Comparison the Risk of Intraoperative Ionic Hypocalcaemia in Adult Patients Receiving Blood Products, 5% Albumin and Crystalloids Only During Living Donor Liver Transplantation

Abstract

Introduction: Ionic hypocalcaemia (IH) seen after blood transfusion during liver transplantation(LT) may result in hemodynamic instability. We have previously reported that the risk of intraoperative IH still exits in patients receiving only 5% albumin without blood transfusion. The risk of IH in adult patients undergoing LT who did not receive blood products nor 5% albumin but crystalloids only is to be elucidated. The aim of current study is to evaluate the risk of intraoperative IH in this group and compare it with our earlier experience. Methods: The anesthesia records of adult LDLT recipients were reviewed retrospectively. Group-1 (GI) received blood products and 5% albumin, Group-2 (GII) received no blood products but 5% albumin and crystalloids, and Group-3 (GIII) received only crystalloids. Serum Ca++ levels after the induction of anesthesia, 2-3 hours after skin incision, the anhepatic phase, 10 min after reperfusion, and at the end of the operation were compared among groups. If serum Ca++ was lower than 0.8 mmol/l, it was corrected with calcium chloride (CaCl2) or calcium gluconate. The total amount of calcium in mEq/kg given was calculated and compared using the Mann Whitney U test; p-value < 0.05 was regarded as statistically significant Results: GIII patients required significantly less amount of CaCl2 supplementation in comparison to that of GI and GII to maintain the serum Ca++ in acceptable ranges. This indicates that IH was significantly less in patients received only crystalloid infusion. The risk of GI group was the highest and GII in intermediate regarding the risk of IH during LT. Conclusion: Only crystalloid infusion may reduce the risk of intraoperative ionic hypocalcaemia in selected patients with minimal blood loss during surgery.[Table 1: * = p <0.05 GI vs GIII, + = p <0.05 GII vs]