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HOMEOSTATIC CHANGES 
DURING ANESTHESIA FOR 
LIVER TRANSPLANTATION 
FROM CADAVERIC DONOR 
AT VIET DUC HOSPITAL 
Presenter: Nguyen Huu Hoang MD
INTRODUCTION 
 1967: The first liver transplant in the world 
Thomas Starzl and Christian Barnard 
 2007: The first liver transplant at Viet Duc 
hospital 
 2010: The first liver transplant from dead 
brain donor at Viet Duc hospital 
 Now: dozens of successful cases 
 Intraoperative: biochemical, blood count, 
coagulation, blood gas changed dramatically in 
each phase of operation
OBJECTS AND METHODS 
 16 liver transplant patients from cadaveric 
donor 
 Anesthesia Protocol: 
 induction: propopol, Fentanyl/sufentanyl, 
suxamethonium, 
 maintain: isoflurance/ sevoflurance, 
fentanyl/sufentanyl, atracium. 
 Mechanical vent: Vt = 10ml/kg f: 10-12 lần/p 
 EtCO2 35-40mmHg.
OBJECTS AND METHODS 
 Monitor: ECG, SpO2, EtCO2, 
 A-line: 
 Right radial: monitor IBP 
 Left radial : Blood samples 
 Monitor CO: Swan-Ganz or PiCCO2 
 Blood samples : biochemical, blood count, coagulation, 
blood gas 
 T1: 30 minutes after induction 
 T2: dissection phase 
 T3: anhepatic phase 
 T4: 1minute after reperfusion 
 T5: 5minutes after reperfusion 
 T6: 60minutes after reperfusion 
 T7: at the end of operation
RESULTS AND DISCUSSION 
Table 1: Patient characteristics 
Parameters Min ÷ Max 
age (year) 52,5 ± 7,7 38 - 64 
Male/female 16(100%)/0(0%) 
Height(cm) 166,5 ± 4,8 160-178 
Weight(kg) 63,8±8,6 52,5-78 
BSA(m2) 1,71±0,14 1,53-1,96 
Cirrhosis 3(18,7%) 
Diagnose 
HCC 13(81,3%) 
SD 9,5±3,5 6-17 
MELD Score <10 
≥ 10 
10(62,5%) 
6(37,5%) 
SD 6,0 ± 1,3 5-9 
Child-Push 
A/B/C(n) 11/5/0 
Swan-Ganz 14(87,5%) 
CO 
PiCCO2 2(12,5%) 
CPB (n) 1(6,25%)
RESULTS AND DISCUSSION 
Table 2: Anesthsia, surgery duration and fluid infusion intraoperation 
Parameters SD Min ÷ Max 
Induction(min) 65,6±22,2 40-130 
Surgery duration(min) 526±153 380-1050 
Time from induction to 
extubation (min) 1187±476 550-2220 
crystalloid (ml) 5293±1831 2000-8500 
Total albumin 20% (ml) 628±227 200-1000 
RBC (ml) 1390±1064 0-4000 
Plasma (ml) 1512±554 625-2500 
Platelet (ml) 609±228 250-1000 
Urine output (ml) 1646±606 900-3000
RESULTS AND DISCUSSION 
900 
800 
700 
600 
500 
400 
300 
200 
100 
0 
* * 
* 
* 
* * 
* 
* 
U/l 
T1 T2 T3 T4 T5 T6 T7 
GOT GPT 
Figure 1: Hepatic enzyme changes intraoperative
RESULTS AND DISCUSSION 
60 
50 
40 
30 
20 
10 
0 
* * 
* * 
* * 
T1 T2 T3 T4 T5 T6 T7 
Total Bilirubin Direct Bilirubin 
Figure 2: Bilirubin changes intraoperative
RESULTS AND DISCUSSION 
mmol/l * 
16 
14 
12 
10 
0 2 4 
6 8 
* * 
* 
T1 T2 T3 T4 T5 T6 T7 
Glucose Kali Canxi 
Figure 3: blood glucose and electrolytes changes intraoperative
RESULTS AND DISCUSSION 
Figure 4: Intraoperative blood lactat levels 
6 
5 
4 
2 3 
1 
0 
T1 T2 T3 T4 T5 T6 T7 
Lactat 
* 
* * 
* 
* 
mmol/l
RESULTS AND DISCUSSION 
* * * * INR 
Figure 5: Intraoperative INR changes 
2 
1.5 
1 
0.5 
0 
T1 T2 T3 T4 T5 T6 T7
RESULTS AND DISCUSSION 
Figure 6: Intraoperative hemoglobin changes 
140 
120 
100 
80 
60 
40 
20 
0 
T1 T2 T3 T4 T5 T6 T7 
Hb 
* * * * 
g/l
RESULTS AND DISCUSSION 
Table 3: Blood gas changes intraoperative 
Parameters T1 T2 T3 T4 T5 T6 T7 p 
pH 7,48±0,12 7,47±0,04 7,43±0,04 7,36±0,06 7,38±0,05 7,41±0,04 7,45±0,05 p 3,4,5<0,001 
PaO2 208±65 199±39 205±82 279±105 315±101 192±39 202±66 p3,4,5<0,05 
PaCO2 31±5 37±6 35±4 39±5 38±3 40±6 38±9 p3,4,5,6<0,05 
P/F 335±66 338±66 347±126 422±125 533±157 341±50 388±110 p3,4,5 <0,05
CONCLUSION 
 Homeostatic changed significantly between 
preanhepatic, anhepatic and reperfution 
phase
THANKYOU

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Nguyen huu hoang ta

  • 1. HOMEOSTATIC CHANGES DURING ANESTHESIA FOR LIVER TRANSPLANTATION FROM CADAVERIC DONOR AT VIET DUC HOSPITAL Presenter: Nguyen Huu Hoang MD
  • 2. INTRODUCTION  1967: The first liver transplant in the world Thomas Starzl and Christian Barnard  2007: The first liver transplant at Viet Duc hospital  2010: The first liver transplant from dead brain donor at Viet Duc hospital  Now: dozens of successful cases  Intraoperative: biochemical, blood count, coagulation, blood gas changed dramatically in each phase of operation
  • 3. OBJECTS AND METHODS  16 liver transplant patients from cadaveric donor  Anesthesia Protocol:  induction: propopol, Fentanyl/sufentanyl, suxamethonium,  maintain: isoflurance/ sevoflurance, fentanyl/sufentanyl, atracium.  Mechanical vent: Vt = 10ml/kg f: 10-12 lần/p  EtCO2 35-40mmHg.
