Intraoperative changes of internal environment in infants undergoing living related liver transplantation

Abstract

Objective To investigate intraoperative changes of internal environment in infants undergoing living related liver transplantation (LRLT), and to explore appropriate treatment measures. Methods Twenty-five infants undergoing LRLT were retrospectively studied, including 12 males, 13 females, with age of (3. 4 ± 4. 6) months (ranging from 2-11 months), weight of (6. 8 ±1. 3) kg (ranging from 3. 1-8. 8 kg). Arterial blood samples were collected before the operation, at preanhepatic phase (5 min before cross-clamping), at anhepatic phase (5 min before opening inferior vena cava), 5 and 30 min after the opening inferior yena cava respectively, and at the completion of the surgery the pH value, bases excess (BE), the levels of sodium, potassium, calcium, glucose and lactate were determined. Results There were large fluctuations to the internal environment during operation. Compared with the preoperative values, the intraoperative concentrations of Na+ had no significant change; The pH value and blood level of K+ had no significant change at pre-anhepatic phase and anhepatic phase (P＞0. 05), the pH value was decreased at anhepatic phase Ⅰ (P＜0. 01 )and returned to the preoperative level at the end of the operation, and the blood level of K+ decreased at anhepatic phase and lasted till the completion of the surgery (P＜0. 01 ). The blood level of Ca2+ was decreased at pre-anhepatic phase and neohepatic phaseⅡ (P＜0. 05), and recovered at the end of the operation. Blood glucose concentration was increased significantly at preanhepatic phase to neohepatic Ⅱ, and still kept at the higher level until the end of operation. The lactate concentrations were increased significantly at pre-an.hepatic phase to neohepatic Ⅱ (P＜0. 01 ), and recovered at the end of operation. The BE was decreased at pre-anhepatic phase to neohepatic Ⅱ (P＜0. 05), and recovered at the end of the operation. Conclusion There are significant disruptions which are unique and inter-related to the internal environment parameters in infants during the operation of LRLT.Monitoring and accurate intraoperative managements for different physiological status at different phases are critical for the success of LRLT in infants. Key words: Liver transplantation; Internal environment; Infants