Hemodynamic Changes, Cardiac Output Monitoring and Inotropic Support
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...
KeywordsHypotension Vasopressors Hemodynamic changes Circulation Vasodilation Catecholamines
- 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
- 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
- 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