Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, Medicine College, Ta-pei Rd. 123, Niao Shung Hsiang, Kaohsiung, Taiwan, ROC.
J Anesth. 2011 Jun;25(3):418-21. doi: 10.1007/s00540-011-1110-y. Epub 2011 Mar 2.
Two adult patients who underwent living donor liver transplantation with acute accumulation of right-side pleural effusion are reported. The chest X-ray of patient 1 showed no specific finding 3 days before the operation, and patient 2 was known to have pleural effusion and underwent pigtail drainage before transplant. After anesthesia induction and insertion of central venous catheters, a portable chest radiograph was taken to confirm the positions of the central venous catheters and endotracheal tube. A massive right-side pleural effusion was noted unexpectedly in both patients. Approximately 2,000 ml transudative fluid was surgically drained through the right diaphragm in patient 1 upon opening of the abdominal cavity. The acute accumulation of massive pleural fluid in patient 2 was caused by clamping of the pigtail drainage tube during patient transfer to the operating room; upon unclamping of the tube, 2,000 ml fluid was drained. The intraoperative and postoperative transplant courses of both patients were uneventful. Both were discharged from the hospital in stable condition. Our cases suggest that chest X-ray after induction of the anesthesia and before liver transplantation surgery is recommended. In addition to documenting the positions of the central venous catheters and endotracheal tube, a potential life-threatening pleural effusion requiring appropriate management may be detected.
报告了 2 例成人活体肝移植术后右侧胸腔大量积液急性积聚的患者。患者 1 的术前 3 天胸部 X 线检查未见特殊发现，患者 2 已知有胸腔积液，并在移植前进行了猪尾引流。在麻醉诱导和中心静脉导管插入后，拍摄便携式胸部 X 光片以确认中心静脉导管和气管内导管的位置。在打开腹腔时，患者 1 中意外地发现大量右侧胸腔积液，约 2000ml 渗出液通过膈肌从右侧引流。患者 2 大量胸腔积液的急性积聚是由于在将患者转移到手术室时夹住猪尾引流管引起的；松开引流管后，排出了 2000ml 液体。这 2 例患者的手术和术后移植过程均无并发症。他们均在稳定的情况下出院。我们的病例提示，建议在麻醉诱导后和肝移植手术前进行胸部 X 光检查。除了记录中心静脉导管和气管内导管的位置外，还可能会发现需要适当处理的潜在危及生命的胸腔积液。
