title: Use of transesophageal Doppler as a sole cardiac output monitor for reperfusion hemodynamic changes during living donor liver transplantation: An observational study.
abstract: OBJECTIVE
  To report the use of transesophageal Doppler (TED), a minimally invasive cardiac output (COP) monitor, before, during and after reperfusion and study its effect on anesthetic management during living donor liver transplantation (LDLT).
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A total of 25 consecutive recipients with a MELD score between 15 and 20 were enrolled. Data were recorded at baseline (TB); anhepatic phase (TA); and post-reperfusion - 1, 5, 10 and 30 minutes. Fluid therapy was guided by corrected flow time (FTc) of the TED. Packed red blood cells (RBCs) were only given when hematocrit was less than 25%. Rotational thromboelastometry (ROTEM) and standard laboratory tests were used to guide component blood products requirements.
  
  
  RESULTS
  Post-reperfusion, the COP, Cardiac Index (CI) and stroke volume (SV) increased significantly at all points of measurements; this was associated with a significant decrease in systemic vascular resistance (SVR) (P ;< .05). Immediately post-reperfusion, for 5 minutes, mean arterial blood pressure (ABP) dropped significantly (P < .05), and 14 out of the 25 patients required boluses of epinephrine (10 μg) to restore the mean ABP; 3 of the 14 patients required norepinephrine infusion till the end of surgery. Central venous pressure (CVP) and urine output (UOP) at all measures were maintained adequately with FTc-guided fluid replacement. Eight out of the 25 patients required no blood transfusion, and 4 of the 8 patients required no catecholamine support.
  
  
  CONCLUSIONS
  TED as a sole monitor for COP was able to present significant and reliable changes in the cardiovascular status of the recipients during reperfusion, which could help to guide fluid- and drug-supportive therapy in this population of patients. This preliminary study needs to be applied on a larger scale.
authors.affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Hussien
authors.forename: E
authors.initials: E
authors.lastname: Refaat
authors.forename: N
authors.initials: N
authors.lastname: Fayed
authors.forename: K
authors.initials: K
authors.lastname: Yassen
authors.forename: M
authors.initials: M
authors.lastname: Khalil
authors.forename: W
authors.initials: W
authors.lastname: Mourad