Ischemia-reperfusion injury
Clinical
Comparison of Femoral Arterial Blood Pressure With Radial Arterial Blood Pressure and Noninvasive Upper Arm Blood Pressure in the Reperfusion Period During Liver Transplantation

https://doi.org/10.1016/j.transproceed.2007.02.075Get rights and content

Abstract

Purpose

The reperfusion period during liver transplantation is hemodynamically unstable. Accurate blood pressure measurements are the mainstay for the efficient management of abrupt cardiovascular changes. We sought to compare femoral arterial blood pressure (FABP) with radial arterial blood pressure (RABP) and noninvasive upper arm blood pressure (NIBP) in the reperfusion period.

Methods

Thirty-six adult living donor liver recipients were enrolled in this prospective study. Blood pressures in 3 locations were simultaneously recorded from 1 minute before reperfusion to 15 minutes after reperfusion. We evaluated agreements between FABP and RABP and between FABP and NIBP using intraclass correlation coefficients. Also, we investigated the rates of postreperfusion syndrome (PRS) based on the measurements from 3 locations.

Results

After reperfusion, the mean and diastolic RABP agreed more with the corresponding FABP than NIBP. However, systolic NIBP showed high agreement with FABP from 3 to 10 minutes after reperfusion in contrast with the moderate agreement between systolic RABP with FABP, and systolic values of NIBP than RABP were closer to FABP. The rates of PRS based on FABP, RABP, and NIBP measurements were 50.0% (18/36), 80.6% (29/36), and 50.0% (18/36), respectively.

Conclusions

We believe that NIBP in addition to RABP may be considered to be a reliable alternative when FABP is not available to evaluate hemodynamic instability in the reperfusion period during liver transplantation.

Section snippets

Materials and Methods

After institutional review board approval and waiver of written informed consent, we enrolled 36 adult patients who underwent living donor orthotopic liver transplantation. They were informed with clear detailed information about the anesthetic guidelines of our hospital and they gave their full agreement by preoperatively signing anesthesia permission documents. A patient diagnosed as having vascular disease was excluded.

After the induction of anesthesia, patients were mechanically ventilated

Results

The patients included 27 men and 9 women of overall mean age of 49.9 ± 8.3 years, with a mean weight of 64.5 ± 11.2 kg and a mean height of 164.2 ± 7.7 cm. Their preoperative diagnosis included 24 with liver cirrhosis, 10 with hepatocellular carcinoma, and 2 with fulminant hepatitis.

At 1 minute before reperfusion, high agreements were observed between FABP and RABP in terms of systolic, mean, and diastolic blood pressures and between FABP and NIBP in terms of systolic and mean blood pressures.

Discussion

Hemodynamic instability including PRS is frequently encountered following graft reperfusion during liver transplantation. Its manifestations are the results of acute vasodilation and ventricular dysfunction.1, 2 Therefore, to facilitate early recognition and precise evaluation of hemodynamic unstability, numerous monitoring systems are currently used in liver transplantation. The accurate measurement of blood pressure is considered a mainstay for efficient management of hemodynamic changes.

References (6)

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