Toprak H İ, Sener A, Gedik E, Uçar M, Karahan K, Aydogan M S, Ersoy M Ö
Department of Anesthesiology, Medical School of Inonu University, Malatya, Turkey.
Transplant Proc. 2011 Apr;43(3):892-5. doi: 10.1016/j.transproceed.2010.11.023.
It has been shown that anesthetic requirements during liver transplantation are inversely proportional to the degree of hepatic dysfunction. We investigate alterations during the three phases of requirements for intraoperative isoflurane within the target of 40 to 55 Bispectral Index (BIS) values concerning patients with end-stage liver disease who are undergoing liver transplantation. After faculty ethics committee approval, we studied 50 patients of (age range, 18 to 65 years) who were undergoing liver transplantation. After induction, we used isoflurane with air/oxygen (FiO(2) = 0.5%) for anesthetic maintenance. The isoflurane concentration was set within the range of 40 to 55 BIS values. Remifentanil (0.15 μg/kg/min) was infused for analgesia and cisatracurium was administered via continuous infusion. After anesthetic induction, we inserted arterial, pulmonary artery, and central venous catheters. The heart rate, mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), body temperature, BIS values, end-tidal isoflurane concentration (ETiso) and end-tidal carbon dioxide concentration (ETCO(2)) were recorded at 30-minute intervals during the dissection and neohepatic phases, at 15-minute intervals during the anhepatic phase. In addition, we calculated the cardiac index during the three phases. There was no difference in heart rates among the operative phases. In contrast, there were significant changes in MAP, MPAP, BIS, ETCO(2) and body temperature values. However, all of these parameters were in physiological ranges and clinically acceptable. The ETiso values were lowest in the anhepatic phase compared to other phases, but the differences were not clinically important. The ETiso values in the dissection and neohepatic phases were compared with the anhepatic phase higher 5% and 8.6% respectively. During liver transplantation, ETiso requirement for the anhepatic phase was lower compared with the other two phases within the range of 40 to 55 BIS values.
研究表明，肝移植期间的麻醉需求与肝功能障碍程度呈反比。我们针对终末期肝病患者在肝移植手术中，以40至55的脑电双频指数（BIS）值为目标，研究术中异氟烷需求在三个阶段的变化情况。经学院伦理委员会批准后，我们对50例年龄在18至65岁之间接受肝移植手术的患者进行了研究。诱导麻醉后，我们使用异氟烷与空气/氧气（FiO₂ = 0.5%）维持麻醉。异氟烷浓度设定在40至55的BIS值范围内。输注瑞芬太尼（0.15μg/kg/min）用于镇痛，并持续输注顺式阿曲库铵。麻醉诱导后，我们插入动脉、肺动脉和中心静脉导管。在解剖和新肝期，每隔30分钟记录心率、平均动脉压（MAP）、平均肺动脉压（MPAP）、体温、BIS值、呼气末异氟烷浓度（ETiso）和呼气末二氧化碳浓度（ETCO₂）；在无肝期，每隔15分钟记录上述指标。此外，我们计算了三个阶段的心脏指数。各手术阶段的心率无差异。相比之下，MAP、MPAP、BIS、ETCO₂和体温值有显著变化。然而，所有这些参数均在生理范围内且临床可接受。与其他阶段相比，无肝期的ETiso值最低，但差异无临床意义。解剖期和新肝期的ETiso值分别比无肝期高5%和8.6%。在肝移植手术中，在40至55的BIS值范围内，无肝期的ETiso需求比其他两个阶段低。