  • 4. OBJECTS AND METHODS  Monitor: ECG, SpO2, EtCO2,  A-line:  Right radial: monitor IBP  Left radial : Blood samples  Monitor CO: Swan-Ganz or PiCCO2  Blood samples : biochemical, blood count, coagulation, blood gas  T1: 30 minutes after induction  T2: dissection phase  T3: anhepatic phase  T4: 1minute after reperfusion  T5: 5minutes after reperfusion  T6: 60minutes after reperfusion  T7: at the end of operation
  • 5. RESULTS AND DISCUSSION Table 1: Patient characteristics Parameters Min ÷ Max age (year) 52,5 ± 7,7 38 - 64 Male/female 16(100%)/0(0%) Height(cm) 166,5 ± 4,8 160-178 Weight(kg) 63,8±8,6 52,5-78 BSA(m2) 1,71±0,14 1,53-1,96 Cirrhosis 3(18,7%) Diagnose HCC 13(81,3%) SD 9,5±3,5 6-17 MELD Score <10 ≥ 10 10(62,5%) 6(37,5%) SD 6,0 ± 1,3 5-9 Child-Push A/B/C(n) 11/5/0 Swan-Ganz 14(87,5%) CO PiCCO2 2(12,5%) CPB (n) 1(6,25%)
  • 6. RESULTS AND DISCUSSION Table 2: Anesthsia, surgery duration and fluid infusion intraoperation Parameters SD Min ÷ Max Induction(min) 65,6±22,2 40-130 Surgery duration(min) 526±153 380-1050 Time from induction to extubation (min) 1187±476 550-2220 crystalloid (ml) 5293±1831 2000-8500 Total albumin 20% (ml) 628±227 200-1000 RBC (ml) 1390±1064 0-4000 Plasma (ml) 1512±554 625-2500 Platelet (ml) 609±228 250-1000 Urine output (ml) 1646±606 900-3000
  • 7. RESULTS AND DISCUSSION 900 800 700 600 500 400 300 200 100 0 * * * * * * * * U/l T1 T2 T3 T4 T5 T6 T7 GOT GPT Figure 1: Hepatic enzyme changes intraoperative
  • 8. RESULTS AND DISCUSSION 60 50 40 30 20 10 0 * * * * * * T1 T2 T3 T4 T5 T6 T7 Total Bilirubin Direct Bilirubin Figure 2: Bilirubin changes intraoperative
  • 9. RESULTS AND DISCUSSION mmol/l * 16 14 12 10 0 2 4 6 8 * * * T1 T2 T3 T4 T5 T6 T7 Glucose Kali Canxi Figure 3: blood glucose and electrolytes changes intraoperative
  • 10. RESULTS AND DISCUSSION Figure 4: Intraoperative blood lactat levels 6 5 4 2 3 1 0 T1 T2 T3 T4 T5 T6 T7 Lactat * * * * * mmol/l
  • 11. RESULTS AND DISCUSSION * * * * INR Figure 5: Intraoperative INR changes 2 1.5 1 0.5 0 T1 T2 T3 T4 T5 T6 T7
  • 12. RESULTS AND DISCUSSION Figure 6: Intraoperative hemoglobin changes 140 120 100 80 60 40 20 0 T1 T2 T3 T4 T5 T6 T7 Hb * * * * g/l
  • 13. RESULTS AND DISCUSSION Table 3: Blood gas changes intraoperative Parameters T1 T2 T3 T4 T5 T6 T7 p pH 7,48±0,12 7,47±0,04 7,43±0,04 7,36±0,06 7,38±0,05 7,41±0,04 7,45±0,05 p 3,4,5<0,001 PaO2 208±65 199±39 205±82 279±105 315±101 192±39 202±66 p3,4,5<0,05 PaCO2 31±5 37±6 35±4 39±5 38±3 40±6 38±9 p3,4,5,6<0,05 P/F 335±66 338±66 347±126 422±125 533±157 341±50 388±110 p3,4,5 <0,05
  • 14. CONCLUSION  Homeostatic changed significantly between preanhepatic, anhepatic and reperfution phase