Perioperative monitoring of adult patients with hepatic encephalopathy under orthotopic liver transplatation

Objective To evaluate the perioperative monitoring of adult patients with hepatic encephalopathy under orthotopic liver transplatation (OLT).Methods Combined intravenous and inhalational general anesthesia was used for 18 patients with hepatic encephalopathy from October 2003 to August 2004. Rapid-sequence induction was performed. Propofol, 1 to 1.5 mg/kg, and fentanyl, 4 μg/kg, were used. Norcuron, 0.1 mg/kg, was added to facilitate tracheal intubation. All patients were subjected to piggyback liver transplantation. Hemodynamics, respiratory, blood gas, blood biochemistry, coagulation function, body temperature, liver and kidney functions, urine output, and bleeding output were monitored during operation. According to the situations of patients, platelet, cryoprecipitate, fibrinogen, coagulation factors and ulinastatin were administrated.Results Eighteen patients tolerated the operation. Only 4 patients died of multiple organ dysfunction syndrome after operation. The survival rate reached was up to 77.8 %. The main blood gas change during perioperative phase was metabolic acidosis and hyposodium, hypokaleamia, hypocalcium. The main hemodynamics change during operation was that HR was increased significantly, and CO was higher than normal value before operation, and CO, CVP, SPAP and DPAP decreased significantly in anhepatic stage. Compared with those before operation, ALT, AST, BUN and Cr were increased significantly in neohepatic stage.Conclusions It is very important to pay more attention to these patients with hepatic encephalopathy during different stages of OLT. Drugs not affecting the function of liver and kidney should be selected. Benzodiazepine should be avoided. Supplementation of coagulation factors, CRBC and electrolyte was necessary. The key point is to protect renal function, maintain enough urine output and treat brain edema.