Transplante hepático: comparação entre as técnicas convencionais sem bypass venovenoso e com preservação da veia cava inferior (piggyback) em pacientes sob anestesia venosa total
Carregando...
Arquivos
Data
2010-02-24
Autores
Soeiro, Fábio Scalet [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo do estudo foi analisar a experiência de um único centro com duas técnicas de transplante de fígado (TOF), convencional (C) e piggyback (PB), e comparar o intra e pós-operatórios, o custo financeiro e a sobrevivência do receptor e enxerto. Uma série consecutiva (2003-2006) de 60 TOF em adultos foi analisada, sendo 29 no grupo PB e 31 no grupo C. Não houve diferença entre o perfil dos doadores dos grupos C e PB, mas 73% dos enxertos foram provenientes de doadores com fígados “marginais”. Todos os pacientes foram submetidos à anestesia venosa total com propofol, remifentanil e cisatracúrio. A sobrevivência dos enxertos foi semelhante nos grupos em um, três e cinco anos (p > 0.05). No grupo C, foram realizados 4 retransplantes e nenhum no grupo PB. A evolução da função renal e hepática no pós-operatório foi semelhante, exceto no 1º e 5º dia do pós-operatório, quando os valores da creatinina plasmática foram maiores no grupo C (p < 0,05). A partir da fase anepática até o término da cirurgia, a pressão venosa central foi menor e a frequência cardíaca maior no grupo C (p < 0,05). A pressão de artéria pulmonar foi menor na fase anepática no grupo C ( p< 0,05). Não houve diferença de débito cardíaco e pressão de artéria pulmonar ocluída entre os grupos (p > 0,05). O tempo de cirurgia, anestesia e fase anepática foi maior no grupo PB (p < 0,05), mas não o tempo de isquemia fria e quente (p > 0,05). Houve maior utilização de concentrado de hemácias no grupo PB durante o intraoperatório (p < 0,05). A maioria dos pacientes, nos dois grupos, teve desintubação traqueal na sala de operação. Não houve diferença entre os grupos no tempo de permanência no hospital e na UTI e nos custos (p >0,05). Concluímos que, no período intraoperatório, a técnica piggyback, em relação à técnica...
The aim of this study was to analysis a single center's experience of two techniques of orthotopic liver transplantation (OLT), conventional (C) and piggyback (PB), regarding intra and postoperative characteristics, costs, graft and patient survival. A consecutive series (2003–2006) of 60 adults submitted to OLT were analyzed. Twenty nine patients had PB and 31 patients had C OLT. There were no differences between groups according to the donors profile, but 73% performed transplants using grafts from marginal donors. All patients received total intravenous anesthesia with propofol, remifentanil and cisatracurium. The 1, 2 and 3-yr patient and graft survival were the same (p>0.05). In C group, four retransplantations were performed and none in PB group. The postoperative liver and kidney function were not different, except on the 1º and 5º postoperative day that the creatinine are highest in C group (p>0.05). From the anhepatic phase until the end of the surgery, the venous central pressure was significantly lower and the heart rate was higher in C group (p< 0.05). The artery pulmonary pressure was lower in the anhepatic phase in C group (p< 0.05). There were no significant difference in the mean arterial pressure, cardiac output and wedge pressure. The surgery and anesthesia time were higher in PB group, but the cold and warm ischemia time weren´t significantly shorter. Except from red blood cells count (RBCC) that was higher in PB group in the operative time, there were no differences between groups in operative and postoperative blood products used. The fast track was performed in the operation room in the majority of the patients. The hospitalization and ICU length stay and costs were also approximately the same. In conclusion, in the PB group on perioperative time the hemodynamic changes were lower and the surgery and anesthetic... (Complete abstract click electronic access below)
The aim of this study was to analysis a single center's experience of two techniques of orthotopic liver transplantation (OLT), conventional (C) and piggyback (PB), regarding intra and postoperative characteristics, costs, graft and patient survival. A consecutive series (2003–2006) of 60 adults submitted to OLT were analyzed. Twenty nine patients had PB and 31 patients had C OLT. There were no differences between groups according to the donors profile, but 73% performed transplants using grafts from marginal donors. All patients received total intravenous anesthesia with propofol, remifentanil and cisatracurium. The 1, 2 and 3-yr patient and graft survival were the same (p>0.05). In C group, four retransplantations were performed and none in PB group. The postoperative liver and kidney function were not different, except on the 1º and 5º postoperative day that the creatinine are highest in C group (p>0.05). From the anhepatic phase until the end of the surgery, the venous central pressure was significantly lower and the heart rate was higher in C group (p< 0.05). The artery pulmonary pressure was lower in the anhepatic phase in C group (p< 0.05). There were no significant difference in the mean arterial pressure, cardiac output and wedge pressure. The surgery and anesthesia time were higher in PB group, but the cold and warm ischemia time weren´t significantly shorter. Except from red blood cells count (RBCC) that was higher in PB group in the operative time, there were no differences between groups in operative and postoperative blood products used. The fast track was performed in the operation room in the majority of the patients. The hospitalization and ICU length stay and costs were also approximately the same. In conclusion, in the PB group on perioperative time the hemodynamic changes were lower and the surgery and anesthetic... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Anestesia - Técnica, Figado - Tranplante
Como citar
SOEIRO, Fábio Scalet. Transplante hepático: comparação entre as técnicas convencionais sem bypass venovenoso e com preservação da veia cava inferior (piggyback) em pacientes sob anestesia venosa total. 2010. 219 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.