Anaesthetic management of a case of HCV-related liver cirrhosis and sickle cell anemia posted for orthotropic liver transplant.

Dr. Priyanka Kangle; Dr.Nisarg Patel

Volume : VII, Issue : XI, November - 2018

Anaesthetic management of a case of HCV-related liver cirrhosis and sickle cell anemia posted for orthotropic liver transplant.

Dr. Priyanka Kangle, Dr. Nisarg Patel

Abstract :

Introduction: Hepatitis C Virus (HCV) is a hepatotropic RNA virus, with a propensity to affect the liver. HCV causes acute hepatitis which is mostly subclinical and gradually evolves into chronic hepatitis in about 80% of those infected. End–stage liver disease caused by HCV has become the most common indication for orthotopic liver transplantation (OLT)^3,4Mortality is higher when it is associated with Sickle cell Disease Meticulous peri–operative management avoiding all the risk factors and preventing all the complications can result in a better outcome giving a new life to a moribund.

Case report:A 36 year old male with 56kgs was diagnosed with sickle cell anaemia in childhood. patient got infected with Hepatitis C virus during multiple blood transfusion. The patient was induced under general anaesthesia and put on SIMV–VC mode of ventilator. Both the radial arteries were cannulated and the right heart was catheterised with Swan Ganz pulmonary artery catheter. The patient was transfused with 5 units of albumin,14 units of PCVs,5 units FFPs and 8 units of PRC by TEG guided component transfusion and a total of 16 litres of infused and a total output of 15 litres was achieved.The patient was maintained intra–operatively with infusions of Atracurium,Fentnyl and Noradrenaline supplemented by Oxygen,Inhalational agent Isoflurane,N₂O and Midazolam was given during anhepatic phase.Inj.calciumgluconate, Inj.soda bicarbonate, Inj.MP1gm, Inj.Mannitol, Inj.Albumine were required dutring intra operatively. Ascitic fluid waS 2 liter.

Conclusion:Liver cirrhosis is a devastating disorder affecting almost every single organ of the body and the metabolism of drugs and other anaesthetic agents are also affected major fluid was shiftedduring liver transplant and demanded massive blood transfusion.Meticulous peri–operative management can result in giving a new life to a moribund patient.