Changes of hemodynamics and homeostasis in orthotopic liver transplantation and anesthetic management

Objective:To investigate the changes of hemodynamics and homeostasis during orthotopic liver transplantation and the anesthetic management.Methods:Fourteen patients with the chronic end-stage liver disease underwent orthotopic liver transplantation under combined intravenous-inhalational anesthesia.The Swan-Ganz tube was inserted to the right ventricle to observe the changes of hemodynamics and homeostasis at different stages.Results:All the patients received the operation smoothly.At anhepatic stage,pulmonary arterial wedge pressure(PAWP),mean systemic arterial pressure(MAP) and central venous pressure(CVP) decreased significantly compared with those before operation(P0.01),but at the point of unclamping vena cava,PAWP and CVP increased significantly,while MAP decreased(P0.01).Mean pulmonary arterial pressure(MPAP) kept at a high level at the end of operation(P0.01).cardiac output(CO) was lower at the point of clamping or unclamping vena cava than before operation(P0.05).Conclusions:The changes of homodynamics mainly occur at anhepatic and early neohepatic stage.Comprehensive treatment and timely management may check the changes.