Changes in intrapulmonary shunting during orthotopic liver transplantation without veno-venous bypass / 中华麻醉学杂志

ABSTRACT

Objective To investigate the changes in pulmonary gas exchange and intrapulmonary shunting during orthotopic liver transplantation (OLT) without veno-venous bypass. Methods Sixteen ASA III-IV patients with end-stage liver diseases were studied. Anesthesia was induced with midazolam 0.1 mg ? kg-1 , fentanyl 10 ?g kg -1 , scopolamine 0.6 mg, and vecuronium 0.1 mg ? kg-1 and maintained with isoflurane and propofol infusion (2-3 mg? kg-1h-1 ) supplemented with intermittent iv boluses of midazolam, fentanyl and vecuronium. The patients were intubated and mechanically ventilated with 100% O2 Swan-Ganz catheter was inserted via right internal jugular vein. Radial artery was cannulated. MAP, HR, ECG, CVP, SpO2 and PET CO2 were continuously monitored. Body temperature was maintained at≥35.5℃ during operation. Blood samples were taken from radial and pulmonary artery for blood gas analysis. P(A-a) O2 and Qs/Qt were calculated immediately before operation (T1 ), cross-clamping (T2) and unclamping of inferior vena cava and portal vein (T3 ) , 5 min (T4) and 90 min (T5 ) after graft reperfusion and at the end of operation (T6). Results P(A-a) O2 and Qs/Qt were both higher than normal value at T1 . PaCO2, P(A-a) O2 and Qs/Qt increased significantly at T3 and T4 as compared with those at T2 P(A-a)O2 and Qs/Qt were significantly decreased at T5 and T6 as compared with those at T3 and T4 Qs/Qt was positively correlated with P(a-A) O2 and PAP. Conclusion There is a certain degree of intrapulmonary shunt before and during orthotopic liver transplantation without veno-venous bypass. The amount of fluid infused should be strictly controlled during anhepatic phase.