Transplantation proceedings
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Comparative Study
The effects of desflurane and isoflurane on hepatic and renal functions after right hepatectomy in living donors.
Considering the severe nature of living donor right hepatectomy (removal of two thirds of the original liver), identification of an anesthetic agent having a minimal impact on postoperative organ function seems important. We compared postoperative hepatic and renal functions between 2 inhalational anesthetics, desflurane (Des) and isoflurane (Iso) among living donors undergoing right hepatectomy. ⋯ The present study showed better postoperative hepatic and renal function tests with Iso than Des at an equivalent dose of 1 MAC among living donors undergoing right hepatectomy.
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To compare the efficacy and dose requirements for intravenous (IV) patient-controlled analgesia (PCA) with morphine only versus morphine with ketorolac for living liver donors after partial hepatectomy. ⋯ Both regimens provided acceptable pain control with daily VAS less than 3. The use of ketorolac in the PCA did not reduce the daily total morphine requirements with a similar incidence of side effects but a significantly reduced requirement for rescue doses, which subsequently reduced the work load of personnel in the pain control service.
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Intermittent inflow occlusion (IIO) is a safe, effective method to reduce blood loss during liver resection and preserve function even among patients with underlying diseases such as steatosis and cirrhosis. Therefore, we evaluated the impact of IIO on postoperative liver function tests (LFT) and on morbidity among living liver donors undergoing a right hepatectomy, including donors with mild degrees (5%-30%) of macrovesicular steatosis (MaS). ⋯ Application of IIO in donors with mild macrosteatosis undergoing right hepatectomy showed significantly higher postoperative peak liver functions tests and number of overall complications than those without IIO.
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Decreased inhalational anesthetic requirements during orthotopic liver transplantation (OLT) have been reported according to the severity of the pre-existent disease as well as decreased opioid requirements thereafter. The aim of the present study was to determine the relationship between postoperative opioid requirements and severity of liver disease among OLT patients. ⋯ OLT patients with high MELD scores required less postoperative opioids and experienced less pain than those with low scores. Therefore, postoperative pain control after OLT should be carefully titrated according to the severity of the liver disease.
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Changes in quality of life (QOL) of donors after living donor liver transplantation surgery were studied using Short Form 36 (SF-36) to evaluate physical health and the Profile of Mood States (POMS) to evaluate mood. ⋯ Some donors had symptoms that persisted for comparatively long periods postoperatively and considered that long-term outpatient observation was required. No significant psychological changes were found, but donors felt anxiety about their future health and considered that patient meetings would be useful and that adequate outpatient health guidance should be provided.