Safety of epidural analgesia in an orthotopic liver transplantation
| Rok vydání: | 2021 |
|---|---|
| Předmět: |
Sodium bicarbonate
Hepatology business.industry medicine.medical_treatment Gastroenterology Hemodynamics Metabolic acidosis Liver transplantation medicine.disease Sevoflurane chemistry.chemical_compound chemistry Anesthesia medicine Arterial blood Hepatectomy medicine.symptom business Acidosis medicine.drug |
| Zdroj: | Experimental and Clinical Gastroenterology. 1:69-74 |
| ISSN: | 1682-8658 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|