Thoracic epidural analgesia in anaesthesia for liver transplantation: the 10-year experience of a single centre.
BACKGROUND
Improvements in operating techniques, methods of anaesthesia and postoperative care in liver transplantation (LT) contribute to better outcomes. In order to restrict postoperative mechanical ventilation, a thoracic epidural analgesia (TEA) has been performed in our centre since 2000. In this report we present our 10-year experience of using TEA as a component of LT anaesthesia.


METHODS
TEA was performed, by anaesthetists experienced in this method, on patients qualified for LT, who consented and met inclusion criteria: INR<1.5, APTT<45s and platelets >70 G/L. Since 2008 the decision to insert an epidural catheter has been additionally supported by thromboelastometry. We assessed extubation time, frequency of complications of TEA and undesired accidents.


RESULTS
From 279 patients undergoing LT, TEA was performed on 67 (24%), and from these 56 (84%) were extubated in the operating theatre. There were 5 cases of unsatisfactory thoracic epidural analgesia. Only 1 epidural catheter was removed accidentally, on the 2nd postoperative day. None of the complications of TEA were observed in the TEA group.


CONCLUSIONS
Based on our observations, it can be assumed that TEA done by experienced an anaesthetist is a safe component of anaesthesia in selected groups of patients undergoing LT, and allows for early extubation.
Trzebicki
Janusz
J
Department of Anaesthesiology and Intensive Care Unit, The Medical University of Warsaw, Poland. jtrzebicki@gmail.com
Nicinska
Barbara
B
Blaszczyk
Beata
B
Jureczko
Lidia
L
Kolacz
Marcin
M
Pacholczyk
Marek
M
Chmura
Andrzej
A
Lagiewska
Beata
B
Adadynski
Leszek
L
Malkowski
Piotr
P
Wasiak
Dariusz
D
Lisik
Wojciech
W
Kwiatkowski
Artur
A
Lazowski
Tomasz
T
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011044:Poland; D011446:Prospective Studies; D012121:Respiration, Artificial