Changes in arterial blood glucose and lactate during orthotopic liver transplantation without bypass / 中华麻醉学杂志

ABSTRACT

Objective Orthotopic liver transplantation (OLT) without bypass is technically simpler butimposes additional stress and strain on already compromised ciroulatory function and milieu interieur. The purposeof this study was to investigate the changes in arterial blood concentrations of glucose and lactate during OLTwithout bypass. Methods Eighty patients (66 male, 14 female) aged 12-67 yr weighing 40-130 kg undergoingOLT without veno-venous bypass for terminal liver cirrhosis (40 patients), liver cancer (28 patients), hepato-lenticular degeneration (5 patients), polycystic liver (3 patients) and severe hepatitis (4 patients). Nine patientswere classified as ASA physical status Ⅱ, thirty-nine patients as ASA Ⅲ, thirty patients ASA Ⅳ and two patientsASAV. Anesthesia was induced with midazolam 2 mg, fentanyl 10-15?g?kg~(-1), propofol 1 .0 - 1 .5 mg?kg~(-1) andpancuronium 0. 15 mg?kg~(-1) and maintained with isoflurane inhalation and intermittent i. v. boluses of fentanyl,midazolam and pipecuronium. The patients were mechanically ventilated after intubation, P_(ET) CO_2 was maintained at32-35 mm Hg. No fluid containing glucose was infused during operation. Radial artery and internal jugular veinwere cannulated for BP and CVP monitoring. ECG, MAP, CVP, SpO_2, P_(ET)CO_2, temperature and urine outputwere continuously monitored during operation. Blood samples were taken from artery before anesthesia (T_0 ), beforecross-clamping of portal vein (T_1), 30 and 60 min during anhepatic phase (T_2, T_3), 5 and 30 min afterunclamping of vena cava before the unclamping of portal vein (T_4, T_5 ) and at the end of surgery (T_6 ) fordetermination of blood glucose and lactate concentrations. Blood lactate was determined only in 50 patients whoreceived no lactated but acetated Ringer's solution during operation. In 70 patients blood samples were obtainedfrom hepatic vein after unclamping of portal vein and before the end of exsanguination from the hepatic vein fordetermination of blood glucose and lactate. Results No patient developed hypoglycemia during operation. Bloodglucose increased slightly before cross-clamping of portal vein (T_1) and during anhepatic phase (T_2, T_3) comparedwith the baseline value before anesthesia (T_0 ) (P