Comparative Biochemistry and Physiology Part D: Genomics and Proteomics, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Purpose: to retrospectively review anesthesia and intensive care management of 145 consented volu... more Purpose: to retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: after local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. results: one hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). the most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). two donors had major complications: one had portal vein thrombosis (PVt) treated with vascular stent. this patient recovered fully. the other donor had serious intraoperative bleeding and developed postoperative PVt and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (Pt) and international normalization ratio (iNr) postoperatively, reaching the maximum on day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on day 1 and 2.3±0.83 mg/dl on day 3 postoperatively. conclusions: Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. Pt and iNr monitoring postoperatively is still necessary for best timing of epidural catheter removal. live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting.
Comparative Biochemistry and Physiology Part D: Genomics and Proteomics, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Purpose: to retrospectively review anesthesia and intensive care management of 145 consented volu... more Purpose: to retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: after local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. results: one hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). the most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). two donors had major complications: one had portal vein thrombosis (PVt) treated with vascular stent. this patient recovered fully. the other donor had serious intraoperative bleeding and developed postoperative PVt and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (Pt) and international normalization ratio (iNr) postoperatively, reaching the maximum on day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on day 1 and 2.3±0.83 mg/dl on day 3 postoperatively. conclusions: Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. Pt and iNr monitoring postoperatively is still necessary for best timing of epidural catheter removal. live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting.
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