A comparison of intra‐operative blood loss and acid–base balance between vasopressor and inotrope strategy during living donor liver transplantation: a randomised, controlled study

Abstract

SummaryAdministration of vasopressors or inotropes during liver transplant surgery is almost universal, as this procedure is often accompanied by massive haemorrhage, acid-base imbalance, and cardiovascular instability. However, the actual agents that should be used and the choice between a vasopressor and an inotrope strategy are not clear from existing published evidence. In this prospective, randomised, controlled and single-blinded study, we compared the effects of a vasopressor strategy on intra-operative blood loss and acid-base status with those of an inotrope strategy during living donor liver transplantation. Seventy-six adult liver recipients with decompensated cirrhosis were randomly assigned to receive a continuous infusion of either phenylephrine at a dose of 0.3-0.4 lg.kg Patients undergoing liver transplantation for decompensated liver cirrhosis invariably demonstrate pathophysiological circulatory changes. Elevated intrahepatic vascular resistance induces dilatation of extrahepatic vessels, which is aggravated by overproduction and impaired hepatic metabolism of endogenous vasodilators such as nitric oxide [1]. Dilatation of extrahepatic vessels, including portosplanchnic vessels, redistributes body fluid from the central to the peripheral compartment, reducing effective blood flow to the major organs. Additionally, wide surgical dissection of porto-systemic collateral vessels and an inherent haemorrhagic

Analysis of pre- and intraoperative clinical factors for successful operating room extubation after living donor liver transplantation: a retrospective observational cohort study

“…The optimal hemodynamic adjustment was made with a mean arterial pressure (MAP) of ≥65 mmHg and a central venous pressure of ≤10 mmHg. According to the Practice Guidelines for Perioperative Blood Management [23], packed red blood cells (PRBCs) were transfused to a hematocrit level of ≥25%, and coagulation factors were replaced as determined by laboratory assessment or thromboelastography (Thromboelastograph Model 5000; Haemoscope Corporation, Niles, IL, USA) [24]. The kidney function of patients who scheduled elective LDLT was regularly monitored by nephrologists, and patients with severely decreased kidney function before surgery (an increase in serum creatinine to ≥4.0 mg.dL − 1 or to 3-fold baseline level, a urine output of ≤0.3 mL.kg − 1 .h − 1 for 24 h, or anuria for 12 h) were intraoperatively given continuous renal replacement therapy (CRRT) (PRISMAFLEX System; Baxter) [25–27].…”

Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

“…5 In another study, increased vascular resistance by infusion of an intraoperative vasopressor agent decreased the amount of intraoperative bleeding during surgery. 6…”

Pharmacologic agents for acute hemodynamic instability: Recent advances in the management of perioperative shock- A systematic review

“…[ 8 ] In addition, the use of phenylephrine to maintain hemodynamic stability during liver transplantation has demonstrated less blood loss and lower lactate levels compared to inotropes, an effect attributable to its ability to increase vascular resistance and thus reduce portal blood flow. [ 61 ] Phenylephrine is considered a first-line agent in hyperdynamic (normal CO) septic shock as it restores SVR and organ perfusion pressure. [ 2 52 ] Also, phenylephrine's reflex bradycardia may prove useful in the treatment of hypotension caused by tachyarrhythmias or when tachyarrhythmias occur in response to other vasoactive agents used in the treatment of circulatory shock[ 2 ] Vasopressin (antidiuretic hormone) levels are increased in response to early shock to maintain organ perfusion,[ 62 ] but levels fall dramatically as shock progresses.…”