Deniz ÖZZEYBEK, Sevda ÖZKARDEŞLER, Uğur KOCA, Remzi ÖZAY, Çimen OLGUNER, Zahide ELAR

Canlı vericiden karaciğer transplantasyonu: Vericilerdeki anestezi deneyimlerimiz

Canlı vericiden gerçekleştirilen karaciğer transplantasyonunda vericilere ilişkin perioperatif dönemin irdelenmesi amacıyla kayıtları retrospektif olarak değerlendirilen 18 olguluk seride yoğun bakım ve hastanede kalış süreleri ile gelişen komplikasyonlar kaydedildi. 18 vericiden ll'ine sağ, 3'üne sol hepatektomi, 4'üne sol lateral segmentektomi, l'ine sol lateral segmentektomi ile birlikte sağ nefrektomi uygulandığı belirlendi. 16'sına kombine epidural + genel anestezi uygulanan olgularda operasyon süresinin ortalama 683.9 dk (405-1200), tahmini kan kaybının 712.5 mL (150-1500) olduğu ve 10 vericide tam kan transfüzyonu yapıldığı saptandı. Vakaların hiç birinde hemodinamik instabilite gelişmediği gözlendi. Postoperatif dönemde 13 olgunun operasyon salonunda, 5 olgunun ortalama 8.5 sa (3.3-11.7) sonra yoğun bakımda ekstübe edildiği; olguların 19.8 sa (10-24) sonra servise gönderildiği; postoperatif epidural analjezi uygulamasının 3 gün (1-6) sürdüğü; mobilizasyon, oral alım ve defekasyonun sırasıyla 1.9 (1-3), 2.5 (1-4) ve 3.7 (1-7) günde gerçekleştiği ve tüm vericilerin 11.8 (6-37) günde taburcu olduğu saptandı. Postoperatif dönemde intraabdominal abse gelişen l, biliyer kaçak gelişen l ve atelehtazi gelişen l olgunun tedavi sonrasında sorunsuz olarak taburcu edildikleri belirlendi. Sonuç olarak anestezi ve cerrahi ekiplerinin artan deneyimi ile anestezi yönteminin kombine epidural + genel anesteziye dönüştürüldüğü; olguların operasyon salonunda ekstübe edildiği; yoğun bakımda kalış süresinin kısaldığı ve hasta kontrollü epidural analjezinin rutine girdiği saptandı.

Anahtar Kelimeler:

Karaciğer nakli, Anestezi, genel, Doku vericileri

Living-related liver transplantation : Our anesthetic experience

The intensive care and hospital stays and complications in 18 living-liver donors were noted and the records were evaluated retrospectively far investigation of the perioperative period in this series. Left hepatectomy in 3 cases, right hepatectomy in 11 cases, left lateral segmentectomy in 4 cases and left lateral segmentectomy with right nephrectomy in l case were performed on 18 donors. Mean operative time was 683.9 (405-1200) min and average blood loss was 712.5 (150-1500) mL for all cases. Whole blood had been transfused to 10 donors. Combined epidural and general anesthesia was performed in 16 cases. Hemodynamic instability was not observed in any of the cases. While extubation was performed in the operation room in 13 cases, 5 cases were extubated in the intensive care unit after average of 8.5 (3.3-11.7) h; all cases were transported to the ward in 19.8 (10-24) h; postoperative epidural analgesia was continuedS (1-6) days; mean times far mobilization, oralintake and defecation were 1.9 (1-3), 2.5 (1-4) and 3.7 (1-7) days, respectively. Ali donors were discharged in 11.8 (6-37) days. One intraabdominal abscess, one biliary leakage and one atelectasis developed during the postoperative period and these patients were dischargedfrom hospital uneventfully after medical treatment. in conclusion; the general anesthetic technique was changed to combined general+epidural anesthesia; the cases were extubated in the operating room; the duration of intensive çare ünü decreased and the patient controlled epidural analgesia was performed rouünely with the increased experience of the anesthetic and surgical teams.

