[The results of biliary reconstructions after liver fragments transplantation].

AIM: To analyze the results of repeated reconstructions of choleresis after living related liver fragments transplantation. MATERIAL AND METHODS: The study included 268 recipients (145 women and 123 men) aged 5 months - 61 years (mean age 16,11 ± 14,62 years) who underwent liver fragments transplantation in the department of liver transplantation of cad. B.V. Petrovskiy Russian Research Surgery Center from 1997 to 2012. Biliary reconstructions were performed at different terms after transplantation in 37 patients (13.81%). Complications followed repeated reconstructions, the initial conditions for biliary anastomosis formation during transplantation, the results of biliary reconstructions after transplantation were analyzed. RESULTS: In most cases despite the prevailing complications there is a combination of various biliary complications requiring biliary reconstruction. It was found that live rfragment used for transplantation, type of primary reconstruction of choler sis, number of bile ducts orifices of graft and biliary anastomoses do not demonstrate statistically significant effect on the incidence of post-transplant biliary reconstructions (p>0.05). Poor prognosis in patients with biliary complications required biliary reconstructionsis determined by the development of graft dysfunction. Early reconstruction before development of liver transplant dysfunction is necessary condition of successful treatment. In the case of graft dysfunction liver retransplantation is unique method of treatment.

[To the issue of postreperfusion syndrome predictors in orthotopic liver transplantation (OLT)].

UNLABELLED: The aim of the study is revelation of postperfusion syndrome (pPS) predictors in orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Was conducted a retrospective analysis of anesthesia maintainance protocols during orthotopic liver transplantation in 261 patients aged from 6 months to 60 years. Investigated the effect of various factors on the development of PPS by the application of methods of non-parametric statistics. RESULTS: Significantly more frequent development of the PPS is noted in the age group from 3 to 18 years (up to 30% of patients). In recipients older than 18 years the frequency of the development of the PPS does not depend on age, with an average of 14%. The development of the PPS does not depend on the recipient sex, the nature of the pathology which served as an indication to the OTP, the initial severity of the state, type of OTP (living related donor or cadaveric transplantation, primary or re-transplantation), the transplant warm ischemia duration, use, or the lack of venous-venous bypass, metabolic status of the patient. The obtained results do not contradict to the data of foreign publications. Among parameters available for screening, predictor of PPS was not detected.

[Anesthetic maintenance of renal transplantation in children].

For many children with severe renal excretory dysfunction, renal transplantation is the sole method of life prolongation. The purpose of the investigation was to analyze the specific features of anesthetic maintenance of transplantation of related and cadaver kidney at 1 to 5 years. The investigation involved a detailed analysis of the specific features of 101 anesthesias made in children aged 1 to 16 years (mean 9.6+/-4.87 years) during transplantation of kidneys from corpses and apparently healthy relatives. The duration of surgery and anesthesia was 5.6+/-1.00 and 7.6+/-1.42 hours, respectively. Operations were made under balanced general anesthesia using a low-flow inhalational isoflurane or sevoflurane (0.5-2.0 MAC) technology. After inclusion of a graft into the bloodstream, a plasmapheresis procedure was initiated in 1-1.5 circulating blood volumes. All the children underwent invasive hemodynamic monitoring: the radial artery and internal jugular vein were catheterized. In 19 cases, the pulmonary artery was catheterized using a Swan-Ganz catheter. In children, the initial period of anesthesia during renal transplantation was marked by a drastic hemodynamic instability tended for hypotension and significant tachycardia in the presence of marked hypovolemia (central venous pressure = 0+/-2.0 mm Hg). The major component of infusion therapy was freshly frozen plasma (up to 50% of the volume). Inclusion of a cold renal graft into systemic circulation and washout of residues of preservative solution and necrobiolysis products from it were accompanied by a 0.5-1.3 degrees C temperature reduction and progression of metabolic acidosis. Safe and successful anesthetic maintenance of renal transplantation in children requires an obligatory informative invasive hemodynamic monitoring, continuous laboratory screening, and knowledge of stage-specific features. Continuous plasmapheresis by means of a plasma filter is preferred.

[Clinical experience in using isoflurane, sevoflurane, and total intravenous anesthesia during visceral transplantation].

