Perioperative nuid management of liver transplantation for biliary atresia in infants

Abstract

Objective To summarize our cxperience on perioperative fluid management of liver transplantation for biliary atresia (BA) in infants.Methods From september 2006 to August 2011,24infants were diagnosed with BA,and underwent liver transplantation.Perioperative hemodynamic parameters including blood gas parameters,lactic acid,serum electrolytes and blood glucose were monitored and retrospectively analyzed.Fluid therapy plan was adjusted according to these parameters.Results Blood pH and base excess decreased immediately at the beginning of anhcpatic phase,and was closed to normal level at the end of operation (7.38 ± 0.09 and - 1.44 ± 0.64).Blood pH and base excess kept increasing after operation,and peaked 12 hours after surgery,then decreased gradually to normal level.Serum lactic acid began to rise immediately at the beginning of anhepatic phase (3.31 ±0.8 mmol/L),peaked at the first 30 minutes of the neohepatic phase,started to drop 6 hours after surgery and reached normal range 12 hours later.Serum potassium concentration decreased significantly since the neohepatic phase (3.21 ± 0.52 mmol/L).Serum calcium concentration decreased significantly since the anhepatic phase ( 1.03 ± 0.12 mmol/L),serum sodium concentration increased gradually since the neohepatic phase ( 141.2 ± 2.9 mmol/L).Blood glucose (BG) after the anhepatic phase was higher than that before the operation (7.4 ± 2.8 nmnol/L).All of the 24 infants received liver transplantation successfully,without dehydration or cardiopulmonary events during the perioperative phases.All infants recovered well from surgery except 4 died.Conclusions During the surgery of liver transplantation for biliary atresia (BA) in infants,colloidal liquid should account for more than 50％ of the total liquid dose.Fluid management after transplantation was sinular to the principles of fluid management of other general surgery. Key words: Liver transplantation; Biliary atresia