Total pancreatectomy with islet cell autotransplantation: Anesthetic implications

Study Objective: To make recommendation for the perioperative management of patients undergoing total pancreatectomy with islet cell autotransplantati on. 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, specificall y investigating the changes in portal venous pressure, blood pressure (BP), and central venous pressure with islet cell injection. The records also we re examined for Blood glucose levels, type of fluids administered, blood lo ss, and postoperative complications. Measurements and Main Results: Injection of islet cells into the portal vei n caused a significant increase in portal venous pressures (8.5 +/- 4.8 to 27 +/- 16 cm/H2O; p < 0.0001, which remained elevated at the end of injecti on (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, sy stolic blood pressures (SBPs) fell with administration of the islet cells ( 110 +/- 15 to 103 +/- 17 mmHg; p < 0.01) but SEP 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 w ere significantly higher immediately prior to islet cell infusion in patien ts who had received dextrose-containing solutions than those who did not (2 46 +/- 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 transfusi ons. Conclusion: Although total pancreatectomy with islet cell autotransplantati on is a difficult operation, with significant blood loss, most patients tol erate surgery and injection of islet cells into their portal system without hemodynamic instability. Glucose-containing solutions should nor be admini stered to patients prior to islet cell infusion because hyperglycemia, whic h can damage islet cells, may result. (C) 1999 by Elsevier Science Inc.