Sevda ÖZKARDEŞLER, Deniz ÖZZEYBEK, Mert AKAN, Uğur KOCA, Seden DURU, Hakan KİLERCİK, Zahide ELAR

Karaciğer transplantasyonunda anestezi deneyimimiz

Fakültemizde gerçekleştirilen 49 transplantasyondan kayıtlarına retrospektif olarak ulaşabilen 38'inin değerlendirildiği bu seride anestezi yöntemleri, intraoperatif üç faza ilişkin hemodinamik ve biyokimyasal parametreler, yoğun bakımda kalış süreleri, gelişen enfeksiyon ve mortalite oranlan kaydedildi. Alıcıların 18'ine canlı vericiden, 20'sine kadavradan nakil yapıldığı belirlendi. İntraoperatif dönemde ort. 67.91 (0-431) mL $kg^-1$ tam kan, 106.82 (10-385) mL $kg^-1$ taze donmuş plazma, 2.63 (1-5) mEq $kg^-1$ sodyum bikarbonat, 9.88 (0.02-65) $mu$g $kg^-1$ noradrenalin infüzyonu yapıldığı saptandı. Kalp debisinin vena kava inferiyora total klemp uygulananlarda % 25.5, parsiyel klemp uygulananlarda % 8.7 oranında düştüğü belirlendi. İntraoperatif dönemde mortalite gelişmediği saptandı. Postoperatif erken dönemde kaybedilen 10 olgu dışındaki 28 olgunun postoperatif 29.35 (2-240) saat sonra ekstübe edildikleri, 61.5 (6-408) saat yoğun bakımda kaldıkları belirlendi. Sonuç olarak; bu seriden elde edilen verilere dayanarak anhepatikfaz ve reperfüzyon aşamasında kalp debisinde literatüre kıyasla daha ılımlı bir değişiklik saptanmış olması dikkat çekici bulunmuştur.

Anahtar Kelimeler:

Anestezi, genel, Geriyedönük çalışma, Karaciğer nakli

Our anesthetic experience in liver transplantation

Thirty-eight cases out of 49 liver transplantations performed in our university hospital were reviewed retrospectively as theirfull records could be obtained. The anesthetic techniques, biochemical and hemodynamic parametersfor the three intra-operative phases, length ofstay in intensive care unit, infection and mortality rates were noted. Eighteen of the recipients had liver transplantation from living donors and 20 of them from cadaveric donors. They received 67.91 (0-431) mL $kg^-1$ of whole blood, 106.82 (10-385) mL $kg^-1$ of fresh frozen plasma, 2.63 (1-5) mEq $kg^-1$ of sodium bicarbonate, and 9.88 (0.02-65) $mu$g $kg^-1$ of noradrenaline during the intraoperative period. Cardiac output decreased of 25.5 % when the inferior vena cava was totally cross-clamped, while of 8.7% when the cava preserving technique was used. There was no mortality in the intraoperative period. Except ten patients who died in the early postoperative period, 28 patients were extubated after mean 29.35 (2-240) hours postoperatively and the length of stay in intensive care unit was 61.5 (6-408) hours. in conclusion; according to the data obtained from this series it was noticeable that cardiac output had less change than the literatüre in anhepatic and reperfusion phases.

Keywords:

Anesthesia, General, Retrospective Studies, Liver Transplantation,

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