Splanchnic and systemic circulation cross talks: Implication for hemodynamic management of liver transplant recipient

Publication date: Available online 17 December 2019Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Ahmed Mukhtar, Ahmed Lotfy, Amr Hussein, Eman FouadAbstractThe interaction between splanchnic and systemic circulation has many hemodynamic and renal consequences during liver transplant. In patient with liver cirrhosis, splanchnic vasodilatation causes arterial steal from systemic circulation into splanchnic bed which decreases effective blood volume. Moreover, rapid volume loading in these patients has little impact on cardiac output because higher proportion of infused fluid is shifted to splanchnic area. Thus, in dissection phase the traditional approach of volume loading to maintain intraoperative hemodynamic stability seems not only ineffective but also may aggravate surgical bleeding. Two approaches of volume therapy have been mentioned to maintain hemodynamic stability during liver transplantation: splanchnic volume reduction by volume restriction with or without and splanchnic decongestion by using splanchnic vasoconstrictors. After reperfusion, increase in central blood volume was thought to have deleterious effect on the new graft function, however, the precise central venous pressure value that causes hepatic congestion after reperfusion is unknown.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research