[To the issue of postreperfusion syndrome predictors in orthotopic liver transplantation (OLT)].

UNLABELLED: The aim of the study is revelation of postperfusion syndrome (pPS) predictors in orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Was conducted a retrospective analysis of anesthesia maintainance protocols during orthotopic liver transplantation in 261 patients aged from 6 months to 60 years. Investigated the effect of various factors on the development of PPS by the application of methods of non-parametric statistics. RESULTS: Significantly more frequent development of the PPS is noted in the age group from 3 to 18 years (up to 30% of patients). In recipients older than 18 years the frequency of the development of the PPS does not depend on age, with an average of 14%. The development of the PPS does not depend on the recipient sex, the nature of the pathology which served as an indication to the OTP, the initial severity of the state, type of OTP (living related donor or cadaveric transplantation, primary or re-transplantation), the transplant warm ischemia duration, use, or the lack of venous-venous bypass, metabolic status of the patient. The obtained results do not contradict to the data of foreign publications. Among parameters available for screening, predictor of PPS was not detected.

[Anesthetic maintenance of renal transplantation in children].

For many children with severe renal excretory dysfunction, renal transplantation is the sole method of life prolongation. The purpose of the investigation was to analyze the specific features of anesthetic maintenance of transplantation of related and cadaver kidney at 1 to 5 years. The investigation involved a detailed analysis of the specific features of 101 anesthesias made in children aged 1 to 16 years (mean 9.6+/-4.87 years) during transplantation of kidneys from corpses and apparently healthy relatives. The duration of surgery and anesthesia was 5.6+/-1.00 and 7.6+/-1.42 hours, respectively. Operations were made under balanced general anesthesia using a low-flow inhalational isoflurane or sevoflurane (0.5-2.0 MAC) technology. After inclusion of a graft into the bloodstream, a plasmapheresis procedure was initiated in 1-1.5 circulating blood volumes. All the children underwent invasive hemodynamic monitoring: the radial artery and internal jugular vein were catheterized. In 19 cases, the pulmonary artery was catheterized using a Swan-Ganz catheter. In children, the initial period of anesthesia during renal transplantation was marked by a drastic hemodynamic instability tended for hypotension and significant tachycardia in the presence of marked hypovolemia (central venous pressure = 0+/-2.0 mm Hg). The major component of infusion therapy was freshly frozen plasma (up to 50% of the volume). Inclusion of a cold renal graft into systemic circulation and washout of residues of preservative solution and necrobiolysis products from it were accompanied by a 0.5-1.3 degrees C temperature reduction and progression of metabolic acidosis. Safe and successful anesthetic maintenance of renal transplantation in children requires an obligatory informative invasive hemodynamic monitoring, continuous laboratory screening, and knowledge of stage-specific features. Continuous plasmapheresis by means of a plasma filter is preferred.