title: [Ex situ surgery of the liver--anesthesiologic management].
abstract: In a 40-year old patient multiple liver tumours that were otherwise regarded as irresectable were removed in an ex situ operation--according to the authors' knowledge for the first time in a human. After protective perfusion with a hypothermic HTK solution hepatectomy was performed. After extirpation of the tumours ex situ, the residual liver was re-implanted. The total operation time was 13 h 50 min, the anhepatic period lasted for 6 h 9 min. During the anhepatic period a venous bypass shunted the blood from the a femoral and the portal vein to an axillary vein. Considerable blood loss was balanced by the transfusion of 26 units of banked blood. Severe disturbances of blood coagulation could be avoided by early substitution with fresh frozen plasma, platelets and fresh blood. The long anhepatic phase caused an acidosis that required the application of 330 mVal NaHCC3. In the discussion the necessity for an aggressive intraoperative monitoring of haemodynamic and laboratory parameters is emphasized.
authors.affiliation: Zentrum Anästhesiologie, Medizinischen Hochschule Hannover.
authors.forename: N
authors.initials: N
authors.lastname: Lübbe
authors.forename: A
authors.initials: A
authors.lastname: Bornscheuer
authors.forename: R
authors.initials: R
authors.lastname: Pichlmayr
authors.forename: H
authors.initials: H
authors.lastname: Grosse
authors.forename: E
authors.initials: E
authors.lastname: Kirchner
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D007890:Leiomyosarcoma / Q000556:secondary* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D010477:Perfusion; D012092:Replantation / Q000379:methods*; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D010100:Oxygen
vernacular_title: Ex-situ-Operation an der Leber--Anästhesiologisches Management.