Keywords:

Liver Transplantation, Anesthesia, General, Tissue Donors,

___

1. Sterneck M, Fisher L. Nishvvitz U et al. Selection of the living liver donor. Transplantation 1995: 60 (7): 667-71.
2. Haberal M, Bilgin N. Arslan G et al. Living-related donor liver transplantation. Transplant Proc 1998; 30: 2267-8.
3. Salame E, Goldstein M, Kinkhabwala M et al. Analysis of donor risk in living-donor hepatectomy: The impact of reseclion type on clinical outcome. Am J Transplant 2002; 2: 780-8.
4. Yamaoka Y, Morimoto T, Inamoto T et al. Safety of the donor in living-related liver transplantationan analysis of 100 parental donors. Transplantation 1995; 59 (2): 224-6.
5. Kawagishi N. Ohkochî N. Fujimori K et al. Safety of the donor operation in living-releated liver transplantation: Analysis of 22 donors. Transplant Proc 1998; 30: 3279-80.
6. Fan S, Lo C, Liu C. Yong B.Chan J. Oi-Lin I. Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg 2000; 135: 336-40.
7. Jawan B, Cheuııg HK, Lee J.H. Anesthesia lor living related donor liver transplanfation. Transplant Proc 1996; 28 (4): 2409-11.
8. Grewal HP, Thistlethwaite J. Loss G et al. Complications in 100 living-liver transplantation. Ann Surg 1998; 228 (2): 214-9.
9. Cammu G, Troisi R. Cuonıo O, Hemptinne B, Florio E, Mortier E. Anaesthetic management and outcome in righl-lobe living-liver donor surgery. Eur J Anaesthesiol 2002; 19: 93-8
10. Beebe DS, Carr R, Komanduri V, Humar A, Gruessner R, Belani KG. Living liver donor surgery: Report of initial anesthesia experience.J Clin Anesth 2000; 12: 157-61.
11. Choudhry DK, Schwartz RE, Stayer SA, Shevchenko Y, Rehman M. Anesthetic management of living liver donors. Can J Anaesth 1999; 46(8): 788-91.
12. Gelman S. Dillard E, Bradley EL. Hepatic circulation during surgical stress and anesthesia with halothane. isoflurane, or fentanyl. Anesth Analg 1987; 66: 936-43.
13. Goldfarb G. Debaene B, Ang ET, Roulot D, Jolis P, Didier L. Hepatic blood flow in humans during isoflurane-N2O anesthesia. Anesth Analg 1990; 71: 349-53.
14. Elliott RH. Strunin L. Hepatotoxicity of volatile anaesthetics. Br J Anaesth 1993:70:339-48.
15. Hendrickx JFA, Dishart MK, Wolf AM. isoflurane and desflurane uptake during liver resection and transplantation. Anesth Analg 2003; 96: 356-62.
16. Thomson IA, Fitch HW, Campbell D. Effects of nitrous oxide on liver hemodynamics and oxygen consumption in the greyhound. Anaesthesia 1982; 37: 548-53.
17. Hatano Y, Murakawa M, Segawa H, Nishida Y. Mori K. Venous air embolism during hepatic resection. Anesthesiology 1990; 73:1282-5.
18. Malot I, Scheinin O, Eid A, Jurim O. Epidural anesthesia and analgesia in liver resection. Anesth Analg 2002: 95: 1179-81.
19. Borremeo CJ. Stix MS, Lally A, Pomfret EA. Epidural catheter and increased prothrombin time after right lobe hepatectomy for living donor transplantation. Anesth Analg 2000; 91: 1139-41.
20. Lutz JT, Gamazo CV, Görlinger K. Malago M, Peters J. Blood-transfusion requirements and blood salvage in donors undergoing right hepatectomy for living related liver transplantation,Anesth Analg 2003; 96: 351-5.
21. Leslie K. Sesler DI. Bjorksten AR, Moaycri A. Mild hypotermia alters propofol pharmacokinetics and increases the duration of action of atracurium. Anesth Analg 1995; 80: 107-14.
22. Zar HA, Tanigawa K. Kim YM, Lancaster JR. Mild therapeutic hypotermia for postisehemic vasoconsîriclion in the perfused rat liver. Anesthesiology 1999; 90: 1103-11.
23. Akpek EA, Arslan G, Erkaya Ç et al. Anesthetic risks for donors in living-related liver transplaniation: Analysis of 30 eases. Transpl Int 2003; 16 (8): 486-90.