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Title: The intensive care of patients following orthotopic liver transplantation
Author: Park, Gilbert Richard
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1991
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This thesis describes the intensive care of patients following orthotopic liver transplantation and the studies that have explored some of the problems such patients may experience at this time. The shortage of organs for transplantation prompted a one year study into the outcome of all patients who became brain dead in Addenbrooke's hospital. This demonstrated that the major causes for organs not being donated were the relatives and the coroner refusing permission for donation and medical unsuitability. Early studies investigated the information obtained from laboratory tests of liver function in the immediate post-operative period. They concluded that changes in liver function occur slowly even after this operation and are modified by blood transfusion. The relief of pain and anxiety is of considerable importance in this group of patients, not only for humanitarian reasons but also to facilitate weaning from artificial ventilation. There was little information about the elimination of analgesic and sedative drugs in this group of patients. Therefore, an intensive investigation into the elimination of midazolam, morphine, alfentanil, nalbuphine and propofol in patients during either the anhepatic period of liver transplantation or in the immediate post-operative period was undertaken. Some drugs were studied in both periods. Several different patterns of metabolism were found. The use of the specific benzodiazepine antagonist flumazenil was also investigated and shown to have a useful role in the assessment of conscious level. As an alternative to systemic analgesia several methods of providing regional analgesia were also investigated. Renal failure in this group carries a high mortality and the use of the dopaminergic agents dopamine and dopexamine to prevent this complication was investigted. Both agents appearing to confer some protection. Post-operative bleeding is a further complication that is difficult to manage. The intraoperative haemodynamic changes associated with the release of abdominal tamponade were described. In some patients conventional haemostatis measures did not produce an improvement in post-operative bleeding, in such patients the use of vasopressin was found to be useful. The final chapter of the thesis reviews the causes of mortality in the 20 years that this operation has been performed in the United Kingdom. Infection has been the major cause of death during this period with bleeding and renal failure becoming less important.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available