ABSTRACT
OBJECTIVES: The most widely used definition of postreperfusion syndrome in liver transplant is a 30% decrease in mean arterial pressure during the first 5 minutes after vascular unclamping. With these criteria, increased postoperative morbidity has been reported. Vasoactivedrugs couldpreventthis syndrome.Themain objective of our study was to determine the incidence and complications associated with postreperfusion syndrome inpatientswho receivedvasoactive support. MATERIALS AND METHODS: We studied 246 patients who received norepinephrine infusions to maintain mean arterial pressure ≥60 mm Hg and who were monitored with a Swan-Ganz catheter. Patients received a bolus of adrenaline after vascular unclamping in cases of insufficient response to norepinephrine. RESULTS: Among the study patients, 57 (23.17%) developed postreperfusion syndrome. Patients who developed postreperfusion syndrome did not present with morepostoperative complications interms ofrenal dysfunction (P = .69), repeat surgery (P = .15), graft rejection (P = .69), transplant replacement surgery (P = .76), hospital stay (P = .70), or survival (P = .17) compared with patients without postreperfusion syndrome. CONCLUSIONS: In patients who underwent orthotopic liver transplant, in whom vasoactive drugs were administered, a diagnosis of self-limited postreperfusion syndrome during the first 5 minutes after unclamping may not be associated with postoperative complications. The administration of vasoconstrictors may have a preventive effect on the postoperative complications associated with postreperfusion syndrome or they may mask the real incidence of postreperfusion syndrome. A broader definition of postreperfusion syndrome should be accepted.
Subject(s)
Liver Transplantation , Reperfusion Injury , Humans , Liver Transplantation/adverse effects , Reperfusion Injury/diagnosis , Reperfusion Injury/etiology , Reperfusion Injury/prevention & control , Pharmaceutical Preparations , Postoperative Complications/etiology , Liver , NorepinephrineABSTRACT
Las lesiones isquémicas relacionadas con los procedimientos quirúrgicos son una de las principales causas de morbilidad en el postoperatorio de la cirugía de los pacientes con patología vascular cerebral. Con el objetivo de detectar intraoperatoriamente los fenómenos isquémicos se han implementado diferentes sistemas de neuromonitorización, entre los que se encuentra la monitorización de la presión tisular de oxígeno (PtiO2). En este trabajo se pretende describir la utilidad de la monitorización intraoperatoria de la PtiO2 en la neurocirugía vascular a partir de la discusión de 4 casos ejemplo. A partir de la presentación de estos casos se discute cómo este tipo de monitorización permite detectar de una forma precoz y fiable las situaciones relacionadas con el procedimiento quirúrgico que ocasionan una hipoxia cerebral isquémica. La monitorización continua de la PtiO2 en el área de riesgo permite además resolver la causa que ha originado los episodios isquémicos y su evolución a un infarto establecido
Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Monitoring, Intraoperative/methods , Hypoxia-Ischemia, Brain/prevention & control , Oxygen Consumption , Vascular Surgical Procedures/methods , Neurosurgical Procedures/methods , Intraoperative Complications/prevention & controlABSTRACT
Ischemic lesions related to surgical procedures are a major cause of postoperative morbidity in patients with cerebral vascular disease. There are different systems of neuromonitoring to detect intraoperative ischemic events, including intraoperative monitoring of oxygen tissue pressure (PtiO2). The aim of this article was to describe, through the discussion of 4 cases, the usefulness of intraoperative PtiO2 monitoring during vascular neurosurgery. In presenting these cases, we demonstrate that monitoring PtiO2 is a reliable way to detect early ischemic events during surgical procedures. Continuous monitoring of PtiO2 in an area at risk allows the surgeon to resolve the cause of the ischemic event before it evolves to an established cerebral infarction.
