Anaesthesiological management in orthotopic liver transplantation - Results of a survey

Objective: Since there is no therapeutical standard for the anaesthesiological approach during liver transplantation (LTX) in Germany at the moment, we have evaluated the current anaesthesiologic procedures during LTX. Methods: All departments of anaesthesiology (n=24) cooperating with transplantation centers in Germany received a questionnaire via mail regarding following complexes: anaesthesiological methods, anaesthetics, blood components therapy, perioperative monitoring, supportive cardiovascular therapy and staff. Results: The answers (n=16) showed following results: Balanced anaesthesia with continuous application of opioids was the standard method (80%). Different volatile anaesthetics as well as different opioids were used, isoflurane (66.7%) and fentanyl (53.3%) were the most common. Veno-venous bypass was never or occasionally used (86.7%). The differentiated use of catecholamines, based on discussions in the last years, was also reflected in the results. Dobutamine/ noradrenaline as combination seemed to be the first choice (46.7%). Whereas there was an accordance with the employment of blood components, there was a large variation in the effectively applicated blood products. Aprotinin was given in 60% of all clinics occasionally, in 20% everytime and in 20% aprotinine was never used. In most departments >= 2 anaesthesiologists (80%) and 1 nurse (53,3%) were needed for intraoperative observation. Postoperative medical attendance was provided on anaesthesiological as well as surgical guided intensive care units (ICU). Generally accepted was an early extubation after arrival at the ICU (86.7%). Conclusion: Even though there was a consensus in the anaesthesiological approach during LTX some departments still use different procedures. This is the first study that will give a basis for discussion of anaesthesiological approaches during LTX.