Perioperative management in orthotopic liver transplantation: results of an Italian national survey.
BACKGROUND
No data are available on the perioperative approach during orthotopic liver transplantation (OLT) in Italy, apart from sporadically single center studies.


METHODS
The Department of Anesthesia cooperating with each Italian licensed OLT center received a questionnaire regarding preoperative evaluation, intraoperative anesthesia management, anesthetic drugs, blood components therapy, perioperative monitoring, supportive therapies, postoperative care, staff and organization.


RESULTS
Twenty-two centers were surveyed and 17 returned the questionnaire. Center specific protocols for OLT anesthesia exist in 12 centers. Balanced anesthesia (volatile anesthetic agents and continuous infusion of opioids) is the standard anesthetic method. In 14 cases a thromboelastogram is available; one center reported not to have a rapid infusion device available. Pulmonary artery catheterization with a continuous cardiac output device is the most used hemodynamic monitoring system; in case of hemodynamic instability, the combination of dopamine/noradrenaline resulted the first choice before vascular clamping whereas noradrenaline alone after graft's reperfusion. No difference about which intraoperative phase is mostly characterized by the use of blood components was reported. Postoperative care is provided on anesthesiological-guided Intensive Care Units (ICU) in all the surveyed centers and in three centers the ICU is dedicated only to transplant patients.


CONCLUSIONS
The results of this survey show that in Italy the perioperative management of patients undergoing OLT is not homogeneous. This database allows to debate on the best practices and pathways for perioperative management of these patients, and to stimulate future clinical trials aimed to assess the different component and steps forwards of the whole process.
Anestesia e Rianimazione SSN, Azienda Ospedaliera Universitaria Pisana, Pisa, Italia. g.biancofiore@med.unipi.it
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Della Rocca
D006801:Humans; D007558:Italy; D016031:Liver Transplantation; D019990:Perioperative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires