Anesthetic Management of Donor in Adult-to-Adult Living Donor Liver Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yi , LUO Chaozhi

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Liver transplantation; 　　Living donor; 　　Anesthesia

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (P gt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.

Citation： LI Yi,LUO Chaozhi. Anesthetic Management of Donor in Adult-to-Adult Living Donor Liver Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(5): 362-365. doi: Copy

1.	de Villa VH, Lo CM, Chen CL. Ethics and rationale of living-donor liver transplantation in Asia [Ｊ]. Transplantation, 2003; 75(3 Suppl)∶S2.
2.	Strong RW, Lynch SV, Ong TH, et al. Successful liver transplantation from a living donor to her son [Ｊ]. N Engl J Med, 1990; 322(21)∶505.
3.	曾勇, 严律南, 李波, 等. 成人间活体右半肝移植供体手术技巧探讨 [Ｊ]. 四川大学学报(医学版), 2007; 38(3)∶518.
4.	严律南. 活体肝移植的现状与展望 [Ｊ].中国普外基础与临床杂志, 2007; 14（2）∶128.
5.	李国强, 王学浩. 活体肝移植临床研究的新进展 [Ｊ].中国普外基础与临床杂志, 2002; 9(4)∶279.
6.	Hoetzel A, Leitz D, Schmidt R, et al. Mechanism of hepatic heme oxygenase-1 induction by isoflurane [Ｊ]. Anesthesiology, 2006; 104(1)∶101.
7.	Schmidt R,Tritschler E,Hoetzel A,et al.Heme oxygenase-1 induction by the clinically used anesthetic isoflurane protects rat livers from ischemia/reperfusion injury[Ｊ].Ann Surg,2007;245(6)∶931.
8.	Tsuchiya M, Asada A, Kasahara E, et al. Antioxidant protection of propofol and its recycling in erythrocyte membranes [Ｊ]. Am J Respir Crit Care Med, 2002; 165(1)∶54.
9.	冯春生, 赵恒兰, 王凡, 等. 异丙酚与安氟醚或七氟醚静吸复合麻醉对肝功能的影响 [Ｊ]. 吉林大学学报(医学版), 2002; 28(4)∶408.
10.	高元兴, 余正平. 异氟醚复合异丙酚控制降压在无血切肝术中的应用 [Ｊ]. 肝胆胰外科杂志, 2003; 15(3)∶189.
11.	Beers R, Camporesi E. Remifentanil update: clinical science and utility [Ｊ]. CNS Drugs, 2004; 18(15)∶1085.
12.	Zoellner H, Hfler M, Beckmann R, et al. Serum albumin is a specific inhibitor of apoptosis in human endothelial cells [Ｊ]. J Cell Sci, 1996; 109(Pt 10)∶2571.
13.	Dubois MJ, Vincent JL. Use of albumin in the intensive care unit [Ｊ]. Curr Opin Crit Care, 2002; 8(4)∶299.
14.	Melendez JA, Arslan V, Fischer ME. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction [Ｊ]. J Am Coll Surg, 1998; 187(6)∶620.
15.	张明礼, 刘燕, 宋乃庆, 等. 国产自体-2000型血液回收机的临床应用 [Ｊ]. 北京医科大学学报, 1998; 30(6)∶559.
16.	柏文悦, 王海滨, 伍明明, 等. 血液回收机在手术中的应用 [Ｊ]. 中华麻醉学杂志, 2000; 20(11)∶700.
17.	Spain DA, Miller FB, Bergamini TM, et al. Quality assessment of intraoperative blood salvage and autotransfusion [Ｊ]. Am Surg, 1997; 63(12)∶1059.
18.	Schmidt H, Flsgaard S, Mortensen PE, et al. Impact of autotransfusion after coronary artery bypass grafting on oxygen transport [Ｊ]. Acta Anaesthesiol Scand, 1997; 41(8)∶995.
19.	Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [Ｊ]. Br J Surg, 1998; 85(8)∶1058.
20.	Chhibber A, Dziak J, Kolano J, et al. Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases [Ｊ]. Liver Transpl, 2007; 13(4)∶537.

