الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Orthotopic liver transplantation is considered the definitive management for patients with end stage liver disease. It involves substituting a diseased old liver with a new one, usually a lobe from a living donor. However the operation is complex and difficult in nature. It is characterized by significant electrolyte, acid – base and hemodynamic disturbances that requires a vigilant anesthesia team to detect and correct these imbalances immediately.
One of the major unavoidable complications of the operations is lactic acidosis, normally lactic acid -produced by anaerobic metabolism- is cleared by the liver in normal persons. However during OLT patients already suffer from decompensated liver disease and later in the operation complete absence of the liver during the anehepatic phase which result in progressive lactic acid accumulation and consequent lactic acidosis which could negatively affect the graft function.
Many techniques have been proposed to treat and ameliorate the deleterious effect of lactic acidosis on the graft. However none was superior over the other lines.
In this study 60 patients were randomized in two groups, namely group (NH) which received sodium bicarbonate infusion and group (RA) which received ringer acetate. Subsequent monitoring and data collection ensued both intraoperatively and postoperatively.
During the intraoperative period both groups were compared regarding duration of surgery, blood product requirements, crystalloid and colloid volumes infused, urine output and requirements for vasoactive therapy, also serum lactate, PH and Base excess were followed closely during each phase of the operation. In the postoperative period in the ICU both groups were compared regarding the graft function, major postoperative complications, duration of mechanical ventilation, vasopressor infusion, length of ICU stay and hospital stay.
Both groups showed comparable results regarding the graft outcome, postoperative complications and ICU course. However the sodium bicarbonate infusion group showed better control of lactic acidosis with lower serum lacic acid levels in the intraoperative and immediate postoperative periods.
This shows that sodium bicarbonate infusion can be used during OLT to mitigate the harmful effects of lactic acidosis.
CONCLUSION
from all above we concluded that ringer acetate may be beneficial when compared with other crystalloids such as lactated ringer or normal saline, but in comparison with sodium bicarbonate as in our study sodium bicarbonate was superior in correction of lactic acidosis, but still there may be a need for further multicentric randomized controlled trials to confirm the findings of the present study.