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Hemodynamic Changes, Cardiac Output Monitoring and Inotropic Support

  • Anand D. Padmakumar
  • Mark C. Bellamy
Chapter

Introduction

Liver transplantation (LTx) poses distinct challenges to the anesthesiologist. Patients presenting for LTx constitute a high-risk surgical group with unique problems and require meticulous attention to their perioperative management. End-stage liver disease (ESLD) is the most common indication for LTx and presents complex pathophysiological changes involving all organ systems. The severity of such changes varies enormously between cases. A further level of complexity is seen in patients presenting with decompensated ESLD and in those presenting with acute hepatic failure. Cardiovascular, respiratory, renal, neurological, gastrointestinal and inflammatory changes all interact to produce a complex clinical picture. Portopulmonary hypertension, ascites, varices and dyselectrolytemia are some of the myriad problems associated with liver disease that require special consideration before anesthetizing patients for LTx. In this chapter, we discuss cardiovascular changes at...

Keywords

Hypotension Vasopressors Hemodynamic changes Circulation Vasodilation Catecholamines 

References

  1. 1.
    Richardson PD. Physiological regulation of the hepatic circulation. Fed Proc. 1982;41(6):2111–6.PubMedGoogle Scholar
  2. 2.
    Lautt WW. Relationship between hepatic blood flow and overall metabolism: the hepatic arterial buffer response. Fed Proc. 1983;42(6):1662–6.PubMedGoogle Scholar
  3. 3.
    Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Phys. 1985;249(5 Pt 1):G549–56.Google Scholar
  4. 4.
    Lautt WW. Regulatory processes interacting to maintain hepatic blood flow constancy: vascular compliance, hepatic arterial buffer response, hepatorenal reflex, liver regeneration, escape from vasoconstriction. Hepatol Res. 2007;37(11):891–903.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kontos HA, Shapiro W, Mauck HP, Patterson JL Jr. General and regional circulatory alterations in cirrhosis of the liver. Am J Med. 1964;37:526–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Baik SK, Jee MG, Jeong PH, Kim JW, Ji SW, Kim HS, Lee DK, Kwon SO, Kim YJ, Park JW, Chang SJ. Relationship of hemodynamic indices and prognosis in patients with liver cirrhosis. Korean J Intern Med. 2004;19(3):165–70.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Liu H, Gaskari SA, Lee SS. Cardiac and vascular changes in cirrhosis: pathogenic mechanisms. World J Gastroenterol. 2006;12(6):837–42.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Smith TW, Balligand JL, Kaye DM, Wiviott SD, Simmons WW, Han X, Michel T, Singh K, Kelly RA. The role of the NO pathway in the control of cardiac function. J Card Fail. 1996;2(4 Suppl):S141–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Van de Casteele M, Omasta A, Janssens S, Roskams T, Desmet V, Nevens F, Fevery J. In vivo gene transfer of endothelial nitric oxide synthase decreases portal pressure in anaesthetised carbon tetrachloride cirrhotic rats. Gut. 2002;51(3):440–5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liu H, Song D, Lee SS. Role of heme oxygenase-carbon monoxide pathway in pathogenesis of cirrhotic cardiomyopathy in the rat. Am J Physiol Gastrointest Liver Physiol. 2001;280(1):G68–74.CrossRefGoogle Scholar
  11. 11.
    Burtenshaw AJ, Isaac JL. The role of trans-oesophageal echocardiography for perioperative cardiovascular monitoring during orthotopic liver transplantation. Liver Transpl. 2006;12(11):1577–83.CrossRefGoogle Scholar
  12. 12.
    Benington S, Ferris P, Nirmalan M. Emerging trends in minimally invasive haemodynamic monitoring and optimization of fluid therapy. Eur J Anaesthesiol. 2009;26(11):893–905.CrossRefGoogle Scholar
  13. 13.
    Escorsell A, Bandi JC, Moitinho E, Feu F, García-Pagan JC, Bosch J, Rodés J. Time profile of the haemodynamic effects of terlipressin in portal hypertension. J Hepatol. 1997;26(3):621–7.CrossRefGoogle Scholar
  14. 14.
    Baik SK, Jeong PH, Ji SW, Yoo BS, Kim HS, Lee DK, Kwon SO, Kim YJ, Park JW, Chang SJ, Lee SS. Acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis: a randomized comparison. Am J Gastroenterol. 2005;100(3):631–5.CrossRefGoogle Scholar
  15. 15.
