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Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow

Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...

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Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
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Published on: May 7, 2015

Hemodynamics during liver transplantation.

M G Costa1, P Chiarandini, G Della Rocca

  • 1Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria, University of Udine, Udine, Italy. gabriella.costa@med.uniud.it

Transplantation Proceedings
|August 19, 2007
PubMed
Summary

Optimizing fluid status during liver transplants is difficult. New methods like continuous end-diastolic volume (CEDVI) and intrathoracic blood volume index (ITBVI) show promise over traditional pressure monitoring for assessing patient volemia.

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Published on: August 17, 2022

Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Cardiovascular Physiology

Background:

  • Optimizing volemia during liver transplantation presents significant challenges for anesthesiologists.
  • Traditional methods like pulmonary artery occlusion pressure (PAOP) demonstrate poor correlation with cardiac output in critically ill patients.
  • Current research explores advanced bedside monitoring techniques for more accurate volume status assessment.

Purpose of the Study:

  • To evaluate the efficacy of advanced hemodynamic monitoring techniques in assessing volemia during liver transplantation.
  • To compare the accuracy of thermodilution-based methods with conventional pressure monitoring for preload assessment.
  • To investigate the utility of transesophageal echocardiography (TEE) in monitoring cardiac function and volume status in this patient population.

Main Methods:

  • Utilized transpulmonary thermodilution techniques to estimate intrathoracic blood volume index (ITBVI).
  • Assessed continuous end-diastolic volume (CEDVI) for correlation with cardiac performance.
  • Employed transesophageal echocardiography (TEE) to visualize cardiac dimensions, function, and left ventricular end-diastolic area index (EDAI).

Main Results:

  • Continuous end-diastolic volume (CEDVI) demonstrated superior correlation with cardiac performance compared to traditional cardiac filling pressures.
  • Intrathoracic blood volume index (ITBVI), measured via PiCCO system, provided a more accurate reflection of left ventricular filling than pressure-derived data.
  • Transesophageal echocardiography (TEE) offers rapid cardiac visualization and EDAI measurement, potentially correlating with hypovolemia, though its preload index validity is under investigation.

Conclusions:

  • Advanced monitoring techniques, including ITBVI and CEDVI, offer improved assessment of volemia compared to traditional methods in liver transplant patients.
  • Transesophageal echocardiography (TEE) shows potential utility in monitoring cardiac status and detecting hypovolemia, warranting further research into its role as a preload index.
  • Accurate volemia management is crucial for optimizing perioperative outcomes in liver transplantation.