Báo cáo một trường hợp rút ống nội khí quản ngay sau mổ ghép gan cho bệnh nhân suy gan cấp trên nền suy gan mạn tính

Abstract

Liver transplantation is the last therapy for end-stage liver disease and acute liver failure patients. Anesthesia for liver transplantation has many challenges: Severe coagulopathy, hemodynamic and acid-base disorder, hemorrhage, and need to massive blood component transfusion, prolong surgery time, especially in acute liver failure with high MELD score patients. Immediate post-operative extubation for liver recipients had been proven to improve graff perfusion, decrease respiratory complications, intensive care unit day, treatment cost. We present a liver recipient with a diagnosis of acute liver failure, MELD score 40, cirrhosis, hepatitis B, hypertension, type 2 diabetes mellitus. The preoperative condition was severe coagulopathy, plasma exchange four times. We chose balance anesthesia, using desfuran follow BIS’s target 40 - 60, rocuronium follow TOF 0, applied lung-protective ventilation post intubated, hemodynamic and transfusion under the direction of Volumview system, maintain thermic 36 - 37^oC. Anesthesia time was 450 minutes, at the end of surgery the patient was full conscious, met extubation criterias, and was extubated in 15 minutes. Post-anesthesia the patient was transfered to intensive care unit. The patient was no complications and discharged to home in 21 days.