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Intramucosal gastric pH during liver transplantation
M Concha1, J Dagnino, F Altermatt
1Department of Anaesthesia, Universidad Católica de Chile, Marcoleta 347, Santiago, Chile.
Insights
Intramucosal gastric pH (pHi) monitoring during pediatric liver transplant revealed lower-than-normal basal values. pH levels dropped further during surgery, with recovery post-reperfusion, though the exact cause remains unclear.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Pediatric Critical Care
Background:
- Liver transplantation is a complex procedure with potential for significant physiological changes.
- Monitoring intramucosal gastric pH (pHi) can indicate gastric mucosal perfusion and oxygenation.
- Pediatric liver transplant patients present unique physiological challenges.
Observation:
- Intramucosal gastric pH (pHi) was measured in a 3-year-old girl undergoing liver transplantation.
- Basal pHi was below the normal range for stable pediatric patients.
- pHi decreased during hepatectomy and anhepatic phases, despite stable hemodynamics and ventilation.
Findings:
- The study observed reduced intramucosal gastric pH (pHi) during critical phases of pediatric liver transplantation.
- A progressive return towards normal pHi values was noted during the reperfusion phase.
- The precise cause of pHi reduction (oxygen delivery vs. surgical alterations) could not be determined due to unmeasured variables.
Implications:
- Findings highlight the potential for gastric mucosal hypoperfusion during pediatric liver transplantation.
- Further research is needed to correlate pHi changes with oxygen delivery and consumption in this population.
- Optimizing perioperative management may benefit from understanding gastric mucosal perfusion dynamics.
Abstract:
Intramucosal gastric pH (pHi) was measured during liver transplantation in a 3-year-old girl. The basal value was below that reported as normal for paediatric patients under stable normal ventilatory and haemodynamic conditions. Additional reductions of the pHi were observed during the hepatectomy and anhepatic phase, in the absence of haemodynamic or ventilatory alterations. The reperfusion phase was characterized by a progressive return toward normal values. Because we did not measure oxygen delivery and consumption, we cannot determine whether the reduction of the pHi was due to insufficient oxygen delivery or a result of the vascular anatomical alterations due to the surgical procedure.