Hasanin Ashraf S, Mahmoud Fatma M A, Yassen Khaled A
Department of Anesthesia and ICU, National Liver Institute, Menofia University, Egypt.
Saudi J Anaesth. 2013 Oct;7(4):399-403. doi: 10.4103/1658-354X.121048.
The three phases of living donor liver transplantation (LDLT) represent different liver conditions. The aim is to study the required end-tidal desflurane concentration (ET-Des) guided with entropy monitoring for the depth of anesthesia.
After the Ethics and Research Committee approval, 40 patients were included in this prospective study. Anesthesia was maintained with Desflurane-O2-air. State entropy (SE) and Response entropy (RE) were kept between 40 and 60.
Age and Model for End-stage Liver Disease (MELD) score were 45±10 years and 15.43±3.92, respectively. ET-Des were significantly lower in the anhepatic phase (2.8±0.4%) than in the pre-anhepatic and neohepatic phases (3.3±0.3%, 3.47±0.3%, respectively, P<0.001). The SE and RE for pre-anhepatic, anhepatic, and neohepatic phases were (45.6±3.7, 47.4±3.2), (44.7±2.1, 46.4±2.04), and (46.1±3.3, 47.9±3.3), respectively, with no significant changes between the phases, P > 0.05. Total operative time was 651±88 minutes, and for each phase it was 276±11, 195±55, and 191±24 minutes, respectively. Significant changes were found in hemoglobin g/dl and hematocrit % between the three phases (10.28±1.5, 30.48±4.3), (9.45±1.34, 28.36±4.1), and (8.88±1.1, 26.63±3.5), P<0.05. The heart rate and mean blood pressures were stable despite the cardiac index demonstrated a significant reduction during the anhepatic phase (2.99±0.22) when compared to the pre-anhepatic and neohepatic phases (3.60±0.29) and (4.72±0.32), respectively, (P<0.05). There was a significant correlation between CI and ET-Des% (r=0.604, P<0.05).
Inhalational anesthetic requirements differed from one phase to another during LDLT, with requirements being the least during the anhepatic phase. Monitoring of the anesthesia depth was required, to avoid excess administration, which could compromise the hemodynamics before the critical time of reperfusion.
活体肝移植（LDLT）的三个阶段代表不同的肝脏状况。目的是研究在熵监测引导下用于麻醉深度的七氟醚呼气末浓度（ET-Des）。
经伦理与研究委员会批准，40例患者纳入本前瞻性研究。采用七氟醚 - 氧气 - 空气维持麻醉。状态熵（SE）和反应熵（RE）保持在40至60之间。
年龄和终末期肝病模型（MELD）评分分别为45±10岁和15.43±3.92。无肝期的ET-Des（2.8±0.4%）显著低于无肝前期和新肝期（分别为3.3±0.3%，3.47±0.3%，P<0.001）。无肝前期、无肝期和新肝期的SE和RE分别为（45.6±3.7，47.4±3.2）、（44.7±2.1，46.4±2.04）和（46.1±3.3，47.9±3.3），各阶段之间无显著变化，P>0.05。总手术时间为651±88分钟，各阶段分别为276±11分钟、195±55分钟和191±24分钟。三个阶段之间血红蛋白g/dl和血细胞比容%有显著变化（分别为10.28±1.5，30.48±4.3）、（9.45±1.34，28.36±4.1）和（8.88±1.1，26.63±3.5），P<0.05。尽管心脏指数在无肝期（2.99±0.22）与无肝前期（3.60±0.29）和新肝期（4.72±0.32）相比有显著降低（P<0.05），但心率和平均血压保持稳定。CI与ET-Des%之间存在显著相关性（r = 0.604，P<0.05）。
在活体肝移植期间，不同阶段吸入麻醉药的需求量不同，无肝期需求量最少。需要监测麻醉深度，以避免过量给药，这可能在再灌注关键时期之前影响血流动力学。
