The controlled hypotension in donor hepatectomy

Background and aim: The difference between patients whom has liver transplantation requirement and donated organs had been increased last 20 years. Shortage of cadaveric donors provides living related liver transplantation is an accepted treatment modality for end-stage liver disease.In this study, our main goal is comparison of cases including different pharmacologic agents for application of controlled hypotension (CH).Patients and methods: We retrospectively scanned files of the 78 patient aged between 18-60 years. Although, there was no difference between anesthesia induction and maintenance, three different pharmacologic agents as remifentanil, nitroglycerin and esmolol for CH had been used. The patients? demographics as gender, age, height, body weight, body mass index, ASA physical status, and perioperative data as total anesthesia time, total surgery time, extubation, eye opening and emergence time were recorded. Postoperative data as the amount of estimated bleeding, total urine output, total consumed amount and type of intravenous fluids were recorded. Surgeon bleeding score was recorded for each patient. Systolic and mean arterial pressure (SAP and MAP), heart rate (HR) and central venous pressure (CVP) values were recorded in every 30 minutes, intraoperatively.Results: There were no difference for data regarding demographics, total anesthesia and surgery times, extubation, eye opening and emergence times, MAP, CVP, hemoglobin and INR values, urine output and estimated bleeding amount between groups.There were statistically significant difference between three groups for HR values in 120., 150., 180., 240. and 270. minutes (p<0.05). The HR values of esmolol group in the same times were significantly lower than other two groups. At the 270. minutes values of esmolol group were lower than remifentanil group (p<0.05) .Surgeon bleeding score was significant higher in esmolol group than remifentanil and nitroglycerine groups (p<0.05). There was higher consumption of intraoperative fluids in remifentanil group than other groups (p<0.05).Discussion and conclusion: As a result, the application of CH in living related liver transplantation may be an effective method for decreasing blood loss. Remifentanil and nitroglycerin were suitable agents that provided ideal surgical comfort than esmolol according to this aim. Additionally, CVP values don?t predict blood loss as a marker. We searched literature but we didn?t find any study about CH application for living related liver transplantation donors. From that reason we believe our study is valuable. But we have some limitations as our study was retrospective manner and we had limited number of patients. We believe that further prospective studies should be done with increased number of patients.