Efficacy of left ventricular ejection time in guiding volume management during liver transplantation

Abstract

Objective To evaluate the efficacy of left ventricular ejection time(LVET)in guiding the volume management during liver transplantation. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 32-64 yr, weighing 54-93 kg, of Child-Pugh grade A or B liver function, scheduled for elective the first liver transplantation with general anesthesia, were divided into either control group(group C)or transesophageal echocardiography(TEE)monitoring group(group TEE), with 30 patients in each group.In group C, the fluctuating range of mean arterial pressure, heart rate and central venous pressure was maintained less than 20% of the baseline value, and the urine volume was maintained >1 ml·kg-1·h-1.LVET was maintained between 0.35-0.40 s in group TEE.The consumption of intraoperative vasoactive agents(dopamine, norepinephrine, epinephrine), volume of fluid infused, volume of blood transfused, blood loss and urine volume were recorded.The occurrence of adverse events was observed during the perioperative period, and postoperative extubation time and intensive care unit residence time were also recorded. Results Compared with group C, the consumption of intraoperative dopamine and norepinephrine was significantly decreased, the urine volume was increased, the incidence of myocardial ischemia, pulmonary edema and renal failure in the perioperative period was decreased, and the postoperative extubation time and intensive care unit residence time were shortened in group TEE(P 0.05). Conclusion LVET produces good efficacy in guiding the volume management during liver transplantation. Key words: Stroke volume; Liver transplantation; Volume management