸入麻醉需求较少。
