HOMEOSTATIC CHANGES DURING ANESTHESIA FOR LIVER TRANSPLANTATION FROM CADAVERIC DONOR AT VIET DUC HOSPITAL

Presenter: Nguyen Huu Hoang MD

INTRODUCTION

1967: The first liver transplant in the world Thomas Starzl and Christian Barnard

2007: The first liver transplant at Viet Duc hospital

2010: The first liver transplant from dead brain donor at Viet Duc hospital

Now: dozens of successful cases Intraoperative: biochemical, blood count,

coagulation, blood gas changed dramatically in each phase of operation

OBJECTS AND METHODS

16 liver transplant patients from cadaveric donor

Anesthesia Protocol: induction: propopol, Fentanyl/sufentanyl,

suxamethonium, maintain: isoflurance/ sevoflurance,

fentanyl/sufentanyl, atracium. Mechanical vent: Vt = 10ml/kg f: 10-12 lần/p

EtCO2 35-40mmHg.

OBJECTS AND METHODS

Monitor: ECG, SpO2, EtCO2, A-line:

Right radial: monitor IBP Left radial : Blood samples

Monitor CO: Swan-Ganz or PiCCO2 Blood samples : biochemical, blood count, coagulation,

blood gas T1: 30 minutes after induction T2: dissection phase T3: anhepatic phase T4: 1minute after reperfusion T5: 5minutes after reperfusion T6: 60minutes after reperfusion T7: at the end of operation

RESULTS AND DISCUSSION

Table 1: Patient characteristicsParameters Min ÷ Max

age (year) 52,5 ± 7,7 38 - 64

Male/female 16(100%)/0(0%)

Height(cm) 166,5 ± 4,8 160-178

Weight(kg) 63,8±8,6 52,5-78

BSA(m2) 1,71±0,14 1,53-1,96

Cirrhosis 3(18,7%) Diagnose

HCC 13(81,3%)

X SD 9,5±3,5 6-17

MELD Score <10

≥ 10

10(62,5%)

6(37,5%)

X SD 6,0 ± 1,3 5-9 Child-Push

A/B/C(n) 11/5/0

Swan-Ganz 14(87,5%) CO

PiCCO2 2(12,5%)

CPB (n) 1(6,25%)

RESULTS AND DISCUSSION

Table 2: Anesthsia, surgery duration and fluid infusion intraoperation Parameters X SD Min ÷ Max

Induction(min) 65,6±22,2 40-130

Surgery duration(min) 526±153 380-1050

Time from induction to

extubation (min) 1187±476 550-2220

crystalloid (ml) 5293±1831 2000-8500

Total albumin 20% (ml) 628±227 200-1000

RBC (ml) 1390±1064 0-4000

Plasma (ml) 1512±554 625-2500

Platelet (ml) 609±228 250-1000

Urine output (ml) 1646±606 900-3000

RESULTS AND DISCUSSION

Figure 1: Hepatic enzyme changes intraoperative

0

100

200

300

400

500

600

700

800

900

T1 T2 T3 T4 T5 T6 T7

GOT GPT

* *

*

*

**

**

U/l

RESULTS AND DISCUSSION

Figure 2: Bilirubin changes intraoperative

0

10

20

30

40

50

60

T1 T2 T3 T4 T5 T6 T7

Total Bilirubin Direct Bilirubin

* ** *

* *

µmol/l

RESULTS AND DISCUSSION

Figure 3: blood glucose and electrolytes changes intraoperative

0

2

4

6

8

10

12

14

16

T1 T2 T3 T4 T5 T6 T7

Glucose Kali Canxi

* **

*mmol/l

RESULTS AND DISCUSSION

Figure 4: Intraoperative blood lactat levels

0

1

23

4

5

6

T1 T2 T3 T4 T5 T6 T7Lactat

** *

*

*

mmol/l

RESULTS AND DISCUSSION

Figure 5: Intraoperative INR changes

0

0.5

1

1.5

2

T1 T2 T3 T4 T5 T6 T7

INR* * * *

RESULTS AND DISCUSSION

Figure 6: Intraoperative hemoglobin changes

0

20

40

60

80

100

120

140

T1 T2 T3 T4 T5 T6 T7

Hb

* * **

g/l

RESULTS AND DISCUSSION

Table 3: Blood gas changes intraoperative

Parameters T1 T2 T3 T4 T5 T6 T7 p

pH 7,48±0,12 7,47±0,04 7,43±0,04 7,36±0,06 7,38±0,05 7,41±0,04 7,45±0,05 p 3,4,5<0,001

PaO2 208±65 199±39 205±82 279±105 315±101 192±39 202±66 p3,4,5<0,05

PaCO2 31±5 37±6 35±4 39±5 38±3 40±6 38±9 p3,4,5,6<0,05

P/F 335±66 338±66 347±126 422±125 533±157 341±50 388±110 p3,4,5 <0,05

CONCLUSION

Homeostatic changed significantly between preanhepatic, anhepatic and reperfution phase

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