Adjunct drugs in liver transplantation

Vater, Youri; Dembo, Greg; Hunter, Charles A.; Martay, Kenneth

doi:10.1053/sane.2002.34196

Cited by 12 publications

(16 citation statements)

References 151 publications

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“…The immediate hemodynamic stabilization (on the face of severely compromised myocardial function, in combination with rapid decrease in SVR, observed during postreperfusion stage), which all these drug combinations provide, should be further maintained with continuous infusion administration of vasoactive agents, such as phenylephrine or vasopressin, targeting primarily reduction of systemic vascular resistance. Compromised myocardial performance due to preexisting dilated cardiomyopathy and especially its worsening after graft reperfusion oftentimes necessitates addition of agents with β-adrenergic activities, such as norepinephrine, and, rarely, epinephrine [82,83].…”

Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Vitin¹,

Tomescu²,

Azamfirei³

2019

Liver Cirrhosis - Debates and Current Challenges

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Nonischemic cardiomyopathy is a collective term, encompassing a spectrum of cardiac comorbidities, accompanying the progressing end-stage liver disease. Alcoholic and cirrhotic cardiomyopathies are the most researched, well-known clinical entities in the list of nonischemic cardiac disorders that bear the most substantial impact on the clinical course, management, and outcomes of liver transplantation in ESLD patients. In this chapter, morphology, pathophysiology, diagnostic criteria, clinical manifestations, and management options of nonischemic cardiomyopathy in liver transplant candidates and recipients, the patients with end-stage liver disease due to advanced stages of cirrhosis, are discussed.

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Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Vitin¹,

Tomescu²,

Azamfirei³

2019

Liver Cirrhosis - Debates and Current Challenges

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“…Manitol can be used in the anhepatic phase before clamping of the IVC (0.5 g/kgc) in order to avoid blood congestion in the liver and intraabdominal organ oedema [36].…”

Section: Volemic Resuscitationmentioning

confidence: 99%

Anesthesia for Liver Transplantation

Droc¹,

Jipa²

2018

Organ Donation and Transplantation - Current Status and Future Challenges

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Liver transplantation is a high-risk surgery performed on a high-risk patient and is the only treatment for end-stage liver disease. Ever since the first successful liver transplant performed, patient survival increased due to improvement of surgical technique and anaesthetic management as well as the emergence of new generations of immunosuppressants. The pre-anaesthetic evaluation is mandatory and plays an important role in patient inclusion on the transplant list. Liver transplantation is performed under general anaesthesia, and the anaesthetic monitoring is very important for a successful liver transplantation as it can expose problems before irreversible damage occurs. Haemodynamic instability is common during surgery, requiring complex invasive haemodynamic monitoring. Continuous assessment of the patient's volemic status and the amount of perfused fluids represent the key to a successful liver transplantation. Inadequate fluid therapy can lead to pulmonary oedema, abnormal gas exchange, congestion, decrease in perfusion and oedema of the graft. Liver reperfusion takes place in the neohepatic phase and is the most unstable period during liver transplantation, representing a real challenge for the anaesthetist. It can have severe consequences due to a decrease in cardiovascular function with haemodynamic instability, abnormal acid base balance and metabolic abnormalities.

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“…Hemodynamic instability during OLT due to blood loss, graft reperfusion, and postreperfusion vascular tone adjustment, substantial fluid shift oftentimes necessitates the use of vasoactive agents. Different vasopressors, such as dopamine, dobutamine, epinephrine, norepinephrine, phenylephrine, vasopressin, and, more recently, terlipressin and octreotide have been used for hemodynamic optimization and end-organ perfusion improvement during OLTs for decades [88,89].…”

Section: Vasoactive Agents Applied Pharmacology and Use In Hemodynamimentioning

confidence: 99%

“…Norepinephrine and phenylephrine have a universal vasoconstrictor effect due to α-receptor stimulation, thus effectively increasing systemic vascular resistance, while decreasing cardiac index, peripheral and portal blood flow [90][91][92][93]. However, norepinephrine in higher doses causes severe peripheral vasospasm and promotes metabolic (lactic) acidosis [88].…”

Section: Vasoactive Agents Applied Pharmacology and Use In Hemodynamimentioning

confidence: 99%

Hemodynamic Optimization Strategies in Anesthesia Care for Liver Transplantation

Vitin¹,

Tomescu²,

Azamfirei³

2017

Liver Cirrhosis - Update and Current Challenges

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In this chapter, aspects of hemodynamic regulation in the end-stage liver disease (ESLD) patient, factors, contributing to the hemodynamic profile, coagulation-related problems, blood products transfusion tactics and problems, and hemodynamic optimization strategies during different stages of liver transplantation procedure-specifically what, when, and how to correct, with special attention to vasoactive agents use, will be discussed.

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Adjunct drugs in liver transplantation

Cited by 12 publications

References 151 publications

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Anesthesia for Liver Transplantation

Hemodynamic Optimization Strategies in Anesthesia Care for Liver Transplantation

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