1. de Villa VH, Lo CM, Chen CL. Ethics and rationale of living-donor liver transplantation in Asia [Ｊ]. Transplantation, 2003; 75(3 Suppl)∶S2.
2. Strong RW, Lynch SV, Ong TH, et al. Successful liver transplantation from a living donor to her son [Ｊ]. N Engl J Med, 1990; 322(21)∶505.
3. 曾勇, 严律南, 李波, 等. 成人间活体右半肝移植供体手术技巧探讨 [Ｊ]. 四川大学学报(医学版), 2007; 38(3)∶518.
4. 严律南. 活体肝移植的现状与展望 [Ｊ].中国普外基础与临床杂志, 2007; 14（2）∶128.
5. 李国强, 王学浩. 活体肝移植临床研究的新进展 [Ｊ].中国普外基础与临床杂志, 2002; 9(4)∶279.
6. Hoetzel A, Leitz D, Schmidt R, et al. Mechanism of hepatic heme oxygenase-1 induction by isoflurane [Ｊ]. Anesthesiology, 2006; 104(1)∶101.
7. Schmidt R,Tritschler E,Hoetzel A,et al.Heme oxygenase-1 induction by the clinically used anesthetic isoflurane protects rat livers from ischemia/reperfusion injury[Ｊ].Ann Surg,2007;245(6)∶931.
8. Tsuchiya M, Asada A, Kasahara E, et al. Antioxidant protection of propofol and its recycling in erythrocyte membranes [Ｊ]. Am J Respir Crit Care Med, 2002; 165(1)∶54.
9. 冯春生, 赵恒兰, 王凡, 等. 异丙酚与安氟醚或七氟醚静吸复合麻醉对肝功能的影响 [Ｊ]. 吉林大学学报(医学版), 2002; 28(4)∶408.
10. 高元兴, 余正平. 异氟醚复合异丙酚控制降压在无血切肝术中的应用 [Ｊ]. 肝胆胰外科杂志, 2003; 15(3)∶189.
11. Beers R, Camporesi E. Remifentanil update: clinical science and utility [Ｊ]. CNS Drugs, 2004; 18(15)∶1085.
12. Zoellner H, Hfler M, Beckmann R, et al. Serum albumin is a specific inhibitor of apoptosis in human endothelial cells [Ｊ]. J Cell Sci, 1996; 109(Pt 10)∶2571.
13. Dubois MJ, Vincent JL. Use of albumin in the intensive care unit [Ｊ]. Curr Opin Crit Care, 2002; 8(4)∶299.
14. Melendez JA, Arslan V, Fischer ME. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction [Ｊ]. J Am Coll Surg, 1998; 187(6)∶620.
15. 张明礼, 刘燕, 宋乃庆, 等. 国产自体-2000型血液回收机的临床应用 [Ｊ]. 北京医科大学学报, 1998; 30(6)∶559.
16. 柏文悦, 王海滨, 伍明明, 等. 血液回收机在手术中的应用 [Ｊ]. 中华麻醉学杂志, 2000; 20(11)∶700.
17. Spain DA, Miller FB, Bergamini TM, et al. Quality assessment of intraoperative blood salvage and autotransfusion [Ｊ]. Am Surg, 1997; 63(12)∶1059.
18. Schmidt H, Flsgaard S, Mortensen PE, et al. Impact of autotransfusion after coronary artery bypass grafting on oxygen transport [Ｊ]. Acta Anaesthesiol Scand, 1997; 41(8)∶995.
19. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection [Ｊ]. Br J Surg, 1998; 85(8)∶1058.
20. Chhibber A, Dziak J, Kolano J, et al. Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases [Ｊ]. Liver Transpl, 2007; 13(4)∶537.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Anesthetic Management of Donor in Adult-to-Adult Living Donor Liver Transplantation

Abstract Full text Figures/Tables Video References Cited by

Format

Content