Anesthesia for Liver Transplantation in a Patient with Hepatic Failure Combined with Primary Renal Failure: A case report / 대한마취과학회지

Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation.

Does Desflurane Anesthesia Delay the Recovery of Bowel Function: A Comparison with Sevoflurane? / 대한마취과학회지

BACKGROUND: Sympathetic nervous hyperactivity presents in response to surgical stress has been implicated as an important component of postoperative ileus. Because desflurane induces sympathetic activation, the effects of desflurane and sevoflurane on the recovery of bowel function were compared. METHODS: Forty patients undergoing a laparoscopic appendectomy were randomly assigned to receive either sevoflurane (Group S, n = 20) or desflurane (Group D, n = 20). The anesthetic, operative, and postoperative pain managements were standardized. The CRP (C-reactive protein), total leukocyte count, and ratio of the neutrophil to leukocyte counts were measured preoperatively and 12 hours postoperatively. The mean arterial blood pressure (MABP), heart rate, and end-tidal anesthetic concentration were measured at 10-min intervals during the surgery. The degree of postoperative pain, 11-graded surgical difficulty score, time to the first passage of flatus and first oral intake of clear fluid, as well as the postoperative hospital stay were also evaluated. RESULTS: Finally, 16 and 17 subjects in Groups S and D were included the analyses. There were no significant differences in the MABP, heart rate, and end-tidal anesthetic concentration between the two groups. The clinical and laboratory parameters related to the severities of inflammation and surgical trauma were similar in both groups. There were no significant differences in the times to the first passage of flatus and first oral intake of clear fluid and the postoperative hospital stay between the two groups. CONCLUSIONS: Although desflurane induces sympathetic activation, unlike sevoflurane, it does not delay the return of bowel function following a laparoscopic appendectomy.