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  • Title: [Intravenous and transfusion therapy and acid-base balance during liver transplantation].
    Journal: Anesteziol Reanimatol; 2011; (6):55-8. PubMed ID: 22379918.
    Abstract:
    UNLABELLED: The aim of the study is to investigate the influence of intravenous fluid therapy and transfusion therapy with different amount of fresh frozen plasma and crystalloids. SUBJECT AND METHODS: 66 patients underwent cognate liver transplantation were divided into three groups. First received fresh frozen plasma and crystalloids at the ratio of 1:2 Second group FFP and crystalloids at the ratio of 1:1. Third at the ratio of 2:1 FFP and crystalloids. pH, SBC, PCO2, lactate was measured at the period of cross-clamping vena cava (anhepatic phase) and at the end of the surgery. As well as anion difference (AD), excess and deficiency of anion difference HCO3 = [(AD-12/24-HCO3)] or difference difference. RESULTS: First group of patient who received FFP 5423+ 417 ml. and crystalloids 11048+ 458 ml. demonstrated metabolic acidosis pH 7,309+0,02 and 7,323+0,01; SBC 17,72+0,96 and 18,36+1,76 mmoll/l; lactate 3,0+1,08 and 2,33+1,16 mmoll/l; difference difference 0,47+0,13 and 0,51 +0,25; chlorine 114,65+1,5 and 114,25+0,7 mmoll/l. At the end of anhepatic phase and at end of the operation the acidosis formed because of increased level of lactate as well as hyperchloremia due to infusion of high dose of fluids with high concentration of chlorine intravenous. Second group received 6882+ 943 ml. of FFP and 6690+882 ml. of crystalloids. There was a tendency to metabolic acidosis at the end of anhepatic phase pH 7,354+0,061; SBC 22,73+0,94; lactate 3,3+0,98 mmoll/l ;AD 12,85+0,86 mmol/l and difference difference 1,00+0,048, chlorine 100,76+1,39mmol/l. The main factor of metabolic acidosis was increased level of lactate. The third group with received 7532+1196ml. of FFP and 3720+629 ml. crystalloids. Metabolic acidosis developed at the end of anhepatic period pH 7,346+0,038; SBC21,28+0,95mmol/l; lactate 2,72+0,97mmol/l; AD 14,72+0,97mmol/l and difference difference 1,00+0,06; chlorine 100,95+2,49mmol/l. The main reason of acidosis was lactate, at the end of the operation there was an metabolic alkalosis pH 7,460+0,039; SBC 29,28+2,63mmol/l; lactate 2,81+1,66mmol/l. CONCLUSION: IVT with equal amount of FFP and crystalloids is optimal for liver transplantation surgery because it prevents development of metabolic acidosis wich appears due to intravenous infusion large dose of crystalloids on the other had it prevent metabolic alkalosis at the end of the surgery because of considerable amount of FFP.
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