Factors affecting acid base status during hepatectomy in cirrhotic patients

Objective: To study acid base changes during hepatectomy in cirrhotic patients and their relations to intraoperative variables and different preoperative scoring systems used to asses hepatic patients. Methods: After obtaining approval of the Ethics and Research Committee of the National Liver Institute - Menoufia University and written informed patient consent, 80 patients scheduled for hepatectomy for hepatocellular carcinoma were included in the study. Anesthesia was induced with propofol, fentanyl, and rocuronium then maintained with desflurane and 50% O-2 in air. Samples for arterial blood gases and serum lactate were withdrawn from a left radial artery catheter just before the start of resection of liver parenchyma and immediately after its completion. Intraoperative events were recorded including use of Pringle maneuver and fluids and blood products infusions. Results: No differences were found in study parameters between Child class A and B patients except for the preresection lactate (p = 0.02). Patients with MELD score < 11 had higher preresection HCO3 (p = 0.004), higher BE (p=0.002), and lower lactate (p=0.001) than patients with MELD score >= 11. These findings were true also for patients with MELD-Na score < 11 as they had higher preresection HCO3 (p = 0.001), higher BE (p= 0.001), and lower lactate (p< 0.001) than patients with MELD-Na score >= 11. All patients had significant decrease in pH (p< 0.001), HCO3 (p< 0.001), and BE (p < 0.001) and significant increase in lactate (p< 0.001). These changes were augmented by intraoperative RBCs and FFP transfusion, using Pringle maneuver, but type of hepatectomy had significant effect only on HCO3 and BE. Again these changes in pH, HCO3, BE, and lactate were more obvious in patients with preoperative MELD score >= 11, and this was also true in patients with preoperative MELD-Na score >= 11 only with HCO3, BE, and lactate, but not with pH. Conclusion: Changes occurred in acid base status during hepatectomy in cirrhotic patients are affected by the preoperative condition of the patient (MELD and MELD-Na scores) as well as by intraoperative transfusion of blood products, use of Pringle maneuver and to a lesser extent by major versus minor hepatectomy. (C) 2013 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists. Open access under CC BY-NC-ND license.