ORIGINAL ARTICLE
Year : 2011  |  Volume : 5  |  Issue : 3  |  Page : 264-269

Use of transesophageal Doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation: An observational study


1 Department of Anaesthesia, Liver Institute, Menoufiya University, Egypt
2 Department of Community Medicine, Liver Institute, Menoufiya University, Egypt

Correspondence Address:
K Yassen
11 A Khalil El Khaiat Street, Moustafa Kamel, Alexandria
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.84099

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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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