Comparison of correlations between pleth variability index (PVİ) and lactate in living liver transplant donors

Objective: We aimed in this study to investigate if there is a significant correlation between PVI and lactate values in liver living donors. Materials and Methods: With the approval of ethical committee, 51 donors from the group of ASA I-II, between the ages of 18-55 who had right hepatectomy for liver transplantation have been selected for the study after their permission was granted. In the operation room the routine monitorization has been applied to the donors without any premedication. After establishing vascular access, pre-oxygenation started with %100 O2. Anesthesia was induced with 1 mg/kg %2 lidocaine, 1 μg/kg fentanyl, 5 mg/kg thiopental, and 0,1 mg/kg vecuronium. Following the endotracheal intubation, 0.5-1.5 isoflurane was used with % 50/50 oxygen-air mixture. Invasive arterial blood pressure monitorization was succeeded by doing radial artery catheterization. Three way central venous catheter was placed into all patients for the aim of CVP follow-up. Pulse co-oximeters were preferred to placed to the ring fingers of left hands. PI and PVI parameters were measured automatically by connecting Masimo screen with PVI software. Anesthesia was maintained with the infusion of isoflurane, remifentanil (0.25 μg/kg/dk) and cisatracurium (0.5ug/kg/sa). In the beginning of the surgery (T1); Hb, Htc, AST, ALT, Na, BUN, Kreatin, PaO₂, PaCO₂, HCO₃, base negativity, and lactate values were recorded. The same parameters were recorded at the first hour of the surgery (T2), at the end of the surgery (T3), and three hours after the surgery (T4). In the 24th post-surgery hour (T5), only AST, ALT, Na, BUN, Kreatin, lactate were recorded. SpO₂, pulse, SAP, DAP, MAP, CVP, PVI, PI parameters, urination, bleeding, and given kristalloid and kolloid amounts were recorded at the same time periods. For the post-surgery analgesia, 0.05 mg/kg iv. morphine was injected after the 44 removal of liver graft. Cisatracurium and remifentanil infusion was stopped before starting to close the abdominal wall. After the surgery, effect of muscle relaxant was antagonized with neostigmine and atropine, then the donors were extubated. Then they were transferred to the ICU. Results: While PVI values at T1 was not statistically significantly correlated (p>0.05) with the values at T2, T3, and T4; there is not any statistically significant correlation between the PVI values of the other time periods (p>0.05). While the lactate value at T1 is statistically significantly correlated with the values at T2, T4, and T5 (p<0.05), similarly the lactate value at T2 is significantly correlated with the values at T3 and T5 (p<0.05) and the lactate value at T4 is statistically significantly correlated with the values at T3 and T5 (p<0.05). In our study, while the lactate value at T3 is statistically significantly correlated with PVI value at T3 (p<0.05), there is not significant correlation between PVI and lactate at other time periods (p>0.05). As far as ALT and AST were concerned, a significant difference was observed between the values at T2, T3, T4, T5 comparing to the values at T1 (p<0.05). Similarly there is a significant difference between lactate values at T2, T3, T4 and T5 compared to the value at T1 (p<0.05). Conclusion: We have found that lactate values and PVI values at the end of surgery are compatible in living donors liver transplantation and liver transplant operation might affect lactate metabolism as well We believe that further studies that investigate the correlation between PVI and lactate in other surgery types are needed.