Anesthesia care for adult live donor hepatectomy: Our experiences with 100 cases

Abstract

A total of 100 patients who underwent elective lobar donor hepatectomy from 2000 to 2002 at the University of Rochester Medical Center were reviewed. Assessed clinical data were estimated blood loss, intraoperative central venous pressure (CVP), blood product and fluid administration, perioperative arterial blood gas tension and acid-base state, metabolic status, perioperative serum levels of aspartate aminotransferase, alanine aminotransferase, prothrombin time, albumin, and lactate, procedure duration, and perioperative complications. All patients survived surgery, and the average duration of surgery (from skin incision to skin closure) was 615 Ϯ 99.6 minutes. Mean blood loss was 549 Ϯ 391 mL (range, 80-2,500 mL), and only 4 patients required homologous blood transfusion. The intraoperative blood loss did not correlate with CVP values. A total of 72 patients received isotonic sodium bicarbonate solution, and their metabolic variables were superior to those of normal saline group patients (arterial pH, 7.35 Ϯ 0.03 vs. 7.29 Ϯ 0.07; base excess, -4.3 Ϯ 2.4 vs. 7.3 Ϯ 3.4; and serum bicarbonate level, 20.6 Ϯ 2.2 vs. 18.6 Ϯ 2.9). However, the better control of metabolic acidosis was not associated with serum lactate levels or other outcome measures. Maintaining the CVP Ͻ 5 mmHg was not associated with blood loss. Clinically significant anesthetic complications were severe metabolic acidosis, pneumothorax and respiratory insufficiency immediately following extubation in the operating room. In conclusion, placement of a thoracic epidural catheter delivering a local anesthetic in addition to intravenous (IV) patient-controlled analgesia with opiates provided safe and effective pain control in most patients. Further prospective studies should shed a light on the optimal care of patients undergoing liver donor hepatic resection. Liver Transpl 13: 537-542, 2007.

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

“…Both groups of donors did not receive any blood transfusion peri-operatively. No significant between-group difference was observed in median (IQR [range]) hospital stay after operation: 11 (10-13 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]) days in the control vs 11 (10-13 [10][11][12][13][14][15][16][17][18][19][20]) days in the high SVV group, p = 0.621.…”

“…Low CVP during liver resection is thought to reflect low hepatic sinusoid pressure, reducing parenchymal congestion. To date, however, maintaining low CVP during hepatectomy to reduce blood loss is controversial, especially in healthy living donors [1,[8][9][10][11].…”

Sevoflurane Protects against Acute Kidney Injury in a Small-Size Liver Transplantation Model

“…Sevoflurane is one of the widely used volatile anesthetics during hepatobiliary surgeries, including LDLT, and its effects on hepatic blood flow, oxygen delivery and liver functions have been extensively evaluated [7]. Recently, anti-inflammation properties of sevoflurane have gained attention.…”

Hepatic Resection: a Challenge to Anaesthesiologist!!!

“…[11] Whereas retrospective reviews of living related donor hepatectomies have reported that CVP monitoring did not reduce blood loss, and that blood loss did not correlate with CVP level. [12,13,14] Reduced blood loss can be attributed to the fact that hepatic venous pressure is dependent on central venous pressure. Low CVP increases negative pressure gradient with respect to right atrium and increase in air embolism which can be detected by transechocardiography.…”