[Anesthesia for removal of a large hepatoma under separated hepatic circulation]

A large hepatoma was removed under isolated hepatic perfusion. Hepatic circulation was separated from systemic circulation by clamping inferior vena cava, potal vein and hepatic artery. Lactated Ringer solution at 4 degrees C was perfused through potal vein, and disposed through the isolated part of inferior vena cava. Blood in proximal part of potal vein and right femoral vein was shunted to right axillary vein using a centrifugal pump. Prothrombin time and activated partial thromboplastin time were prolonged to more than 200 seconds and 300 seconds, respectively, 50 minutes after the commencement of isolated hepatic circulation. They recovered to normal ranges 115 minutes after the declamping, by injection of fresh frozen plasma. On clamping of the inferior vena cava, superior vena cava pressure was elevated and cardiac output decreased. When declamped, an excessive hemorrhage from the cross section of the liver was observed. It took 30 minutes for the systolic blood pressure to recover to 80 mmHg by rapid blood transfusion (150 ml.min-1). The hepatic perfusion with chilled lactated linger solution reduced the peripheral body temperature to 29 degrees C. Hypocalcemia, which was probably due to the massive blood transfusion, was treated with calcium gluconate and calcium chloride.