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(P<0.01),but at the point of unclamping vena cava,PAWP and CVP increased significantly,while MAP decreased(P<0.01).Mean pulmonary arterial pressure(MPAP) kept at a high level at the end of operation(P<0.01).cardiac output(CO) was lower at the point of clamping or unclamping vena cava than before operation(P<0.05).Conclusions: The changes of homodynamics mainly occur at anhepatic and early neohepatic stage.Comprehensive treatment and timely management may check the changes.