الفهرس | Only 14 pages are availabe for public view |
Abstract Background: End stage Liver disease is usually accompanied by a decline in systemic vascular resistance (SVR) and haemodynamic changes that can be of significance when combined with anaesthesia adminsterd during liver transplantation Aim to assess the impact of intra-operative and post-operative Terlipressin infusion in respect to Haemodynamic and renal parameters. Patient and Methods: After ethics committee approval for this prospective hospital based comparative study. Fifty recipients were allocated into Controls group (n = 25) and Terlipressin group (n = 25), In Terlipressin group Terlipressin infusion started at beginning of surgery (1.0 μg/kg / hr), the rate later titrated (1.0 – 4.0 μg/kg / hr) to maintain a MAP > 65 mmHg and SVRI < 2600 dyne·s/cm5 / m2 till day 4. Norepinepherine infusion was used as appropriate in all patients. Haemodynamic and Oesophageal Doppler parameters, Renal function, Peak Portal Vein Blood flow velocity(PPV), Hepatic Artery Resistive Index (HARI), urine output, liver enzymes, catecholamine support and ICU stay were compared intraoperatively and 4 days postoperatively. Results: Terlipressin was able to maintain better MAP and SVR (P<0 .01) during reperfusion compared to Controls (66.5 + 16.08 versus 47.7+ 4.7 mmHg and 687.7 + 189.7 versus 425.0 + 26.0 dyn.sec/cm5), respectively. Noradrenaline was only used in 5 patients out of 25 versus 20 in controls. Urea, creatinine, urine output, liver enzymes and ICU stay were significantly better with Terlipressin. Portal blood velocity was reduced with Terlipressin without affecting hepatic artery blood flow. Summary 102 Conclusion: Terlipressin infusion significantly improved low SVR and blood pressure with less need for catecholamine support and with lesser renal dysfunctions Peak portal blood flow was reduced without hepatic artery vasoconstriction and with less impairment of postoperative liver functions tests . |