Based on 256 anesthesias, the authors comparatively studied the results of total intravenous anesthesia (TIVA) with neuroleptic analgesics and inhalational low- and minimal flow anesthesia with isoflurane in the anesthestic support of major operations on the liver. Both sevoflurane and isoflurane may be widely used during long and traumatic operations on the liver since the agents are distinguished by a low hepatotoxicity, the absence of pharmacological activity of their metabolism, a rapid elimination from the body in a virtually unchanged form. The use of sevoflurane and isoflurane in the low and minimal flow modes can substantially reduce the pharmacological load with opiates and myorelaxants, which is particularly important in patients with liver diseases and these modes have some advantage over TIVA during which the consumption of myorelaxants and neuroleptic analgesics has proved to be significantly higher. The minimal flow (0.4-0.5 l/min) mode uses mostly few inhalation anesthetics. The use of seroflurane reduces the period of spontaneous breathing recovery to a greater extent, activates the patient more rapidly, and substantially reduces the risk of iatrogenic complications after long and traumatic operations associated with visceral transplantation.

[Hemodynamic disorders in liver transplantation and their correction].

To study the pre- and intraoperative causes of hemodynamic disorders at the basic stages of liver transplantation in adult recipients, case histories and anesthesia protocols were analyzed in detail in 15 recipients of the cadaveric liver (Group 1) and 60 recipients of a liver portion taken from a living relative donor (Group 2). The patients' preoperative status, the etiology of the disease, the pattern and scope of preoperative preparation and examination, the cause of anesthesia, the volume, pattern, and rate of infusion were studied. Particular emphasis was placed on the presence of pathophysiological prerequisites and various intraoperative factors, which are causes of hemodynamic disorders. Orthotopic transplantation of the liver was performed under generalized balanced anesthesia whose major components were the inhalational anesthetics isoflurane and sevoflurane (89.3%) or total intravenous anesthesia based on neuroleptic anesthetics (10.7%). The main causes of hemodynamic disorders were the patients' severe baseline condition, anemia, ascitis, intoxication, encephalopathy, and the specific features of a surgical intervention, blood loss, heavy plasma and perspiration losses, water-electrolyte balance impairments, vein-vein shunt and reperfusion syndrome. Operations of extraordinary duration (longer than 15-20 hours) required higher plasma compensation volumes (36-52 ml/kg). Severest hemodynamic disorders were observed in patients admitted to hospital for emergency transplantation of the cadaveric liver. These patients who are to undergo transplantation are outside hospital in most cases, which is why any operation should be regarded in them as an emergency one made in patients who are in a very severe state (ASA IV-VE).

[Hemodynamic changes during anesthesia in orthotopic liver transplantation in 1-5-year-old children]. / Izmeneniia gemodinamiki vo vremia anestezii pri ortotopicheskoi transplantatsii pecheni u detei v vozraste 1-5 let.

The anesthetic management of orthotopic hepatic transplantation (OHT) was analyzed in 49 children aged 1 to 15 years. Ten protocols of anesthesia implemented in small-age children (1 to 5 years) were analyzed in detail. The mean age of children (6 girls, 4 boys), operated on in 2002-2004, was 3.0 +/- 2.7 years; their mean weight was 13.6 +/- 4.17 (9-22) kg. The purpose of the case study was to study the dynamics of the cardiovascular system and the pattern of hemodynamic impairments accompanying the anesthetic course in OHT from a living related donor. All surgeries were made under balanced general anesthesia: induction - midazol (0.04 +/- 0.01 mg/kg), cetamine (2.77 +/- 0.64 mg/kg), phentanile (3.1 +/- 0.21 mg/kg), myorelaxation--pipecuronium bromide (arduan) (80.3 +/- 11.44 microg/kg). Low-flow inhalation by isofluoran -0.8-2.0 ALC%, minimal-flow (0.7-1.6 MAC), was used.

[Anesthesia during liver transplantation]. / Anesteziologicheskoe obespechenie transplantatsii pecheni.

Different methods and components of anesthesia during operations in donors and recipients were studied by using the experience in maintaining anesthesia during 39 relative and 7 cadaveric hepatic transplantations. The experience in using epidural anesthesia and total intravenous anesthesia at the donor stage of hepatic lobar transplantation was comparatively analyzed. Combined epidural anesthesia (CEA) may be used during long-term and traumatic operations dealing with hepatic lobectomy in a relative donor since it is noted for low hepatotoxicity and no drastic hemodynamic exposures. CEA can substantially reduce pharmacological loading with opioids or myorelaxants, which is particularly important in taking the lobe of the liver. This reduces the recovery period of adequate own respiration, activates a patient more rapidly, substantially reduces the risk for postoperative iatrogenic complications. Balanced general anesthesia whose major component is inhalational anesthesia with isoflurane is the method of choice in performing an operation in the recipient. The use of isoflurane in the minimal-flow mode is cost-effective and safe. When anesthesia is performed in the recipient, it is necessary to take in account drastic hemodynamic pattern changes at the liverless stage during vein-venous bypass surgery, including the liver into systemic circulation, and the likelihood of development of significant reperfusion and concomitant metabolic and coagulative disorders.