Abstract
In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable.Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications.Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation.Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration.Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.
Highlights
Особенности гемодинамики пациентов с хронической печёночной недостаточностью, преимущественно обусловленной циррозом, хорошо изучены
In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, theoretically the benefits of a sympathetic block are considered
All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three-component anesthesia according to the Breivik-Niemi method
Summary
MD, Professor of the Department of Anesthesiology and Resuscitation of the Medical Faculty; Chief Pediatric Anesthesiologist- Resuscitator of the Ministry of Health of the Government of the NSD; ORCID: 0000–0002–6214–3897 N. L. Elizar’eva, professor of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty A. Professor, Head of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty E. M. Loktin, assistant professor of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty Kristina V. MD, Professor of the Department of General Surgery; ORCID: 0000–0002–4816–0527 Evgeny I. Vereshchagin, MD, Head of the Department of Anesthesiology and Resuscitation named after prof. MD, Associate Professor of the Department of Anesthesiology and Resuscitation named after prof. Polyakevich, MD, Associate Professor of the Department of Hospital and Pediatric Surgery; ORCID: 0000–0002–1800–6422
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