[Anesthetic considerations for hepatic resection using veno-venous bypass].
Anesthetic experience of 4 cases of hepatic resection using veno-venous bypass was reported. Non-forced bypass (passive shunt) was used in case 1. Hepatic resection was performed while supporting hemodynamic stability during the subsequent anhepatic phase using pump-driven veno-venous bypass (active shunt) in case 2-4. Various problems arose in each case. In the non-forced bypass case, hypotension during the bypass created a problem; whereas, hypothermia was pronounced during bypass in the pump-driven bypass cases. Massive transfusion due to bleeding, hypocalcemia, and unintentional hypothermia after veno-venous bypass precipitated heart failure. Attention should therefore be directed toward, (1) preparation for massive transfusion, (2) measurement and correction of the plasma calcium ion concentration, (3) maintenance of body temperature, and (4) hemodynamic control with a Swan-Ganz catheter and an inferior vena cava catheter. Extracorporeal bypass using a pump-driven veno-venous bypass (Bio-pump) and splanchnic decompression system via the portal system appear to be advantageous.
Okutani
R
R
Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya.
Kono
K
K
Fukuda
T
T
Terashita
K
K
Ozaki
K
K
Ishida
H
H
Furukawa
K
K
Kato
T
T
Fujiwara
S
S
Yamanaka
N
N
D000368:Aged; D000714:Anastomosis, Surgical; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014680:Veins / Q000601:surgery*