[Coagulation profiles following donor hepatectomy and implications for the risk of epidural hematoma associated with epidural anesthesia].

ABSTRACT

BACKGROUND: Continuous epidural analgesia has become an accepted technique used in laparotomy including liver resections. Although American Society of Regional Anesthesia and Pain Medicine recommends that epidural catheter be removed with prothrombin time-international normalized ratio (PT-INR) less than 1.5, it is possible that liver surgery causes coagulation disturbances. We examined the postoperative changes in coagulation profiles of living liver donors to elucidate whether hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters or not. METHODS: From January 2007 to October 2009, 42 living liver related transplantations were performed in Hokkaido University Hospital. We reviewed the donor data including PT-INR obtained during perioperative days [preoperative, immediately postoperative, postoperative day 1, 3 and 7] and epidural catheter-related-complications, retrospectively. RESULTS: While in all donors values of PT-INR obtained during preoperative periods were within normal limits, 14 donors had a PT-INR over 1.5 during postoperative periods. There was no epidural hematoma case in this study. CONCLUSIONS: Our study suggested that hepatectomy increases the risk of epidural hematoma related to removal of epidural catheters, even in the living liver transplant donors with normal liver function.