| Use of transesophageal Doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation: An observational study. | |
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MedLine Citation:
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PMID: 21957404 Owner: NLM Status: PubMed-not-MEDLINE |
Abstract/OtherAbstract:
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AIMS: To report the use of transesophageal Doppler (TED), a minimally invasive cardiac output (COP) monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation (LDLT). SETTING AND DESIGN: A prospective observational study. METHODS: A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline (TB); anhepatic phase (TA); and post-reperfusion - 1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time (FTc) of the TED. Packed red blood cells (RBCs) were only given when hematocrit was less than 25%. Rotational thromboelastometry (ROTEM) and standard laboratory tests were used to guide component blood products requirements. RESULTS: Post-reperfusion, the COP, Cardiac Index (CI) and stroke volume (SV) increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance (SVR) (P ;< .05). Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure (ABP) dropped significantly (P < .05), and 14 out of the 25 patients required boluses of epinephrine (10 μg) to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure (CVP) and urine output (UOP) at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support. CONCLUSION: TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid- and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale. |
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Authors:
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M Hussien; E Refaat; N Fayed; K Yassen; M Khalil; W Mourad |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Saudi journal of anaesthesia Volume: 5 ISSN: 0975-3125 ISO Abbreviation: Saudi J Anaesth Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-09-29 Completed Date: 2011-11-10 Revised Date: 2012-04-27 |
Medline Journal Info:
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Nlm Unique ID: 101500601 Medline TA: Saudi J Anaesth Country: India |
Other Details:
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Languages: eng Pagination: 264-9 Citation Subset: - |
Affiliation:
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Department of Anaesthesia, Liver Institute, Menoufiya University, Egypt. |
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