Anaesthesia management and surgery
SVV, stroke, blood loss
MUSCLE RELAXATION, BLOOD LOSS, STROKE, HEMODYNAMIC INSTABILITY, BLOOD, EDWARDS
In our centre, anaesthesia for liver transplantation is accomplished via a standard protocol; all patients were monitored first by electrocardiogram, noninvasive blood pressure monitoring, and pulse oximetry. Radial artery puncture catheterization was performed under local anaesthesia, and the FloTrac/Vigileo monitoring system (Edwards Lifescience, USA) was connected to continuously monitor cardiac output (CO), cardiac index (CI), and stroke volume variability (SVV). The A-2000 BIS monitor (Aspect Medical System, USA) was used to monitor BIS values. After anaesthesia induction, when the patient’s BIS value reached 50 ~ 60 and the muscle relaxation was satisfactory, endotracheal intubation was performed for mechanical ventilation. A central venous pressure (CVP) catheter was inserted into the right internal jugular vein under ultrasound guidance.Intraoperative anaesthesia was maintained with sevoflurane, propofol and remifentanil. Goal-directed fluid management established on SVV was used to guide fluid infusion. From the beginning of anaesthetic induction, the participants were continuously infused with 2 ml/kg/h crystalloid. When SVV > 12%, a bolus of 3 ~ 5 ml/kg polygelatin was administered within 10 min and then repeatedly until SVV ≤ 12%. The perioperative patient blood management followed the Transfusion of Whole Blood and Blood Components WS/T 623–2018 guidelines of China. When haemoglobin was lower than 80 g/L, a red blood cell suspension was infused to maintain haemoglobin ≥ 80 g/L. During surgery, blood products and factor concentrates were transfused according to blood loss and coagulation function tests. Autologous blood reinfusion technology was used when necessary. In the anhepatic phase, hemodynamic instability was anticipated and dominantly treated by vasopressors to maintain a mean arterial pressure (MAP) greater than 60 mmHg. If necessary, patients were treated with continuous intravenous dopamine administration (3 ~ 10 µg/kg/min) and intermittent intravenous norepinephrine administration to maintain stable circulation. 5% Sodium bicarbonate was infused to maintain acid-base balance according to the results of arterial blood gas analysis. If BE was <-4 mmol/L, 5% sodium bicarbonate (mL) was infused according to the formula 1/2 ~ 2/3 [BE× weight (kg) × 0.25 × 1.6]. Appropriate calcium chloride and potassium chloride were infused to maintain electrolyte balance.All patients underwent conventional OLT without venovenous bypass. 1000 ml crystalloids were used to prepare the 2% albumin solution which was used for flushing before graft reperfusion. The perfusion solution was inflowed from the anastomosis of the suprahepatic and infrahepatic inferior vena by and outflowed the portal vein (PV) to flush the University of Wisconsin (UW) preservation solution.After the completion of surgery, all patients were transferred to the intensive care unit (ICU) for ongoing monitoring and postoperative care.