Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
Can J Anaesth. 2023 Jul;70(7):1155-1166. doi: 10.1007/s12630-023-02499-y. Epub 2023 Jun 2.
The objective of this study was to describe some components of the perioperative practice in liver transplantation as reported by clinicians.
We conducted a cross-sectional clinical practice survey using an online instrument containing questions on selected themes related to the perioperative care of liver transplant recipients. We sent email invitations to Canadian anesthesiologists, Canadian surgeons, and French anesthesiologists specialized in liver transplantation. We used five-point Likert-type scales (from "never" to "always") and numerical or categorical answers. Results are presented as medians or proportions.
We obtained answers from 130 participants (estimated response rate of 71% in Canada and 26% in France). Respondents reported rarely using transesophageal echocardiography routinely but often using it for hemodynamic instability, often using an intraoperative goal-directed hemodynamic management strategy, and never using a phlebotomy (medians from ordinal scales). Fifty-nine percent of respondents reported using a restrictive fluid management strategy to manage hemodynamic instability during the dissection phase. Forty-two percent and 15% of respondents reported using viscoelastic tests to guide intraoperative and postoperative transfusions, respectively. Fifty-four percent of respondents reported not pre-emptively treating preoperative coagulations disturbances, and 91% reported treating them intraoperatively only when bleeding was significant. Most respondents (48-64%) did not have an opinion on the maximal graft ischemic times. Forty-seven percent of respondents reported that a piggyback technique was the preferred vena cava anastomosis approach.
Different interventions were reported to be used regarding most components of perioperative care in liver transplantation. Our results suggest that significant equipoise exists on the optimal perioperative management of this population.
本研究旨在描述肝移植围手术期实践的一些方面，这些方面是由临床医生报告的。
我们使用包含与肝移植受者围手术期护理相关的选定主题问题的在线工具进行了横断面临床实践调查。我们向加拿大麻醉师、加拿大外科医生和专门从事肝移植的法国麻醉师发送了电子邮件邀请。我们使用了五点 Likert 量表（从“从不”到“总是”）和数字或分类答案。结果以中位数或比例表示。
我们收到了 130 名参与者的回答（在加拿大的估计回复率为 71%，在法国为 26%）。受访者报告说，他们很少常规使用经食管超声心动图，但经常在出现血流动力学不稳定时使用，经常使用术中目标导向的血流动力学管理策略，并且从不进行放血（来自有序量表的中位数）。59%的受访者报告在解剖阶段使用限制性液体管理策略来管理血流动力学不稳定。42%和 15%的受访者分别报告在术中使用粘弹性测试来指导术中输血和术后输血。54%的受访者报告不预先治疗术前凝血功能障碍，91%的受访者报告仅在出血明显时在术中进行治疗。大多数受访者（48%-64%）对最大移植物缺血时间没有意见。47%的受访者报告说，背驮式技术是首选的腔静脉吻合术方法。
对于肝移植围手术期护理的大多数方面，报告了不同的干预措施。我们的结果表明，在该人群的最佳围手术期管理方面存在显著的均衡。
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