Anesthetic management and complications in living donor hepatectomy.
A total of 112 living donor hepatectomies (LDHs) performed from October 1999 to April 2003 at Ege University Hospital Organ Transplantation Center were reviewed and perioperative anesthetic courses and complications were determined. There was no perioperative mortality. Mean duration of operations was 333 +/- 77 minutes (range, 160 to 540 minutes) for right lobectomies and 277 +/- 88 minutes (range, 150 to 500 minutes) for left lateral segment plus left lobe operations. The remnant liver volume ratios of the patients was 0.58 +/- 0.16 (range, 0.30 to 0.91) after harvesting. Crystalloids, colloid infusions, and transfusions aimed to keep hematocrit >25%, central venous pressure (CVP) <5 mm Hg and to maintain a urine output >1 mL/kg(-1) while nitroglycerin was infused (0.5 to 2.0 microg/kg(-1)h(-1)) when needed to allow fluid infusions freely without increasing the CVP values. No transfusion was needed for 91 patients (81%) and 21 right lobectomy patients needed transfusion of blood products. Initial mean hematocrit of 38.9 +/- 4.9% (range, 27% to 50%) for all patients was found 31.5% +/- 5% (21% to 44%) at the end of the operation. Albumin blood levels averaged 4.27 +/- 0.49 g/dL(-1) at the beginning and 3.28 +/- 0.45 g/dL(-1) after hepatic resection. Perioperative complications were one air embolism, postoperative systemic inflammatory response syndrome in one patient, transient but severe hemoglobinuria due to a predonated autologous blood transfusion in another, prolonged recovery for neuromuscular blocker overdose in one patient, and postoperative atelectasis in three patients, two of whom had pneumonia later while two other patients had pleural effusions. One required a drainage. Living donor hepatectomies were performed with acceptable complications in anesthetic management during this study. The operation provides us with an optimal liver segment without resulting in mortality.
Ayanoglu
H O
HO
Department of Anesthesiology and Reanimation, Ege University Medical School, Izmir 35100, Turkey. ayanoglu@med.ege.edu.tr
Ulukaya
S
S
Yuzer
Y
Y
Tokat
Y
Y
D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D016913:Blood Component Transfusion; D006400:Hematocrit; D006439:Hemodynamics; D006456:Hemoglobinuria; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008111:Liver Function Tests; D019520:Living Donors; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*