[Accuracy of perioperative cardiac preload monitoring by global end-diastolic volume and intrathoracic blood volume in orthotopic liver transplantation].
OBJECTIVE
To investigate the clinical value of global end-diastolic volume (GEDV) and intrathoracic blood volume (ITBV) in perioperative monitoring of the cardiac preload in patients undergoing orthotopic liver transplantations (OLT).


METHODS
Eight ASA III or IV patients aged 42-50 years undergoing OLT without venovenous bypass under general anesthesia were enrolled in this study. Before the induction, a thermodilution femoral artery catheter was inserted into the femoral artery under local anesthesia and connected to a PiCCOplus system to monitor ITBV and GEDV. A CCO catheter was inserted into the right internal jugular vein to monitor the pulmonary artery obstruction pressure (PAOP), central venous press (CVP) and stroke volume (SVPAC). Anesthesia was induced with a combination of midazolam (0.1 mg/kg), propofol (1 mg/kg) and fentanyl (3 microg/kg). Pipecuronium (0.1 mg/kg) was given to facilitate naso-endotracheal intubation. Before anesthesia (T0) and at 10 min before the anhepatic phase (T1), 10 min after anhepatic phase (T2), 10 min after neohepatic phase (T3) and at the end of surgery (T4), all the TPTD and CCO parameters were measured by injecting 10 ml cold saline solution (below 8 degrees celsius;) via the distal port of the central venous catheter.


RESULTS
ITBV and GEDV at T2 were significantly lower than those at T0, T1, T3 and T4 (P<0.05). SVPAC at T2 was dramatically decreased compared with that at T0 and T1 (P<0.05). The changes in the pressure preload parameters of the pulmonary artery catheter (PAOP and CVP) did not correlate to the changes in SVPAC, whereas the changes in the volume preload parameters (ITBV and GEDV) of the TPTD was significantly correlated to the changes in SVPAC (P<0.01). PAOP and CVP did not correlate to the changes in ITBV and GEDV.


CONCLUSIONS
ITBV and GEDV are more reliable than PAOP and CVP in perioperative monitoring of the cardiac preload in patients undergoing OLT.
Zhang
Hong-fei
HF
Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China. hongfeiz2003@yahoo.com.cn
Xu
Shi-yuan
SY
Ye
Xiao-ping
XP
Zhou
Jian
J
Liang
Qi-bo
QB
Xu
Ping
P
Zhang
Xin-jian
XJ
D000328:Adult; D001810:Blood Volume; D002302:Cardiac Output; D002407:Catheterization, Swan-Ganz; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D013318:Stroke Volume; D013815:Thermodilution