Lee Sangho, Kim Kyoung-Sun, Sang Bo-Hyun, Hwang Gyu-Sam
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Anesth Pain Med (Seoul). 2022 Jan;17(1):57-61. doi: 10.17085/apm.21045. Epub 2021 Dec 30.
Excessive citrate load during therapeutic plasma exchange (TPE) can cause metabolic alkalosis with compensatory hypercarbia and electrolyte disturbances. If TPE is required immediately before ABO-incompatible (ABOi) liver transplant (LT) surgery, metabolic derangement and severe electrolyte disturbance could worsen during LT anesthesia.
We report two ABOi LT cases who received TPE on the day of surgery because isoagglutinin titers did not be dropped below 1:8. One case had a surprisingly high metabolic alkalosis with a pH of 7.73 immediately after tracheal intubation because of hyperventilation during mask bagging. The other experienced sudden ventricular tachycardia and blood pressure drop after surgical incision accompanied with severe hypokalemia of 1.8 mmol/L despite supplementation with potassium.
Special attention should be paid to patients who just completed TPE the operative day morning as they are vulnerable to severe acid-base disturbances and life-threatening ventricular arrhythmias in ABOi LT.
治疗性血浆置换（TPE）期间过量的柠檬酸盐负荷可导致代谢性碱中毒伴代偿性高碳酸血症和电解质紊乱。如果在ABO血型不相容（ABOi）肝移植（LT）手术前立即进行TPE，LT麻醉期间代谢紊乱和严重电解质紊乱可能会恶化。
我们报告两例ABOi LT病例，由于同种凝集素滴度未降至1:8以下，在手术当天接受了TPE。一例在气管插管后立即出现令人惊讶的高代谢性碱中毒，pH值为7.73，原因是面罩通气时过度通气。另一例在手术切口后出现突然的室性心动过速和血压下降，尽管补充了钾，但仍伴有严重低钾血症，血钾为1.8 mmol/L。
对于手术当天上午刚完成TPE的患者应特别关注，因为他们在ABOi LT中易发生严重的酸碱紊乱和危及生命的室性心律失常。
