Liver Transplantation
Conditions
Keywords
Liver transplantaion , fluid management , noradrenaline
Brief summary
Early administration of NE in liver transplant recipient might enhance cardiac output through an increase in cardiac preload .
Detailed description
The derangement of circulatory blood volume in patients with liver cirrhosis makes intraoperative fluid management during liver transplant is challenging . Cirrhotic patients not only have large blood volume but abnormal blood volume distribution, with a substantial fraction of this volume in the splanchnic circulation (. These hemodynamic changes render volume loading in these patients has little impact on CO because a large proportion of infused fluid is shifted to the splanchnic system . In addition, patients with liver cirrhosis is similar to septic patients who have increased total vascular compliance which may cause pooling of blood in venous pool. Several studies in patients with sepsis found that use of low dose vasopressor may convert unstressed blood volume (i.e the amount of blood not causing pressure on the vessels) to stressed volume (i.e additional blood causing a distending pressure on the vascular walls and reflects the effective circulating volume) . However, no previous studies tested the effect of using norepinephrine (NE) on venous return and cardiac preload in patients undergoing liver transplant. An obvious advantage of this possibility is that NE will be used instead of true fluid replacement which may minimize fluid replacement during operation. Recently, a method was described to estimate the changes in intravascular volume and vascular capacitance by calculating mean systemic filling pressure (MSFP) . MSFP is the driving pressure in venous return, and it allows calculation of the arterial and venous components of systemic vascular resistance .
Interventions
DRUGNoradrenaline
Noradrenaline infusion for patients undergoing liver transplantaion from living donor .
Sponsors
Cairo University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* All Adults (age \> 18 years) patients undergoing living donor liver transplant (LDLT) will be considered for inclusion in the study..
Exclusion criteria
* Patients less than 18 years. * Patients undergoing liver transplantation for acute liver failure . * All Chronic Hypertensive patients on medication , whether controlled on not controlled * Those with high risk of post transplant renal dysfunction (serum creatinine \>1.5 mg/dL at time of transplant)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The effect of Noradrenaline on change of cardiac output . | along the procedure ; from skin incision to the end of surgery | The effect of Noradrenaline on change of cardiac output . |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The effect of NE on mean systemic filling pressure . | along the procedure ; from skin incision to the end of surgery | The effect of NE on mean systemic filling pressure . |
| The effect of NE on venous return . | along the procedure ; from skin incision to the end of surgery | The effect of NE on venous return . |
| The effect of NE on central venous pressure . | along the procedure ; from skin incision to the end of surgery | The effect of NE on central venous pressure . |
Countries
Egypt
Outcome results
None listed