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Total pancreatectomy with islet cell autotransplantation: anesthetic implications
1Department of Anesthesiology, University of Minnesota Medical School, Minneapolis 55455, USA.
Study Objective:
To make recommendations for the perioperative management of patients undergoing total pancreatectomy with islet cell autotransplantation.
Design:
Retrospective review.
Setting:
University hospital.
Patients:
41 patients undergoing total pancreatectomy with autologous islet cell transplantation for chronic pancreatitis from 1977 to 1996.
Interventions:
The charts and anesthetic records were reviewed, specifically investigating the changes in portal venous pressure, blood pressure (BP), and central venous pressure with islet cell injection. The records also were examined for blood glucose levels, type of fluids administered, blood loss, and postoperative complications.
Measurements And Main Results:
Injection of islet cells into the portal vein caused a significant increase in portal venous pressures (8.5 +/- 4.8 to 27 +/- 16 cm/H2O; p < 0.001), which remained elevated at the end of injection (23 +/- 12 cm/H2O; p < 0.001). Central venous pressures also increased a small amount (9.3 +/- 4.3 to 10.6 +/- 5.8 mmHg; p < 0.05). In contrast, systolic blood pressures (SBPs) fell with administration of the islet cells (110 +/- 15 to 103 +/- 17 mmHg; p < 0.01), but SBP recovered in most patients at the end of injection (106 +/- 16 mmHg; p = NS). However, 6 patients (14.6%) required vasopressors to maintain adequate BPs. Blood glucose levels were significantly higher immediately prior to islet cell infusion in patients who had received dextrose-containing solutions than those who did not (246 +/- 80 vs. 176 +/- 43 gm/dl; p = 0.002). Median blood loss was 2000 ml (range 350 to 12,000 ml), and most patients (95.1%) required blood transfusions.
Conclusion:
Although total pancreatectomy with islet cell autotransplantation is a difficult operation, with significant blood loss, most patients tolerate surgery and injection of islet cells into their portal system without hemodynamic instability. Glucose-containing solutions should not be administered to patients prior to islet cell infusion because hyperglycemia, which can damage islet cells, may result.