Anesthetic management of living liver donors

Abstract

Purpose: Living organ donation is being performed with increasing frequency to overcome the shortage of organs for transplantation. Our experience in the anesthetic management of donors with relevant issues is discussed and complications encountered are recorded. Methods: Data were collected retrospectively and analyzed on all 22 left lateral hepatectomies performed at our institution between 1993 to 1997 for transplantation. ]~lts Major ethical concern was the risk to the donors and anesthetic issues were those of a major abdominal procedure. All except four donors were parents (mother/father). Average blood loss was 805 _+ 479 ml and only two donors required blood transfusion. Mean operative time was 8.2 -+ 1.5 hr. Thoracic epidural analgesia was the most commonly adopted mode of pain relief. Average time to return of bowel sound postoperatively was 3. I ___ 1.0 days and was not influenced by the postoperative analgesic technique used. Total duration of hospital stay was 8.4 _ I. I days. Three donors developed minor postoperative complications atrial fibrillation and retained JP drain; left lower lobe pneumonia; and incisional hernia. All patients recovered uneventfully. Concision: Living organ donors contribute towards decreasing the shortage of organs for transplantation. Minimizing the discomfort associated with the surgical intervention and providing a complication-free perioperative course will positively influence the continued availability of such donations. On review of the first 22 left lateral hapatectomies performed, we observed only minor complications. Postoperative pain was a serious problem and thoracic epidural provided satisfactory analgesia.Objectis Le don d'organe vivant se fait de plus en plus souvent en raison du manque d'organes pour la transplantation. Notre exp&ience de I'anesth&ie des donneurs ainsi que les questions qui y sont pertinentes sont examin6es et les complications qui surviennent sont pr&ent~es. M(:thode : Une collecte r&rospective suivie d'une analyse des donn~es des 22 h6patectomies lat&ales gauches r~alisEes pour la transplantation entre 1993 et 1997 ~ notre institution. ~ltats :Notre principale souci &hique a EtE celui du risque encouru par les donneurs, etnos choix anesth&iques, ceux d'une intervention abdominale majeure. Les donneurs, sauf quatre, &aient des parents (m&e/p&e). La perte sanguine moyenne a &6 de 805 -479 ml, et deux donneurs ont eu besoin de transfusion. Le temps moyen de I'op&ation a ~t~ de 8,2 -1,5 h. I'analg&ie ~pidurale thoracique a &6 privil6gi& comme traitement de la douleur. Le temps moyen n6cessaire au retour des bruits intestinaux postop6ratoires a EtE de 3, I _ 1,0 jours peu importe la technique analg6sique postop6ratoire utilis~e. La dur& totale du s~jour hospitalier a &~ de 8,4 -+ I, I jours. Trois donneurs ont d~velopp6 des complications postop&atoires mineures de fibrillation auriculaire et de r&ention du drain de Jackson-Pratt, de pneumonie du lobe inf&ieur gauche et de hernie au site de I'incision. Tous les patients se sont r&ablis sans i...

Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

“…3,4,[7][8][9][10][11] Hence, development of an optimal perioperative pain management strategy for donors is a complex clinical challenge. Although epidural pain management has been recommended, 12 and used successfully in living liver donor surgery, 8,9,12 a systematic assessment of its efficacy and safety in living donors for adult liver transplantation, who typically donate approximately 60% of their liver, 13,14 is not available.Reports in operations other than liver donation suggest that epidural pain management, in combination with local anesthetic field infiltration, offers effective, opioid-sparing analgesia [15][16][17] as an alternative to systemic opioids with their potential hepatotoxicity 18,19 and risk of sedation. In the current case series, we evaluated the efficacy and safety of this 2-site approach and assessed postoperative changes in liver function tests and coagulation.…”

“…3,4,[7][8][9][10][11] Hence, development of an optimal perioperative pain management strategy for donors is a complex clinical challenge. Although epidural pain management has been recommended, 12 and used successfully in living liver donor surgery, 8,9,12 a systematic assessment of its efficacy and safety in living donors for adult liver transplantation, who typically donate approximately 60% of their liver, 13,14 is not available.…”

Innovationen in der Leberchirurgie durch die Transplantation mit Lebendspende

“…Im Wesentlichen wird die Narkose bei der Spenderoperation wie bei einer Leberteilresektion durchgeführt [9]. In der Resektionsphase halten wir den zentralvenösen Druck niedrig.…”

Anaesthesie zur Organentnahme

“…standardisierten Induktionsmedikamenten Thiopental und Fentanyl, Atracurium und cis-Atracurium zur Muskelrelaxierung [5,11].…”

“…für die Blutgerinnung durch perioperative Wärmemaßnah-men vermieden werden sollte [5]. Für die ᭤ postoperative Schmerztherapie eignet sich in besonderem Masse ein thorakaler Periduralkatheter [11]. Allerdings muss bedacht werden, dass durch die Leberresektion die ᭤ Blutgerinnung innerhalb der ersten 3-6 Tage nach Explantation propotional zur Resektionsgröße der Leber beeinträchtigt wird [6].…”