ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS

Abstract

Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.