Perioperative anesthetic management for fulminant hepatic failure patients receiving liver transplantation

Hai-Tao XU

ABSTRACT

Objective:

To summarize our experience in perioperative anesthetic management for fulminant hepatic failure (FHF) patients receiving liver transplantation.

Methods:

The clinical anesthetic data of 48 FHF patients receiving orthotopic liver transplantations (OLT) from January 2006 to January 2007 were retrospectively analyzed, and the anesthetic management experience was summarized. General anesthesia was applied; the hemodynamics was monitored during the operation and doses of adrenaline and phenylephrine were adjusted according to the monitoring results. Blood samples were obtained before operation, before anheptic, 30 min after anhepatic P base, 5 min before neohepatic phase, and 5 min, 30 min and 60 min after neohepatic phase for blood gas and electrolyte analysis and for determination of coagulation function; the drugs were subsequently adjusted according to analysis results.

Results:

All the 48 patient underwent successful anesthetic management and there was no death during opearation. The average blood loss during operation was (5 219±478) ml. Mild alkalosis, hypokalemia, hyponatrium, and hypocalcemia were present before operations. pH, BE and HCO3-were obviously reduced 30 min after anhepatic phase and increased 60 min after neohepatic phase. Kalemia was obviously increased 30 min following anhepatic phase and began to increase 60 min following neohepatic phase. Calium concentration was decreased at the end of preanhepatic phase (PProthrombin time (PT) before operation was significantly longer than the norm (Pafter treatment; however, it prolonged again 5 min before and after neohepatic phase. The fibrinogen (FIB) level was significantly decreased compared with that before operation (Pcardiac output or mean aterial pressure at anhepatic phase, and the hemodynamics was stable at other phases.

Conclusion:

FHF patients are often complicated with disorders in the inner environment; their hemodynamics, blood gas and coagulation functions should be monitored perioperatively, and drugs should be adusted accordingly to maintain the stability of the inner environment.