Anesthetic management for patients undergoing orthotopic liver transplantation

To investigate the peri-operative hemodynamic and internal environment changes and anesthetic management during orthotopic liver transplantation (OLT).Methods Fifty-two patients with end-stage liver diseases were studied.Age ranged from 27～70 yr.General anesthesia was applied.Anesthesia was induced with midazolam,pethidine and vecuronium,and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and pipecuronium/vecuronium.The patients were mechanically ventilated with 100% O2 during operation.EEG,CVP,body temperature,SpO2 and PetCO2 were continuously monitored.Left radial artery was cannulated for continuous direct blood pressure monitoring.Arterial blood samples were taken at the beginning of operation,every 60 min during preanhepatic stage,every 30 min during anhepatic stage and neohepatic stage,and at the end of operation.Blood gas,biochemistry,urinary output and bleeding output were monitored.According to the different characteristics of the preanheptic phase,anheptic phase and neoheptic phase during OLT,the corresponding anesthetic management was supplied.Results MAP and HR were increased during the operation.PH value and BE had obvious changes and the patients were in the state of metabolic acidosis during reperfusion phases.Plasma calcium was in lower level during the surgery.Conclusion There are profound chages in hemodynamics,plasma electrolytes and acid-base during OLT.Through comprehensive management such as volume replacement,anti-acidosis and calcium supplement,there is no serious hemodynamic and internal environment disturbance during the phases.8 refs,2 tabs.