Assessment of Right Ventricular Function During Orthotopic Liver Transplantation / 대한마취과학회지

BACKGROUND: Patients undergoing orthotopic liver transplantation(OLT) may develop significant hemodynamic instability. This study was performed to assess the role of right ventricular function in the hemodynamic alteration during 23 cases of OLT. METHODS: A thermodilution ejection fraction catheter was used to measure ejection fraction(EFrv), allowing for calculation of right ventricular(RV) end-diastolic volume index(EDVIrv), end-systolic volume index(ESVIrv), stroke volume index(SVIrv). RV stroke work index(SWIrv), maximum elastance (Emaxrv) and performance index(PIrv) as the functions of contractility were also calculated. Those RV hemodynamic measures were taken during preanhepatic phase(stage I), anhepatic phase (stage II), after reperfusion of the grafted liver and postanhepatic phase (stage III). All of measures in each surgical stage were statistically analyzed for their differences by repeated measured ANOVA. And correlation between changes from baseline of RV hemodynamic variables was determined by polynomial regression analysis. RESULTS: EFrv, SVIrv, SWIrv appeared to be well preserved throughout the prdegrees Cedure during stage I, II, III and much higher 5 min after reperfusion. No correlation was observed between right atrial pressure(Pra) and EDVIrv. There were significant correlation between EDVIrv and SVIrv, SWIrv and EFrv, Emaxrv and EFrv. CONCLUSION: RV function was well preserved during uncomplicated OLT using venovenous bypass. EDVIrv were more reliable determinants of RV preload than Pra for assessing RV contractility under conditions of this operation.

Central Pontine Myelinolysis after Liver Transplantation: A case report / 대한마취과학회지

Central pontine myelinolysis (CPM) is a demyelinating disorder that almost exclusively affects the central portion of basis pontis and occurs in patients with malnutrition, chronic debilitating disorders and electrolyte abnormalities. CPM after liver transplantation is considered that had the relationship to rapid correction of hyponatremia and shift in osmolality. Our first case of 4 liver transplantations altered consciousness at the 5th day after transplantation and did not recover fully until 14 months. At first, atrial fibrillation and atelectasis due to left main broncheal obstruction were thought the causes of impaired consciousness as postoperative hypoxic event. At that time, CT scan showed diffuse brain atropy that suggested previous hepatic encephalopathy and/or hypoxic ischemic encephalopathy. After that, MRI revealed CPM and diffuse cortical atropy. We concluded that CPM associated with rapid correction of hyponatremia perioperatively alter patient's consciousness with hypoxic brain injury.

The Continuous Monitoring of Mixed Venous Oxygen Saturation for the Estimation of Cardiac Output Changes for Liver Transplantation in Dogs / 대한마취과학회지

BACKGROUND: In the management of liver transplantation, massive blood loss, interruption of venous retum to the heart, sudden infusion of acidic, cold and hyperkalemic blood from the graft, and uses of inotropic and vasoactive agents make cardiac output (CO) change unpredictably. We tried to find convenient method to estimate the change of CO by mixed venous oxygen saturation (SvO2) which can be monitored by pulmonary artery catheterization with fiberoptic oximeter using a spectrophotometer, By adapting the equation of oxygen transport and oxygen consumption(VO2), the equation CO=V/O2(Hbx0.134)x1/(SaO2-SvO2) can be obtained. If we assume the VO2 and hemoglobin concentration is constant and hypoxemia is excluded, CO might be proportional to I/(100-Sv O2). METHOD: For the management of orthotopic liver transplantations in 5 mongrel dogs, we continuously monitored Sv O2 with fiberoptic pulmonary catheter and intermittently measured the CO by thermodilution method according to operative phases. The Pearsons correlation coefficients between CO and mean arterial pressure, CO and S vO. and CO and 1/(100 SvO2) were measured in each dog. RESULT: The correlation coefficients between CO and 1/(100 SvO2) are raging from 0.74 to 0.98 with a corrected mean of 0.847 and significant in all dogs (p<0.05), and the correlation coefficients between CO and SvO2 are ranging from 0.67 to 0.96 with a corrected means of 0.786 and significant in 4 of 5 dogs. CONCLUSIONS: For the management of liver transplantation, the continuous monitoring of mixed venous oxygen saturation by a fiberoptic pulmonary catheter is helpful to detect changes of cardiac output.