Safety of epidural analgesia in an orthotopic liver transplantation
A. N. Shmakov,
N. L. Elizar’eva,
A. N. Kolosov,
K. A. Gryaznov,
K. Yu. Beloborodov,
V. N. Kohno,
E. M. Loktin,
K. V. Budarov,
M. N. Chekanov,
E. I. Vereshchagin,
I. V. Peshkova,
A. S. Polyakevich https://doi.org/10.31146/1682-8658-ecg-190-6-69-74
Abstract
In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable.
Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications.
Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation.
Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration.
Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.
About the Authors
A. N. Shmakov
FSBEI HE Novosibirsk State Medical University MOH Russia; State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
Alexey N. Shmakov, MD, Professor of the Department of Anesthesiology and Resuscitation of the Medical Faculty; Chief Pediatric Anesthesiologist- Resuscitator of the Ministry of Health of the Government of the NSD
630091 Novosibirsk, Krasniy prospekt, 52
630087 Novosibirsk, Nemirovich- Danchenko str., 130
N. L. Elizar’eva
FSBEI HE Novosibirsk State Medical University MOH Russia; State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
N. L. Elizar’eva, professor of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty
630091 Novosibirsk, Krasniy prospekt, 52
630087 Novosibirsk, Nemirovich- Danchenko str., 130
A. N. Kolosov
State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
A. N. Kolosov, Head, Department of Anaesthesia
630087 Novosibirsk, Nemirovich- Danchenko str., 130
K. A. Gryaznov
State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
K. A. Gryaznov, doctor of Department of Anaesthesia
630087 Novosibirsk, Nemirovich- Danchenko str., 130
K. Yu. Beloborodov
State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
K. Yu. Beloborodov, doctor of Department of Anaesthesia
630087 Novosibirsk, Nemirovich- Danchenko str., 130
V. N. Kohno
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
Vladimir N. Kohno, Professor, Head of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty
630091 Novosibirsk, Krasniy prospekt, 52
E. M. Loktin
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
E. M. Loktin, assistant professor of the Chair of Anesthesiology and Emergency Medicine of the Medical Faculty
630091 Novosibirsk, Krasniy prospekt, 52
K. V. Budarov
FSBEI HE Novosibirsk State Medical University MOH Russia; State Novosibirsk Regional Clinical Hospital
Russian Federation
Russian Federation
Kristina V. Budarova, Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Resuscitation; anesthesiologist- resuscitator of the Children’s Department of Resuscitation and Intensive Care
630091 Novosibirsk, Krasniy prospekt, 52
630087 Novosibirsk, Nemirovich- Danchenko str., 130
M. N. Chekanov
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
Mikhail N. Chekanov, MD, Professor of the Department of General Surgery
630091 Novosibirsk, Krasniy prospekt, 52
E. I. Vereshchagin
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
Evgeny I. Vereshchagin, MD, Head of the Department of Anesthesiology and Resuscitation named after prof. I. P. Vereshchagin
630091 Novosibirsk, Krasniy prospekt, 52
I. V. Peshkova
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
Inessa V. Peshkova, MD, Associate Professor of the Department of Anesthesiology and Resuscitation named after prof. I. P. Vereshchagin
630091 Novosibirsk, Krasniy prospekt, 52
A. S. Polyakevich
FSBEI HE Novosibirsk State Medical University MOH Russia
Russian Federation
Russian Federation
Alexey S. Polyakevich, MD, Associate Professor of the Department of Hospital and Pediatric Surgery
630091 Novosibirsk, Krasniy prospekt, 52
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Review
For citations:
Shmakov A.N., Elizar’eva N.L., Kolosov A.N., Gryaznov K.A., Beloborodov K.Yu., Kohno V.N., Loktin E.M., Budarov K.V., Chekanov M.N., Vereshchagin E.I., Peshkova I.V., Polyakevich A.S. Safety of epidural analgesia in an orthotopic liver transplantation. Experimental and Clinical Gastroenterology. 2021;1(6):69-74. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-190-6-69-74
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