Anaesthesiological strategies to improve outcome in liver transplantation recipients

Valter Perilli, Cristina Modesti, Liliana Sollazzi, Paola Aceto, Teresa Sacco, Pierpaolo Ciocchetti, Francesca Vitale, Andrea Russo, Giovanni Fasano, Alessandra Dottarelli

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

14 Citazioni (Scopus)

Abstract

Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes. The pulmonary artery catheter still represents the more reliable method to monitor cardiac output by using the intermittent bolus thermodilution technique. Minimally invasive hemodynamic monitoring devices may be considered only in stable cirrhotic patients. Goal-directed fluid-therapy has not yet defined for LT, but it could have a role in optimizing the long-term sequelae associated with volume depletion or overload. The use of vasopressor may affect LT recipient's outcome, by preventing prolonged hypotension, decreasing blood products transfusion and counteracting hepato-renal syndrome. The use of viscoelastic point of care is also warranted in order to reduce blood products requirements. Decreasing mechanical ventilation time, when it is feasible, may considerably improve survival. Finally, monitoring the depth of anesthesia when integrated into an early extubation protocol might have a positive effect on graft function.
Lingua originaleEnglish
pagine (da-a)3172-3177
Numero di pagine6
RivistaEuropean Review for Medical and Pharmacological Sciences
Volume20
Stato di pubblicazionePubblicato - 2016

Keywords

  • Blood products transfusion
  • Early extubation
  • Hemodynamic monitoring
  • Liver transplantation
  • Outcome

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