    Ryckwaert F, Virsolvy A, Fort A, Murat B, Richard S, Guillon G, Colson PH. Terlipressin, a provasopressin drug exhibits direct vasoconstrictor properties: consequences on heart perfusion and performance. Crit Care Med. 2009;37(3):876–81.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Landry DW, Oliver JA. The pathogenesis of vasodilatory shock. N Engl J Med. 2001;345(8):588–95.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wagener G, Kovalevskaya G, Minhaz M, Mattis F, Emond JC, Landry DW. Vasopressin deficiency and vasodilatory state in end-stage liver disease. J Cardiothorac Vasc Anesth. 2011;25(4):665–70.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gray TA, Buckley BM, Sealey MM, Smith SC, Tomlin P, McMaster P. Plasma ionized calcium monitoring during liver transplantation. Transplantation. 1986;41(3):335–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Díaz J, Acosta F, Parrilla P, Sansano T, Contreras RF, Bueno FS, Martínez P. Correlation among ionized calcium, citrate, and total calcium levels during hepatic transplantation. Clin Biochem. 1995;28(3):315–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Molenaar IQ, Begliomini B, Martinelli G, Putter H, Terpstra OT, Porte RJ. Reduced need for vasopressors in patients receiving aprotinin during orthotopic liver transplantation. Anesthesiology. 2001;94(3):433–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Koelzow H, Gedney JA, Baumann J, Snook NJ, Bellamy MC. The effect of methylene blue on the hemodynamic changes during ischemia reperfusion injury in orthotopic liver transplantation. Anesth Analg. 2002;94(4):824–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Møller S, Henriksen JH. Cirrhotic cardiomyopathy. J Hepatol. 2010;53(1):179–90.CrossRefPubMedGoogle Scholar
  23. 23.
    Busani S, Marconi G, Schiavon L, Rinaldi L, Del Buono M, Masetti M, Girardis M. Living donor liver transplantation and management of portal venous pressure. Transplant Proc. 2006;38(4):1074–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Cheema SP, Hughes A, Webster NR, Bellamy MC. Cardiac function during orthotopic liver transplantation with venovenous bypass. Anaesthesia. 1995;50(9):776–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Matsusaki T, Hilmi IA, Planinsic RM, Humar A, Sakai T. Cardiac arrest during adult liver transplantation: a single institution's experience with 1238 deceased donor transplants. Liver Transpl. 2013;19(11):1262–71.CrossRefPubMedGoogle Scholar
  26. 26.
    Bellamy MC, Gedney JA, Buglass H, Gooi JH. Leeds Liver Group. Complement membrane attack complex and hemodynamic changes during human orthotopic liver transplantation. Liver Transpl. 2004;10(2):273–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Bellamy MC, Galley HF, Webster NR. Changes in inflammatory mediators during orthotopic liver transplantation. Br J Anaesth. 1997;79(3):338–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Aggarwal S, Kang Y, Freeman JA, Fortunato FL, Pinsky MR. Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc. 1987;19(4 Suppl 3):54–5.PubMedGoogle Scholar
  29. 29.
    Tejani M, Yi SY, Eudailey KW, George I, Guarrera JV, Wagener G. Extracorporeal membrane oxygenation as a rescue device for postreperfusion cardiac arrest during liver transplantation. Liver Transpl. 2015;21(3):410–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Webster NR, Bellamy MC, Lodge JP, Sadek SA. Haemodynamics of liver reperfusion: comparison of two anaesthetic techniques. Br J Anaesth. 1994;72(4):418–21.CrossRefGoogle Scholar
  31. 31.
    Salazar Vázquez BY, Martini J, Chávez Negrete A, Cabrales P, Tsai AG, Intaglietta M. Microvascular benefits of increasing plasma viscosity and maintaining blood viscosity: counterintuitive experimental findings. Biorheology. 2009;46(3):167–79.Google Scholar
  32. 32.
    Glauser FL. Systemic hemodynamic and cardiac function changes in patients undergoing orthotopic liver transplantation. Chest. 1990;98(5):1210–5.CrossRefGoogle Scholar
  33. 33.
    Glanemann M, Busch T, Neuhaus P, Kaisers U. Fast tracking in liver transplantation. Immediate postoperative tracheal extubation: feasibility and clinical impact. Swiss Med Wkly. 2007;137(13–14):187–91.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.St. James’s University Hospital, Leeds Teaching Hospitals NHS TrustLeedsUK

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