Intraoperative thoracic epidural anesthesia in liver transplantation live delivery effect of liver blood flow

SUMMARY Backround and aim: Depending on the needs of the growing population and shortage of cadaveric organ donation, the rate of live donor liver transplantation has been increased in our country. In liver transplant patients, graft functionis affected by many factors such as hemodynamic parameters and organ blood flow. Donors are volunteers without any health problems. Therefore, the anesthetic management of donor safety is an important issue. Patients undergoing major abdominal surgery such as hepatectomy are at risk for. postoperative complications including multiple organ failure. Epidural anesthesia and analgesia has been shown to be effective in reducing perioperative risk such as intraoperative blood loss, reduction in the incidence of thromboembolic events, improved postoperative pulmonary, cardiovascular and intestinal function and modified immune function. İn addition to epidural anesthesia by sympathetic blockade is thought to increase organ perfusion in splenic area. Indocyanine green (ICG) clearance test originally intended for the measurement of blood flow. For the time being, it has been most widely used to evaluate the liver function. ICG clearance test is indicated in liver transplant recipients and their donors for the assessment and monitoring hepatic function. Our aim in this study, thoracic epidural anesthesia compared to general anesthesia effects on liver blood flow by liver function tests and indocyanine green is compared with in the living donor liver transplantation. Materials and Methods: After Ethics Committee approval and patient consent right hepatectomy was performed in 40 patients. Patients' sex, age, height, smoking, body weight, body mass index, ASA classification were recorded. Cases, the control group (Group 1) and the epidural block group (Group 2) with closed envelope method were divided into two equal groups. In the operating room electrocardiography, oxygen saturation, noninvasive blood pressure monitoring was performed and basal hemodynamic values were recorded. BIS was used to assess depth of anesthesia. Epidural blocks to be implemented group (Group 2) patients, the epidural catheter is inserted T6-8 level. In all patients, anesthesia was standardized with lidocaine, fentanyl and thiopental. Patients were intubated after muscle relaxation provided with vecuronium. Anesthesia maintenence of Cases, in 50/50% oxygen-air mixture in Group 1 patients isoflurane, remifentanil infusion and cisatracurium infusion, Group 2 patients isoflurane, epidural infusion and cisatracurium infusion was provided. . Nondominant radial artery invasive arterial blood pressure monitoring was provided. Internal jugular venous catheter was inserted to central venous pressure monitoring in all patients. Patients MAP, HR, SpO2 and BIS values were recorded. If applied Pringle maneuver time, remmant liver total amount of bleeding, the amount of urine, total anesthesia time, the total operation time, times ofoperation phases, total amount of liquid during operation and type of fluid (crystalloid, colloid, blood and blood products) were recorded. After transection, the graft weight were also recorded. After antagonizes the effects of muscle relaxants end of the operation, patients was extubated. After observed in the postoperative care unit along half an hour, patients was sent to the surgical intensive care unit. Indocyanine green clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), postoperative 24 and 72 hours were recorded. Simultaneously, hemoglobin (Hb), hematocrit (Hct), platelet count, PT, INR, total bilirubin, direct bilirubin, albumin, AST, ALT values were analyzed. Results: İn terms of operation time, the percentage of KC remnant, the graft weight and amount of bleeding statistically significant difference was not observed between groups (p> 0.05). At a dose of volatile anesthetics statistically significant differences were found between groups (p <0.05). PDR and R15 compared to the groups; statistically significant difference was not observed between groups (p> 0.05). İntra-group comparison both PDR and R15 values in both groups Z1, Z2, Z3 and Z4 the values in the time according to Z0 was statistically significant (p <0.05). Significant changes in the ALT levels was observed at measurement time points within groups (p <0.05) but no significant difference between groups (p> 0.05). PT and INR values were significant differences in the changes in the within the group (p <0.05). SAP, DAP, and MAP between the groups were found statistically significant differences in the stages of dissection (p <0.05). Conclusion: It was concluded that used thoracic epidural anesthesia has no effecton global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery. Key words: Liver donor liver transplantation, indocyanine green, thoracic epidural anesthesia, liver function tests.