Hemodynamic Optimization Strategies in Anesthesia Care for Liver Transplantation

Vitin, Alexander A.; Tomescu, Dana; Azamfirei, Leonard

doi:10.5772/intechopen.68416

Cited by 3 publications

(3 citation statements)

References 103 publications

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“…The clinical manifestations of cirrhosis-related myocardial dysfunction are becoming evident during liver transplantation surgery, when the hemodynamics are affected by numerous factors that include blood loss and fluid shifts with substantial third space formation, mechanical ventilation, large vessel clamping (specifically portal vein and IVC), and effects of anesthesia. In severe cases, heart failure manifests in significant reduction in the cardiac output [66,67]. The problem is that, considering the baseline abnormally increased CO (up to 10-12 L/min), a gradual decrease to 4-5 L/min may not be immediately perceived as such and interpreted as a sign of ongoing myocardial decompensation.…”

Section: Clinical Manifestations and Reversibilitymentioning

confidence: 99%

“…Patients with preexisting cardiomyopathy, mostly impaired left ventricular function, express a limited ability to generate an adequate CO. These patients, too, may benefit from the ameliorative effect of the preload, associated with VVB, throughout the whole of liver transplant surgery, but particularly during anhepatic and postreperfusion stages [67].…”

Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

“…Different drug combinations have been tested and recommended for rapid hemodynamic recovery after liver graft reperfusion. Vasopressin in small boluses, 1-2 U, may be highly efficient in opposing the significant and rapid decrease of SVR, and calcium chloride, up to 1000 mg, may enhance inotropic effects of epinephrine [67,80]. Methylene blue, 2 mg/kg, has been reported as very efficient and "last resort" drug for prolong and profound hypotension, refractory to treatment with other vasoactive drugs [81].…”

Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

See 2 more Smart Citations

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: Clinical Manifestations and Reversibilitymentioning

confidence: 99%

Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

Section: Management: Possible Treatment Optionsmentioning

confidence: 99%

See 1 more Smart Citation

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Vitin¹,

Tomescu²,

Azamfirei³

2019

Liver Cirrhosis - Debates and Current Challenges

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Role of Vasopressors in Liver Transplant Surgery

Saraf¹

2023

Peri-Operative Anesthetic Management in Liver Transplantation

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Changes in Hemostasis during Liver Transplantation in Children

Novikov

Zaitsev

Дубровин

et al. 2022

Vestn. anesteziol. reanimatol.

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The objective: to assess changes of clinical and laboratory hemostasic parameters in children at the stages of orthotopic liver transplantation.Subjects and Methods. A single-centre, prospective, pilot study of coagulation test scores was performed in 20 children aged 0 to 11 years with hepatoblastoma after a course of PRETEX IV chemotherapy who underwent liver transplantation from a related donor.Results. Children from 0 to 11 years old with hepatoblastoma, after chemotherapy, retain the normal functional activity of the hemostasis system at the pre-hepatic stage of transplantation: APTT 34.6 (34.45; 38.65) s; prothrombin index (PI) 83.53 (74.09; 87.87) %; INR 1.22 (1.16; 1.42) in the 0‒2 year group, APTT 40.45 (34.9; 41, 68), PI 75.57 (64.41; 80.45) %, and INR 1.39 (1.36; 1.87) in the group aged 3‒11 years. Severe hypocoagulation develops by the end of the hepatic stage and in the first 15 minutes after the start of arterial blood flow through the graft: CT and CFT from 195.0 (189.0; 228.5) s and 163.0 (129.5; 171.5) s to 537.0 (456.0; 1,651.5) s and 468.0 (324.5; 611.5) s (p < 0.05), respectively, in the INTEM test. Hypocoagulation at this time develops due to deficiency of coagulation factors and the release of endogenous glycosaminoglycans from the endothelium transplant, as indicated by an increase in CT and CFT to 666.0 (468.5; 2,209.5) s and 254.5 (203.25; 305.75) s in INTEM, CT to 525.0 (389.0; 2028.0) s with p < 0.05 in HEPTEM in children under the age group of up to 2. Within 1 hour after the start of arterial blood flow, the effects of systemic heparinoid effects persist, which is confirmed by the dynamics of CT 360.0 (219.5; 2,116.5) s with up to 960.0 (560.5; 1,440.5) s with p < 0.05 in the EXTEM test.Conclusion. Changes in hemostasis system parameters during surgery make it possible to judge about rapidly developing coagulation and anticoagulation disorders in children of the presented age groups. Specific changes in the coagulation profile at the stages of liver transplantation in children under the age of 11 inclusive, make it possible to do without routine correction of changes in the hemostasis system.

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Hemodynamic Optimization Strategies in Anesthesia Care for Liver Transplantation

Cited by 3 publications

References 103 publications

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Nonischemic Cardiomyopathy in Liver Transplant Recipients

Role of Vasopressors in Liver Transplant Surgery

Changes in Hemostasis during Liver Transplantation in Children

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