The changes of hemodynamics during general anesthesia combined with epidural nerve block for orthotopic liver transplantation

Objective To study the changes of hemodynamics during general anesthesia combined with epidural block for orthotopic liver transplantation(OLT).Methods Twenty-four liver cancer patients were un-dergone OLT.During the pre-anesthesia phase and anhepatic phase,extracorporeal veno-venous bypass(EVVB) was not used.HR,MAP,CVP,PCWP,MPAP,CO,CI,SVR,PVR,FVP were monitored during the operation.According to the characteristics of pre-anhepatic phase,anhepatic phase and neohepatic phases,corresponding anesthetic management measures were supplied.Results Twenty-four patients were undergone the orthotopic liver transplantation.Duration of operation was(435±48)min,amount of bleeding(2 258± 325)ml,transfusion of RBC(6.6±1.5)U,serum(785±68)ml,Ringer’s solution(1 856±86)ml,blood substi-tute(1 625±115)ml.(1)At the time of incision,CVP,FVP,MPAP,PCWP,CO,CI and MAP decreased(P≤0.05 or P≤0.01).(2)At the end of pre-anhepatic phase,CVP,FVP,MPAP,PCWP,CO,CI and MAP decreased(P≤0.01).(3)At the five minutes’ primary stages of anhepatic phase,CVP,MPAP,PCWP,CO,CI and MAP decreased(P≤0.01),SVR,PVR and FVP increased(P≤0.05 or P≤0.01).(4)At the thirty minutes’ stages of anhepatic phase,compared with before FVP decreased(P≤0.01),MPAP,PCWP,CO,CI increased(P≤0.01).(5)At the fifteen minutes’ neohepatic period,CVP,MPAP,PCWP,CO,CI and MAP increased(P≤0.001);SVR and FVP decrease(P≤0.05 or P≤0.01).(6)At the end of operation,CVP,FVP and MPAP increased(P≤0.01).MAP,MPAP,PCWP,CO and CI returned to the level of pre-anesthesia period(P≤0.05).FVP was almost equal to CVP(P≤0.05).Conclusion Attention should be paid to the anesthetic management and monitoring during different phases of OLT.General anesthesia combined with epiduarl block helped to keep stable circulation during OLT,by way of dilation blood vessel in epidural block area,increase returned blood volume during the period of block of partial vein and inferior vena cava,intensification of the nacrotics,minimum of side effect of anesthetics on vital organs.