Anestéziológia a intenzívna medicína 1/2015

Patients with liver cirrhosis and invasive elective procedure

Introduction: Patients with liver cirrhosis (End Stage Liver Disease, ESLD) often undergo invasive elective procedure. Risk of decompensation ESLD increase by any elective surgery under general anaesthesia carries. To indicate the patient is used risk stratification (scoring criteria). The choice of surgical technique and optimal anaesthesia, management of abnormalities of haemostasis are modified risk factors. The paradigm of the ESLD, the cirrhotic patient is bleeding varies. The development of the ESLD arise unstable equilibrium, fluid-coagulopathy balance. The patient is then after a little insult subject to the risk of bleeding as well as thrombosis. Objectives: The aim of this work is to highlight the major changes in the perioperative management of patients with the ESLD, identify risk group and to assess the effect of personalized thromboelastometry guided therapy on the incidence of perioperative bleeding, thrombotic complications and postoperative morbidity. Methods: The work is a retrospective study, which enrolled 108 consecutive patients undergoing operation with high degrease of invasivity. Data have withdraw from information health care system and used it in Excel table, due to statistics analysis by Fisher, Wilcoxonov test. Significant differences was p < 0,05. Results: After identifying risk group of 51 patients (incidence of spontaneous bleeding/thrombosis in the past) 46,3 % (108/51) of these patients were divided into groups A – without using TEM controlled haemostasis, B – using TEM. Patients using TEM had lower intraoperative blood loss 5,0 l versus 7,1 l, lower operation time 309,4 min. versus 436,6 had higher average age 53,4 versus 50,4, higher MELD score 17,4 versus 15,4, lower consumption of the blood transfusion units 4,3 vz. 6,4 lower consumption antifibrinolytic therapy 37,5 % versus 52,6 %. In the same group was lower post-operative revision for bleeding, thrombotic complications 6,3 % versus 10,5 %, lower period in ICU 6,8 days versus 7,6 and lower incidence of septic complications 43,8 % versus 52,6 %.

Keywords: liver cirrhosis, surgery, thromboelastometry, bleeding, thrombosis.