Advances in liver transplantationSurgical procedure: AnesthesiaStroke Volume Variation Derived by Arterial Pulse Contour Analysis Is a Good Indicator for Preload Estimation During Liver Transplantation
Section snippets
Patients
After the approval of the institutional ethics committee, the study was performed between March 2009 and March 2011. Written informed consents were obtained from all the participants. Thirty end-stage cirrhosis patients receiving OLT were included in the study. Exclusion criteria included (1) patients with arrhythmia either noted in the preoperative examination or during the periodic measurements taken during. OLT, (2) patients who were on large doses of inotrope or vasoconstrictor before. OLT,
Cardiopulmonary Monitoring
Perioperative monitorings were comprised of arterial pressure, pulse oximetry, and anesthesia gas analysis. The left-hand radial artery was cannulated and the arterial line was connected to the Flo Trac/Vigileo system (Software Ver 3.02, Edwards Lifesciences) for both artery pressure monitoring and SVV calculation. An 8.0 French PAC (Swan-Ganz CCOmbo CCO/SvO2/CEDV/VIP777HF8 catheter, Edward Lifesciences) was inserted through the right-side internal jugular vein. The PAC was connected to a
Experimental Procedure
After the placement of the catheter, hemodynamic data were collected at 11 defined points in time during steady-state periods, which means at least 15 minutes elapsed after any changes occurred in the ventilator settings, or in the infusion rate of catecholamines or sedatives. Sudden changes in the position of the liver or retractors were avoided through liaison between the anesthesiologists and the surgeons. The 11 defined points were (1) 30 minutes after the induction of anesthesia, (2) 1
Statistical Methods
Statistical analysis was performed with MedCalc software, version 11.5.1.0 (MedCalc Inc, Mariakerke, Belgium) and SPSS, version 17.0 (SPSS Inc, Chicago, Ill, USA). Descriptive statistics were used for demographic, clinical, and hemodynamic data. Spearman's test was used for correlation estimation in order to describe the relationship between RVEDVI and other preload indices (SVV, CVP, PAOP). A P value of less than .05 is considered statistically significant.
Result
Thirty patients participated in the study. The demographic data of the patients are listed in Table 1. There is a statistically significant (P < .01) relationship between SVV and RVEDVI with a correlation coefficient of −0.87. CVP (r = 0.42, P < .05) and PAOP (r = 0.46, P < .05) correlated less strongly with RVEDVI (Fig 1).
Discussion
Our results indicate that during. OLT, SVV is a better preload indicator than CVP or PAOP. A higher SVV value correlated with a lower RVEDVI value. In other words, a higher SVV value is associated with a more hypovolemic fluid status.
During OLT, hemodynamic instabilities may exist. Insufficient preload, low cardiac output, and low systemic vascular resistance are potential contributing causes of hypotension during OLT. Rapidly differentiating causes in order to decide on further optimal
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Cited by (38)
Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial
2016, HPBCitation Excerpt :Many recent trials support its reliability in operative room with mechanically ventilated patients to assess fluid responsiveness.21 Preliminary reports during liver transplantation31,32 demonstrated a negative effect of low levels of SVV in terms of increased blood loss.32 Since the correlation between blood loss and both short- and long-term outcome has been described,11,12 it is evident that the importance of every surgical or anaesthesiological manoeuver affecting the risk of bleeding is key.
Optimal central venous pressure during the neohepatic phase to decrease peak portal vein flow velocity for the prevention of portal hyperperfusion in patients undergoing living donor liver transplantation
2015, Transplantation ProceedingsCitation Excerpt :Stroke volume variation, one of the dynamic preload indices, has been used to assess a patient's fluid responsiveness objectively by measuring shifts in the position of the Frank-Starling curve in liver transplantation [29]. Further, its superiority over CVP has already been reported [30]. However, there were no correlations between stroke volume variation and HHPs in the results of our study.
FloTrac® monitoring system: What are its uses in critically ill medical patients?
2015, American Journal of the Medical SciencesCitation Excerpt :More supportive data that compare CO measured by these devices and SV variation measured by FloTrac® compared with transthoracic echocardiography show good tracking capabilities of arterial pressure waveform analysis in patients who respond to fluid administration with a median TVSR of 970 dyne·s–1·cm–5.22 Also, an inverse relationship was found between SV variation and right ventricular end diastolic volume index measured by a PAC, but this study did not assess TSVR in patients with liver disease.23 In summary, although patients with advanced cirrhosis undergoing liver transplantation represent a unique group of patients, study outcomes are similar to those in patients with sepsis.
Utilization of bioreactance technique as indicator for preload responsiveness during living donor liver donation
2014, Transplantation ProceedingsCitation Excerpt :As blood returns to the left ventricle, the decrease in the left ventricular preload coincides with the expiratory phase of mechanical ventilation. Hypovolemic status will amplify such variation across the respiratory cycle [15]. These respiratory-related dynamic indices either derived from arterial waveform analysis (SPV, PPV), pulse contour analysis (SVV), or plethysmography analysis.
Corrected flow time is a good indicator for preload responsiveness during living donor liver donation
2014, Transplantation ProceedingsCitation Excerpt :As it is difficult to predict which Frank-Starling curve the patient lies on, considering preload responsiveness to guide fluid therapy seems more rational and practical. Several parameters are regarded as preload responsiveness-specific indicators [13–16]. Most of them are respiratory-based dynamic indices.