The Effect of Intraoperative Restricted Normal Saline during Orthotopic Liver Transplantation on Amount of Administered Sodium Bicarbonate.
BACKGROUND
Severe metabolic acidosis occurs during orthotopic liver transplantation (OLT) particularly during the anhepatic phase. Although NaHCO3 is considered as the current standard therapy, there are numerous adverse effects. The aim of this study was to determine whether the restricted use of normal saline during anesthesia could reduce the need for NaHCO3.


METHODS
In this study we enrolled 75 patients with end-stage liver disease who underwent OLT from February 2010 until September 2010 at the Shiraz Organ Transplantation Center. Fluid management of two different transplant anesthetics were compared. The effect of restricted normal saline fluid was compared with non-restricted normal saline fluid on hemodynamic and acid-base parameters at three times during OLT: after the skin incision (T1), 15 min before reperfusion (T2), and 5 min after reperfusion (T3).


RESULTS
There were no significant differences in demographic characteristics of the donors and recipients (P>0.05). In the restricted normal saline group there was significantly lower central venous pressure (CVP) than in the non-restricted normal saline group (P=0.002). No significant differences were noted in the other hemodynamic parameters between the two groups (P>0.05). In the non-restricted normal saline group arterial blood pH (P=0.01) and HCO3 (P=0.0001) were significantly less than the restricted normal saline group. The NaHCO3 requirement before reperfusion was significantly more than with the restricted normal saline group (P=0.001).


CONCLUSIONS
Restricted normal saline administration during OLT reduced the severity of metabolic acidosis and the need for NaHCO3 during the anhepatic phase.


BACKGROUND
IRCT2013110711662N5.
Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
Mohammad Ali
MA
Sahmeddini
Department of Anesthesiology and Critical Care, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Farahzad
F
Janatmakan
Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
Mohammad Bagher
MB
Khosravi
Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
Sina
S
Ghaffaripour
Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
Mohammad Hossein
MH
Eghbal
Shiraz Anesthesiology and Critical Care Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran;
Sakine
S
Shokrizadeh
Acidosis; Crystalloid solution; Liver transplantation; Sodium bicarbonate