The method and accuracy of documentation of intraoperative fluids management in liver transplantation recipients.

BACKGROUND: In liver transplantation, blood loss can be massive, requiring timely and rapid fluid resuscitation. Maintaining proper documentation of fluids during such situations can be difficult and may often lead to counting errors. We report our method of documentation of fluid management during liver transplantation. MATERIAL/METHODS: Each unit of red blood cells (125 cc) that comes from the blood bank had a serial number of 10 Arabic numbers which were verified and double-checked. Each unit was then numbered and labeled as encircled absolute numbers (e.g., 1, 2, 3). Both the encircled number and the serial number of the bag were recorded in the anesthesia chart. Each liter of crystalloids and colloids were similarly numbered and labeled in sequence for ease of calculation. At the end of the operation, the nurse anesthetist ascertains that the number of units of blood products used matched with the number of units supplied by the blood bank. The total amounts of crystalloids and colloids given during the operation was also calculated, rechecked and written in a tabulated form. RESULTS: Since the introduction of this method, we have detected and readily corrected 3 incidences of counting discrepancy in the total units of blood products transfused and the products supplied by the blood bank. Moreover, our records have now become transparent data that are easily retrievable for future scientific research. CONCLUSIONS: Our method of documentation of fluid management during liver transplantation is easy, accurate and effective.

Is there any difference in anesthetic management of biliary atresia and glycogen storage disease patients undergoing liver transplantation?

BACKGROUND: The purpose of the study was to compare the intraoperative blood glucose changes and the dosage of glucose infused between biliary atresia and glycogen storage disease (GSD) patients undergoing living donor liver transplantation (LDLT). PATIENTS AND METHODS: The anesthesia records of biliary atresia and GSD patients undergoing LDLT were reviewed retrospectively. The levels of intraoperative blood glucose before operation, after induction of anesthesia, in the dissection, anhepatic, 10 min after reperfusion, and at the end of operation, as well as the dosage glucose infused, were compared between groups. The Mann-Whitney U test was used for statistical analysis; P < 0.05 was regarded as significant. RESULTS: Seventy-two biliary atresia patients were grouped into group I (GI) and 8 GSD patients into group II (GII). The blood glucose levels of both groups increased after operation and remained hyperglycemic, around 100-300 mg/dl, until the end of the operation. The mean glucose amounts infused were 2.7 +/- 1.9 and 2.5 +/- 1.15 mg/kg/min for GI and GII, respectively. CONCLUSION: No significant difference was found in the anesthetic management between groups. The only difference was that the GSD patients required continuous glucose supply the night before the operation, while biliary atresia patients did not.

Maintenance of normothermia at operation room temperature of 24 degrees C in adult and pediatric patients undergoing liver transplantation.

Hypothermia is common during surgery in regular operating room (OR) temperature. The effect of increasing the OR temperature to 24 degrees C coupled with simple warming measures to maintain normothermia in both pediatric and adult patients during living donor liver transplantation (LDLT) was evaluated. One hundred patients undergoing LDLT were separated into pediatric (GI) and adult (GII) groups. Nasopharyngeal temperature (NT) at each hour for the first 6 h, at the time of anhepatic phase, 5 and 30 min after reperfusion, and each hour for the last 2 h of the operation was recorded, compared and analyzed. A significant difference in core temperature variation was noted between the two groups. GI tended to be hyperthermic, while GII remained mildly hypothermic throughout the procedure. A sudden decrease of NT was observed in both groups during the anhepatic and reperfusion phases. Correlation between liver graft weight over recipient body weight ratio rather than the graft weight itself was found in GI, but no such correlation was found in GII. OR temperature of 24 degrees C, together with simple active and passive warming measures are more effective in maintaining normothermia during liver transplantation in pediatric patients than in adults.